Intraoral administration of probiotics and postbiotics: An overview of microorganisms and formulation strategies

Abstract The last decade provided significant advances in the understanding of microbiota and its role in human health. Probiotics are live microorganisms with proven benefits for the host and were mostly studied in the context of gut health, but they can also confer significant benefits for oral health, mainly in the treatment of gingivitis. Postbiotics are cell-free extracts and metabolites of microorganisms which can provide additional preventive and therapeutic value for human health. This opens opportunities for new preventive or therapeutic formulations for oral administration. The microorganisms that colonize the oral cavity, their role in oral health and disease, as well as the probiotics and postbiotics which could have beneficial effects in this complex environment were discussed. The aim of this study was to review, analyse and discuss novel probiotic and postbiotic formulations intended for oral administration that could be of great preventive and therapeutic importance. A special attention has been put on the formulation of the pharmaceutical dosage forms that are expected to provide new benefits for the patients and technological advantages relevant for industry. An adequate dosage form could significantly enhance the efficiency of these products.

Traits of the host trees, not community diversity, drive epiphytes abundance in tropical seasonal forests / Atributos das árvores hospedeiras, e não a diversidade da comunidade, conduzem a abundância de epífitas em florestas tropicais sazonais

Abstract Epiphytes are considered indicators of forest ecological integrity, but the factors that explain their abundance are still not well understood. We here evaluated tree colonization by epiphytes in old-growth monospecific reforestation stands of Astronium urundeuva (M.Allemão) Engl. (Anacardiaceae) and Eucalyptus saligna Sm. (Myrtaceae), in comparison to a neighbor seasonal tropical forest fragment under similar environmental conditions. In each forest type, we identified and measured all trees (planted and colonizers) from 5-cm stem diameter in five 200 m² plots and quantified all vascular epiphytes per tree. Tree species were categorized by bark roughness, canopy deciduousness and growth rate. The abundance of epiphytes and the frequency of host trees were higher in the A. urundeuva plantation than in the native forest, with the E. saligna stand in an intermediate position. Also, we found that host traits influenced the abundance of epiphytes in their trunks. Host trees had average stem perimeter and height both higher than non-hosts, which indicates that colonization is more likely to occur in older trees. The average abundance of epiphytes per tree was higher in species with rough bark, but no relationship was found with canopy deciduousness or tree growth rate. We evidenced, therefore, that forest plantations, even if monospecific, can provide habitat for epiphytes. However, at community level, colonization success, either in native or restored forest, depends on the relative abundance of species whose bark type favors epiphytes establishment.

Resumo Epífitas são consideradas indicadores de integridade ecológica em florestas, mas os fatores que explicam sua abundância ainda não são bem compreendidos. Neste estudo, avaliamos a colonização por epífitas em antigos talhões monoespecíficos de Astronium urundeuva (M.Allemão) Engl. (Anacardiaceae) e Eucalyptus saligna Sm. (Myrtaceae), em comparação com um fragmento vizinho de floresta estacional semidecidual sob condições ambientais semelhantes. Em cada tipologia florestal, identificamos e medimos todas as árvores (plantadas e que colonizaram os locais) a partir de 5 cm de diâmetro à altura padrão, em cinco parcelas de 200 m². Nelas, também quantificamos todas as epífitas vasculares por árvore. Em busca de uma explicação funcional para as diferenças entre espécies, utilizamos rugosidade da casca, deciduidade da copa e taxa de crescimento como atributos potencialmente relevantes. A abundância das epífitas e a frequência de forófitos foi maior no talhão de A. urundeuva do que na floresta nativa, com o talhão de E. saligna ocupando uma posição intermediária. Encontramos evidências, também, de que os atributos dos forófitos influenciaram a abundância de epífitas em seus troncos. Os forófitos apresentaram maior perímetro médio e altura que as árvores não hospedeiras, o que indica que a colonização é mais provável de ocorrer em árvores mais velhas. A abundância média de epífitas por árvore foi maior em espécies com casca rugosa, mas nem a deciduidade da copa, nem a velocidade de crescimento exerceram efeito neste aspecto. Evidenciamos, portanto que, plantações florestais, ainda que monoespecíficas, podem prover habitat para epífitas. Contudo, em nível de comunidade, o sucesso da colonização, seja em florestas nativas ou restauradas, depende da abundância relativa de espécies cujo tipo de casca favorece o estabelecimento de epífitas.

