Metabolic and physiological adaptations of microalgal growth-promoting bacterium Azospirillum brasilense growing under biogas atmosphere: a microarray-based transcriptome analysis.

Using microalgal growth-promoting bacteria (MGPB) to improve the cultured microalga metabolism during biotechnological processes is one of the most promising strategies to enhance their benefits. Nonetheless, the culture condition effect used during the biotechnological process on MGPB growth and metabolism is key to ensure the expected positive bacterium growth and metabolism of microalgae. In this sense, the present research study investigated the effect of the synthetic biogas atmosphere (75% CH4-25% CO2) on metabolic and physiological adaptations of the MGPB Azospirillum brasilense by a microarray-based transcriptome approach. A total of 394 A. brasilense differentially expressed genes (DEGs) were found: 201 DEGs (34 upregulated and 167 downregulated) at 24 h and 193 DEGs (140 upregulated and 53 downregulated) under the same conditions at 72 h. The results showed a series of A. brasilense genes regulating processes that could be essential for its adaptation to the early stressful condition generated by biogas. Evidence of energy production is shown by nitrate/nitrite reduction and activation of the hypothetical first steps of hydrogenotrophic methanogenesis; signal molecule modulation is observed: indole-3-acetic acid (IAA), riboflavin, and vitamin B6, activation of Type VI secretion system responding to IAA exposure, as well as polyhydroxybutyrate (PHB) biosynthesis and accumulation. Moreover, an overexpression of ipdC, ribB, and phaC genes, encoding the key enzymes for the production of the signal molecule IAA, vitamin riboflavin, and PHB production of 2, 1.5 and 11 folds, respectively, was observed at the first 24 h of incubation under biogas atmosphere Overall, the ability of A. brasilense to metabolically adapt to a biogas atmosphere is demonstrated, which allows its implementation for generating biogas with high calorific values and the use of renewable energies through microalga biotechnologies.

[Síndrome hemofagocítico linfohistiocitario secundario a Dengue en una paciente de 6 años: reporte de caso].

Background: Dengue fever is a mosquito-borne infectious disease endemic in over 100 countries around the world. Among the complications that dengue can cause the Hemophagocytic Lymphohistiocytosis is one of great concern for its severity and complex diagnosis. Case report: Hereby we document a case of this disease expressed on a previously healthy 6-year-old female patient whose dengue infection was so severe that needed intensive care management with vasoactive drugs and diuretics. After a short period of wellness began newly with fever, pancytopenia, hepatitis, and inflammatory response symptoms. Conclusions: A Dengue associated Hemophagocytic Lymphohistiocytosis syndrome was suspected and treated with intravenous corticosteroids on a 3-day scheme at no signs of malignancy with excellent response. The health care professionals must know about this not novel entity in order to reach an efficient diagnosis and treatment mostly, but not only, those in tropical and sub-tropical regions of the word were dengue virus is endemic.

Antecedentes: La fiebre por dengue es una enfermedad infecciosa transmitida por mosquitos, endémica en más de 100 países alrededor del mundo. La Linfohistiocitosis Hemofagocítica, dentro de las complicaciones que puede ocasionar el dengue, es una de las más preocupantes por su complejidad diagnostica y gravedad. Reporte de caso: Femenino de 6 años de edad, previamente sana, cuya infección por dengue fue tan grave que requirió manejo en cuidados intensivos. Después de un breve período de bienestar recrudeció la fiebre, además de pancitopenia, hepatitis y síntomas de respuesta inflamatoria. Conclusiones: Se sospechó síndrome de Linfohistiocitosis Hemofagocítica asociada a Dengue y se trató con corticoides intravenosos en un esquema de 3 días con excelente respuesta. Los profesionales de la salud deben conocer esta entidad no novedosa para poder llegar a un diagnóstico y tratamiento eficaz en su mayoría, pero no solo, en las regiones tropicales y subtropicales del mundo donde el virus del dengue es endémico.

Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium / Validación de indicadores de resultados enfermeros en pacientes con delirium postquirúrgico / Validação de indicadores de resultados de enfermagem em pacientes com delirium pós-cirúrgico

Objective. To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Methods. Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. Results. The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. Conclusion. The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.

Objetivo. Validar el contenido de los indicadores propuestos a partir de Nursing Outcome Classification en un plan de cuidados para el manejo de delirium en los adultos mayores. Métodos. Estudio de validación de contenido realizado bajo la técnica de juicio de expertos. El procedimiento se desarrolló en cinco momentos: organización de los indicadores que responden a la clasificación de resultados de enfermería para manejo de delirium, soporte con literatura de los indicadores que responde al resultado, selección de expertos, establecimiento de acuerdos y discusión. Criterios de calidad evaluados: pertinencia y relevancia. Se calculó el Coeficiente de Validez de Contenido, así como los promedios de los puntajes asignados por los expertos. Resultados. Se contó con la participación de 14 expertos. Los indicadores según los criterios de pertinencia y relevancia evaluados por expertos mostraron un valor global promedio de índice de contenido de 0.93. El 97.05% (66) de los indicadores presentaron Coeficiente de Validez de Contenido mayor a 0.75. Conclusión. Los hallazgos cuantitativos del proceso de validación de los indicadores mostraron alto índice de relevancia y pertinencia lo que favorece que puedan ser aplicados para medir cambios de cuidado en los pacientes con delirium.

Objetivo. Validar o conteúdo dos indicadores propostos pela Classificação dos Resultados de Enfermagem em um plano de cuidados para o manejo do delirium em idosos. Métodos. Estudo de validação de conteúdo, realizado através da técnica de julgamento de especialistas. O procedimento foi desenvolvido em 5 momentos: organização dos indicadores que respondem à classificação dos resultados de enfermagem para manejo do delirium, suporte com literatura dos indicadores que respondem ao resultado, seleção de especialistas, estabelecimento de acordos e discussão. Foram calculados os critérios de qualidade avaliados: relevância e pertinência, o Coeficiente de Validade de Conteúdo e as médias das notas atribuídas pelos especialistas. Resultados. Participaram 14 especialistas. Os indicadores segundo os critérios de relevância e pertinência avaliados por especialistas apresentaram valor médio do índice de conteúdo global de 0.93. O 97.05% (66) dos indicadores apresentaram Coeficiente de Validade de Conteúdo superior a 0.75. Conclusão. Os achados quantitativos do processo de validação dos indicadores apresentaram alto índice de relevância e pertinência, o que favorece sua aplicação para mensurar mudanças no cuidado de pacientes com delirium.

Soluble receptor for advanced glycation end-products (sRAGE) in childhood obesity: association with gene expression of RAGE and cardiometabolic markers / Receptor soluble para productos finales de glicación avanzada (sRAGE) en la obesidad infantil:asociación con la expresión génica de RAGE y marcadores cardiometabólicos

Introduction: advanced glycation end-products (AGEs) interact with the receptor for AGEs (RAGE). Full-length RAGE is associated with intracellular signal transduction, and soluble-RAGE (sRAGE) lacks the transmembrane and cytoplasmic domains, acting as a competitive inhibitor ofAGEs-RAGE binding. sRAGE levels in healthy children are associated with cell surface expression of RAGE. However, the expression of RAGE hasnot been explored in childhood obesity.Objective: the study aim was to evaluate the sRAGE levels and the gene expression of RAGE in children and its association with cardiometabolicmarkers.Methods: this is a cross-sectional study with 6-11-year children, 20 with overweight and 20 with obesity. Anthropometric measurements includedwaist circumference (cm) (WC), neck circumference (NC), weight (kg), fat mass (%), trunk fat (kg), muscular mass (kg), height (cm), and bodymass index (BMI) (kg/m2). Blood samples following an