Conocimientos de vicecoordinadores docentes sobre la superación profesional. Estado Táchira, Venezuela, I trimestre de 2020

Fundamento: La labor docente en la Misión Médica Cubana en Venezuela está encaminada a garantizar el cumplimiento de las exigencias y necesidades sociales en la formación de profesionales en pre y posgrado, orientada a la preparación de los profesores y a la ejecución del proceso de enseñanza aprendizaje con bases sólidas. Objetivo: Identificar los conocimientos que poseen los coordinadores docentes relacionados con los procedimientos metodológicos de la superación profesional en el Estado Táchira de Venezuela, en el I Trimestre de 2020. Metodología: Se realizó un estudio descriptivo de corte transversal sobre superación profesional durante el primer trimestre de 2022 que incluyó los 25 vicecoordinadores docentes nombrados en las Áreas de Salud Integral Comunitaria de la Misión Barrio Adentro del Estado Táchira. Se diseñó y aplicó un cuestionario encaminado a medir conocimientos sobre procedimientos metodológicos de superación profesional. Resultados: Se observaron dificultades en la identificación de las necesidades de aprendizaje, con relación a otras formas organizativas de superación, modalidades de las actividades de posgrado, comparecencia del cuerpo docente y de evaluación final. Conclusiones: La caracterización realizada permitió determinar las necesidades de aprendizaje, principalmente en el área de la didáctica general y fundamenta la necesidad de elaborar para su ejecución un programa de superación profesional dirigido a los docentes noveles.

Background: The teaching labor for the Cuban Medical Mission in Venezuela is aimed to guarantee the accomplishment of the demands and social needs for professionals in undergraduate and postgraduate preparation, oriented to the preparation of teachers and to the execution with solid foundations of the teaching and learning process. Objective: To identify the knowledge possessed by the teaching coordinators related to the methodological procedures in professional upgrading in Táchira State, Venezuela, during the first quarter in 2020. Methodology: A descriptive cross-sectional study was conducted about professional upgrading, and included the 25 teaching vice coordinators named in the Integral Community Health Areas of the Barrio Adentro Mission in the Táchira State. A questionnaire was designed and applied in order to measure knowledge on professional upgrading methodological procedures. Results: Difficulties were observed in the learning needs identification, in relation to other organizational forms of improvement, modalities of postgraduate activities, teaching staff appearance and final evaluation. Conclusions: The conducted characterization made it possible to determine the learning needs, mainly in the general didactic area and substantiates the necessity to elaborate for its execution, a professional upgrading program for novice teachers.

Conocimientos básicos para la preparación y uso de fórmulas magistrales en oftalmología / Basic Knowledge for the Preparation and Use of Masterful Formulas in Ophthalmology

Los colirios fortificados o reforzados son fórmulas magistrales que reciben ese nombre por la vigorización que se les realiza a los colirios industriales con principios activos de antibióticos, antivirales, citostáticos y antimicóticos, en dependencia de los requerimientos individuales de los pacientes. Por tanto, la utilización de la formulación magistral es, por su capacidad y flexibilidad, un potencial para concebir nuevas pautas terapéuticas y posibilitar la creación de nuevas formulaciones o bien la actualización de antiguas fórmulas con principios activos más modernos, con el fin de lograr una alternativa a los colirios industriales de manera potente, eficaz y segura. El objetivo de este trabajo es describir los fundamentos teóricos, las tendencias nacionales e internacionales de la preparación y el uso oftalmológico de los colirios fortificados. Se realizó una revisión bibliográfica y documental actualizada, se utilizaron fuentes primarias, secundarias y terciarias y experiencias nacionales. La utilización de los colirios fortificados es cada día más frecuente en la especialidad de oftalmología, lo que obliga al farmacéutico hospitalario y al oftalmólogo a estar actualizado en temas como elaboración segura, composición, indicación y uso correctos(AU)

Fortified or reinforced eye drops are masterful formulas that receive such name due to the industrial eye drops' invigoration with antibiotic, antiviral, cytostatic and antifungal active ingredients, depending on the patients' individual requirements. Therefore, the use of a masterful formulation is, due to its capacity and flexibility, a potential for conceiving new therapeutic guidelines and also for making possible the creation of new formulations or the updating of old formulations with more modern active ingredients, in order to achieve an alternative to industrial eye drops in a potent, effective and safe way. The objective of this work is to describe the theoretical foundations, the national and international trends in the preparation of fortified eye drops, as well as their ophthalmologic use. An updated bibliographic and documentary review was carried out, using primary, secondary and tertiary sources, together with national experiences. The use of fortified eye drops is becoming increasingly frequent in the ophthalmology specialty, which obliges the hospital pharmacist or the ophthalmologist to be updated on issues such as safe preparation, composition, prescription and correct use(AU)

Mutation distributions among patients with congenital adrenal hyperplasia from five regions of Brazil: a systematic review

ABSTRACT Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by CYP21A2 gene mutations, and its molecular diagnosis is widely used in clinical practice to confirm the hormonal diagnosis. Hence, considering the miscegenation of the Brazilian population, it is important to determine a mutations panel to optimise the molecular diagnosis. The objective was to review the CYP21A2 mutations' distribution among Brazilian regions.Two reviewers screened Brazilian papers up to February 2020 in five databases. The pair-wise comparison test and Holm method were used in the statistical analysis. Nine studies were selected, comprising 769 patients from all regions. Low proportion of males and salt-wasters was identified in the North and Northeast regions, although without significant difference. Large gene rearrangements also had a low frequency, except in the Center-West and South regions (p < 0.05). The most frequent mutations were p.I172N, IVS2-13A/C>G, p.V281L and p.Q318X, and significant differences in their distributions were found: p.V281L was more frequent in the Southeast and p.Q318X in the Center-West and Northeast regions (p < 0.05). Thirteen new mutations were identified in 3.8%-15.2% of alleles, being more prevalent in the North region, and six mutations presented a founder effect gene. Genotype-phenotype correlation varied from 75.9%-97.3% among regions. The low prevalence of the salt-wasting form, affected males and severe mutations in some regions indicated pitfalls in the clinical diagnosis. The good genotype-phenotype correlation confirms the usefulness of molecular diagnosis; however, the Brazilian population also presents significant prevalence of novel mutations, which should be considered for a molecular panel.

Formulation and evaluation of Buccal mucoadhesive tablets of diclofenac sodium using 23 factorial designs

Buccal tablets

Diclofenac sodium

Drug release

Mucoadhesion

Mucoadhesive tablets

Release kinetics

Research progress on use of common packaging forms of injections / 药学实践杂志

Objective To provide theoretical reference and practical basis for accurately choosing the suitable packaging forms for different Injections. Methods Based on the raw materials in the common packaging forms of injections, the research and application progress on different packaging forms for injections were reviewed by analyzing the characteristics and technical requirements of different packaging forms, and the current registration information of pharmaceutical packaging materials in the Center for Drug Evaluation, NMPA were introduced. Results For preparations with small single-dose and low-cost, the ampoules or injection vials could be chosen. Powder injections are usually packaged in injection vials. For rescue medicines and valuable medicines, the pre-filled syringes could be chosen. For chronic disease treatment drugs (such as insulin) that require long-term injection, or some injections for emergency use, a pen-type syringe package that patients can inject themselves could be used. Neutral glass packaging or plastic packaging should be used for some acidic or alkaline. Conclusion The drug manufacturers should comprehensively consider the physicochemical properties of drugs, the performance of packaging raw materials, compatibility test results, price-cost, and convenience in carrying and use when choosing the appropriate packaging form to ensure the quality, safety, and effectivity of drugs.

Research on analgesic effect and prospect of clinical application of rutin / 中国药理学通报

Rutin is extracted from Ruta graveolens L. with many pharmacological activities such as anti-inflammation, anti-oxidation , protecting cardiovascular system and analgesia. As a natural product, rutin has the advantages of low side effects and difficult tolerance, but its instability and low bioavailability still limit its clinical application. This paper summarizes the analgesic mechnism of rutin, and looks forward to the clinical applica¬tion of rutin based on its derivative and dosage forms. It is expected to provide ideas for further analgesic research and drug development and application of rutin in the future.

The Construction of Human Health Community from the Perspective of Marx’s Space Theory: Challenges, Connotations, and Approaches / 中国医学伦理学

Capital’s penetration and mastery of global space shape a human health space that coexists with homogeneity and fragmentation, compressibility and expansion, digestion and remodeling. Capital exacerbates the deprivation of health resources in the global space through means such as controlling the power field, expanding the scope of flow, and monopolizing resource allocation, seriously constraining the overall improvement of human health. The human health community focuses on the healthy development of health in the global space, showing strong human sentiments and profound spatial implications. It aims to break the dominance of capital forces on human health in space, scientifically respond to the space crises caused by major public health events, and build a global space for the balanced and sustainable development of human health. It is Chinese concept, Chinese plan, and Chinese wisdom for reshaping the global justice space and safeguarding human health. To realize the value of health in the global space, it is necessary to take Marx’s space theory as the guide, continuously promote the construction of human health community from the three-dimensional space of individual micro, regional meso, and global macro, and create a space for health justice.

An Approach for Providing Drug Information to Primary Care Physicians of Patients Undergoing Nephrectomy Using Information Forms Created by Urologists and Pharmacists / 日本プライマリ・ケア連合学会誌

Tohoku Medical and Pharmaceutical University Hospital uses an information form created by doctors and pharmacists to provide postoperative information to patients who undergo nephrectomy at the Department of Urology. The form recommends that patients' physicians change prescriptions and adjust medication doses considering post-nephrectomy deterioration of renal function in patients with a single remaining kidney. Of the 7 patients who used this information form, prescription changes were made in 4 patients. An information form jointly created by a physician and pharmacist may affect prescription changes.

Shared decision-making and specific informed consent in patients with aortic aneurysms

ABSTRACT Objective To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery.

Predictors of Trypanosoma cruzi PCR positivity in patients with chronic Chagas disease

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR.

Acessibilidade do termo de consentimento na pesquisa clínica no Brasil / Accessibility of the consent form in Brazilian clinical research / Accesibilidad al formulario de consentimiento en la investigación clínica en Brasil

Resumo O termo de consentimento livre e esclarecido tem a função de informar o participante de pesquisas clínicas sobre a natureza da pesquisa e seus direitos, formalizando sua decisão de participar. Estudos indicam que esse documento é redigido de modo complexo, comprometendo a autonomia do participante. Para este trabalho, foram redigidos dois termos de consentimento da mesma pesquisa hipotética, com estilos de redação diferentes. Ambos os termos foram analisados pela ferramenta Coh-Metrix Port, que avalia métricas linguísticas e acessibilidade textual. A análise indicou que os textos são complexos e exigem alta escolaridade para serem entendidos. Esses achados reforçam a percepção de que, no Brasil, os termos de consentimento podem ter sua real função comprometida e apontam a importância de modificar sua forma de elaboração.

Abstract The informed consent form informs clinical research patients about the nature of the research and their rights, formalizing their decision to participate; however, studies show that this document is written in a complex manner, compromising patient autonomy. Two consent forms from the same hypothetical research were developed with different writing styles and analyzed by the Coh-Metrix Port tool, which evaluates linguistic metrics and textual accessibility. Results showed that both texts were complex and required high schooling level to be understood. These findings reinforce the perception that consent forms may have their real function compromised and point to the importance of changing its elaboration.

Resumen El formulario de consentimiento informado tiene la finalidad de mostrar la naturaleza de la investigación y sus derechos al participante de la investigación clínica para formalizar su decisión de participar en el estudio. Los estudios indican que la redacción de este documento es compleja, lo que compromete la autonomía del participante. Para este estudio se redactaron dos formularios de consentimiento de una misma investigación hipotética, con diferentes estilos de escritura. Para el análisis de ambos formularios se utilizó la herramienta Coh-Metrix Port, que evalúa las métricas lingüísticas y la accesibilidad textual. Los resultados apuntaron a que los textos son complejos, lo que requiere un alto nivel de educación para su comprensión. Estos hallazgos coinciden que, en Brasil, los formularios de consentimiento pueden tener su finalidad comprometida y señalan la necesidad de modificar su forma de elaboración.

Development, physicochemical evaluation, and in vivo permeation studies of topical formulations containing 0.1% tacrolimus

Abstract The objective of this paper was to develop and evaluate two semi-solid pharmaceutical forms containing 0.1% tacrolimus: cream (CRT01) and gel (GLT01). For the evaluation of physicochemical stability, at times 0, 30, 60 and 90 days, at 23°C and at 40°C, High Performance Liquid Chromatography coupled with a Diode Array Detector (HPLC-DAD) was employed. This method was developed and validated for tacrolimus quantification. The occlusivity test and skin permeation assay were also performed, using an animal model (Wistar rats), and the CRT01 and GLT01 were compared to the 0.1% tacrolimus ointment (PFU01) obtained from the University Pharmacy, Federal University of Rio de Janeiro, Brazil. CRT01 and GLT01 presented a homogeneous aspect and consistency adequate for topical products, along with sensory characteristics above PFU01. They also presented adequate physicochemical stability for 90 days and a lower occlusive effect than PFU01 (p<0.05). CRT01 showed greater affinity for the skin when compared to PFU01 and GLT01, with low systemic absorption. The CRT01 semi-solid formulation was considered the most adequate one to treat patients with atopic dermatitis or other dermatologic inflammatory diseases, promoting rational use of tacrolimus

Processo de obtenção de consentimento livre e esclarecido para pessoas analfabetas em procedimentos de saúde / Process for obtaining informed consent for illiterate people in healthcare procedures

O Termo de Consentimento Livre e Esclarecido (TCLE) é um documento que faz parte do processo de obtenção da anuência de pacientes ou de participantes de pesquisa, para garantir seus direitos e atribuir seus deveres. Caso o TCLE contenha um texto complexo, ele restringirá, de certa forma, a liberdade de decisão de indivíduos analfabetos. Objetivo: avaliar a percepção de analfabetos sobre o conhecimento do TCLE e suas formas de manifestação de anuência para procedimentos de saúde. Material e método: trata-se de uma pesquisa transversal quali-quantitativa, cuja coleta de dados foi realizada com alunos da Educação de Jovens e Adultos (EJA) por meio de entrevista gravada após leitura de um TCLE modelo. Os resultados qualitativos foram analisados segundo a Técnica de Análise de Conteúdo, proposta por Bardin. Os quantitativos foram analisados pelo teste qui-quadrado e por análise de regressão logística por meio do software JAMOVI. Resultados: participaram da pesquisa 32 alunos. Os dados obtidos mostraram que o conhecimento prévio acerca do TCLE era baixo (34,37%), apenas 46,87% dos participantes compreenderam o documento, sendo 38% da 4ª etapa da EJA. Quase todos os participantes entenderam os benefícios em aplicar o TCLE nas práticas clínicas e 75% informaram que imagens facilitariam a compreensão do documento. Conclusão: concluiu-se que baixas habilidades de alfabetização afetam diretamente a autonomia para anuência em TCLE. A dificuldade na compreensão do TCLE pode estar relacionada aos elementos textuais, como o tamanho da fonte, utilização de termos difíceis e apresentação de um texto extenso contendo muitas informações

The Informed Consent (IC) is a document that is part of the process for obtaining the consent of patients or research participants, to guarantee their rights and assign their duties. The IC, by containing a complex text, restricts, in some way, the freedom of decision of illiterate individuals. Objective: to evaluate the perception of illiterate individuals on the knowledge of the IC and their forms of expression of consent to health procedures. Material and method: this is a quali-quantitative cross-sectional study, whose data collection was carried out with students of Youth and Adult Education (YAE) by means of recorded interview after reading an IC model. The qualitative results were analyzed according to the Content Analysis Technique, proposed by Bardin. Quantitative results were analyzed applying the Chi-square test and logistic regression analysis using the JAMOVI software. Results: 32 students participated in the research. The data obtained showed that the previous knowledge about the ICF is low (34.37%), only 46.87% of the participants understood the document, 38% of them from the 4th stage of YAE. Almost all participants understood the benefits in applying the IC in clinical practices and 75% claimed that images would facilitate understanding of the document. Conclusion: It was concluded that low literacy skills directly affect the autonomy to consent using the IC. The difficulty in understanding the IC may be related to textual elements, such as font size, use of difficult terms, and presentation of an extensive text containing a lot of information

Dever de informação em medicina: análise de processos judiciais / Disclosure of information in medicine: analysis of judicial cases / El deber de informar en medicina: análisis de las demandas

Resumo Termo de consentimento é a expressão de uma decisão voluntária, tomada após processo informativo, no sentido de aceitar um tratamento considerando riscos, benefícios e possíveis consequências. Este estudo analisou o papel do termo de consentimento em decisões do Tribunal de Justiça do Estado de São Paulo. No período de um ano, realizou-se busca com as palavras-chave "termo de consentimento" e "erro médico", e os dados dos 65 acórdãos estudados foram expostos mediante recursos do programa Excel. Em 15 casos não se utilizou o documento, dos quais 12 demostraram falta do dever de informar. Em 31% dos processos houve condenação do réu e a maioria dos autores que receberam compensação financeira fez jus a indenização por danos morais. As áreas de atuação na medicina que mais figuraram como rés foram cirurgia plástica e ginecologia e obstetrícia. Ficou demonstrada a relevância da aplicação do termo de consentimento e da atuação do perito médico.

Abstract Consent expresses a voluntary decision, taken after disclosure of information, to accept treatment considering risks, benefits, and possible consequences. This study analyzed the role of consent forms in decisions by the São Paulo State Court of Justice. Bibliographic search was conducted using the keywords "consent form" and "medical error." The 65 rulings identified were analyzed using Excel. Of the 15 cases in which patients were not presented with a consent form, 12 showed lack of information disclosure. In 31% of the cases, the defendant was found guilty, and most of the plaintiffs who received financial compensation were awarded moral damages. Plastic surgery, gynecology and obstetrics were the branches that most often featured as defendants. The findings attest the relevant role played by the consent form and the medical expert.

Resumen El formulario de consentimiento expresa una toma de decisión voluntaria al aceptar el tratamiento después de informados los riesgos, beneficios y posibles consecuencias. Este estudio analizó el papel del formulario de consentimiento en las decisiones del Tribunal de Justicia del Estado de São Paulo. Durante un año se realizó una búsqueda con las palabras clave "formulario de consentimiento" y "error médico", y los datos de las 65 demandas se expusieron en el programa Excel. En 15 casos no se utilizó el documento, de los cuales 12 demostraron haber una falla del deber de informar. El 31% de los casos lo condenó al acusado, y la mayoría de los autores que recibieron una compensación económica tenían derecho a indemnización por daño moral. Las áreas de la Medicina que recibieron más demandas fueron la cirugía plástica y la ginecología y obstetricia. Son fundamentales aplicar el formulario y la actuación del perito médico.

Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico / Proposal of an informed consent form to obtain audiovisual material from patients

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Musicalidad y juego en la primera infancia: el andamiaje que el juego con las formas de la vitalidad provee al juego de ficción / Musicality and play in early childhood: the scaffolding that forms of vitality play provides to pretend play

Resumen El juego de ficción, aquel que comporta la creación de una situación imaginaria, ha sido un objeto de estudio privilegiado en la psicología del desarrollo y se ha señalado su rol en el desarrollo de funciones psicológicas complejas. Recientemente, gracias a la utilización de herramientas de análisis de las artes temporales, se ha documentado una nueva forma de juego, el juego con las formas de la vitalidad, cuyo foco es la repetición y variación de motivos sonoro-kinéticos de modo interactivo, en detrimento de cualquier contenido figurativo. Se ha observado que durante el tercer año de vida este tipo de juego se presenta de modo combinado con el juego de ficción y que en esos casos podría ser parte del andamiaje del desarrollo del juego de ficción. El objetivo del presente estudio fue realizar un microanálisis de los sonidos y movimientos de una escena de juego de ficción combinado con juego con las formas de la vitalidad de una niña de 1 año y 11 meses de edad, con el fin de conocer cómo se produce dicho andamiaje. Entre los resultados se destacan la presencia de sincronía interactiva basada en un pulso subyacente, la construcción de una mutualidad entre adulto e infante a partir de la calidad de los motivos compartidos, la ampliación del espacio de juego y el sostenimiento de la atención conjunta y la fluidez interactiva.

Abstract The pretend play, one that involves the creation of an imaginary situation, has been a privileged object of study in developmental psychology framed in the linguistic turn. Its important role in the development of complex psychological functions, such as language, theory of mind or narrative capacity, has been pointed out. In recent years, there has been a change in focus in the human sciences that has been dubbed the corporal turn: a re-focus on the analysis and conceptualization of bodily aspects that are at the base of various cognitive capacities. Thanks to the use of analysis tools typical of the temporal arts -such as music and dance- to the field of cognitive psychology, a new form of play has been documented in early childhood: the forms of vitality play. It recovers the idea of forms of vitality from Stern (2010), which refers to affects that cannot be reflected in the lexicon of Darwinian emotions. The forms of vitality are a Gestalt, an emergent property where movement, time, force, space and directionality/intentionality are integrated; they are a fundamental property of multimodal exchanges in the adult-baby dyad as well as of the experience, as spectator or performer, of non-figurative temporal arts such as dance and music. The forms of vitality play arise as a reconceptualization of the notion of musical play and is considered a reissue of early social play with a symmetrical participation of the child in the composition of play. It is defined as any pleasant or self-remunerative activity, in which motifs of movements and/or sounds are elaborated according to the repetition-variation form, at the expense of any figurative content. The forms of vitality play have been observed in the third year of the child's life and it has been pointed out that it can manifest in a simple way or in combination with the pretend play. Likewise, it was suggested that when the pretend play is presented in combination with the forms of vitality play, the latter could be scaffolding the pretend play, although how this happens has not been clearly specified. The objective of the present study is to carry out a microanalysis of the sounds and movements of a pretend play scene combined with forms of vitality play of a girl of 1 year and 11 months of age and an adult, in order to know how such scaffolding is produced. The sound envelope was analyzed in order to identify and describe the timing of the sounds. Regarding movement, specialized software was used to graph its trajectory and for the analysis of the expression of movements, the basic categories "Shape and Effort" of the Laban-Bartenieff system of movement analysis were used (Laban, 1971). The results indicate the presence of interactive synchrony based on an underlying pulse that sustains mutuality between the players and provides a temporal structure on which the synchrony of the self can be anchored. Furthermore, it allows the sharing of continuity and contrast in the quality of sounds and movements and thus provides the dyad with a primary level of understanding with non-mediated meanings; promotes the exploration of the play space and the expansion of the potential of the fictional scene; it favors the maintenance of joint attention and mutual understanding through ontogenetically pre-fiction semiotic mechanisms, which favor the interactive fluidity of play.

Dinámica de la evolución de las formas de Blastocystis spp. en un medio de cultivo simple / Dynamics of the evolution of the forms of Blastocystis spp. in a simple culture medium

Resumen Blastocystis spp. es un parásito muy frecuente en materia fecal humana, pero la naturaleza polimórfica y el número de Blastocystis en la muestra pueden complicar su detección por microscopía. El objetivo del trabajo fue describir la dinámica de los morfotipos de Blastocystis a corto plazo en un medio de cultivo simple y determinar su aplicabilidad para utilizarlo como complemento del análisis coproparasitológico y para estudios morfológicos, bioquímicos y moleculares del parásito. Se sembraron 10 muestras de materia fecal con Blastocystis en un medio Pavlova adaptado, se examinaron diariamente por examen microscópico durante 6 días y se registraron las formas y el recuento. El desarrollo fue regular y abundante y las formas fueron de tamaños variables y claramente identificables. El cultivo ensayado puede ser útil para la detección de Blastocystis cuando existan dudas diagnósticas por microscopía, para estudios de sensibilidad y especificidad diagnóstica o cuando se requiera aumentar la carga para realizar otros estudios.

Abstract Blastocystis spp. is a very frequent parasite in human fecal matter, but the polymorphic nature and the number of Blastocystis in a sample can complicate its detection by microscopy. The objective of the present work was to describe the dynamics of Blastocystis morphotypes in the short term in a simple culture medium and to determine its applicability to use it as a complement to coproparasitological analysis and for morphological, biochemical and molecular studies of the parasite. Ten stool samples with Blastocystis were cultured in an adapted Pavlova medium and examined during 6 days by microscopy to record the forms and the count. The development was regular and abundant and the shapes were of variable sizes and clearly identifiable. The tested culture could be used for the detection of Blastocystis when microscopic diagnosis is dubious, for studies of diagnostic sensitivity and specificity or when it is necessary to increase the load to perform other studies.

Resumo Blastocystis spp. é um parasita muito frequente nas fezes humanas, mas a natureza polimórfica e o número de Blastocystis na amostra podem complicar a sua detecção através do microscópio. O objetivo do trabalho foi descrever a dinâmica dos morfotipos de Blastocystis no curto prazo em um meio de cultura simples e determinar sua aplicabilidade para ser utilizado como complemento da análise coproparasitológica e para estudos morfológicos, bioquímicos e moleculares do parasita. Foram semeadas dez amostras de fezes com Blastocystis em um meio Pavlova adaptado e examinadas diariamente através de exame microscópico durante 6 dias, registrando as formas e fazendo recontagem. O desenvolvimento foi regular e abundante e as formas foram de tamanhos variáveis e claramente identificáveis. A cultura testada pode ser útil para a detecção de Blastocystis quando houver dúvidas diagnósticas por microscopia; para estudos de sensibilidade e especificidade diagnóstica ou quando for necessário aumentar a carga para a realização de outros estudos.

ISO 15189 Internal Auditor Training- Feedback From Participant To Make It More Effective And Convenient

Background:ISO 15189 will equip traineeswith effective auditing techniques and will increase understandingof audit methodologies. Trying to improve the quality of training that will be given underNABL ISO 15189. Material And Methods:The study was done forimproving the training of internal audit. Participants who have already taken training were asked to fill questionnaire in the google form regarding the cost effectiveness, mode of training, material of reference,No. of days of training, frequency at which training should be conducted and mock audit. For each question we had given certain option which will be chosen by earlier participants. For each question % of the answers are calculated individually to analyses whether the training is up to mark or has to be improved.Result:The results obtained are as follow s, for the cost of training to be 58.1% answered it to be five thousand. For the no of days maximum people gave the answer as 3 days. For mode of training results obtained was 80.23% offline.60.46% of trainees wanted weekdays as the days to be included for training session.60.4% of participants wanted power point presentation as the method for training to be conducted. Once in year was selected by 40.6% of trainees for how frequently the training should be conducted. All the participants have answered for the mock audit to be conducted.Conclusion:Most of them seem satisfactory with the training. Many of them suggested we have small break sessions during training. Live training sessions was also suggested as it could be more interactive.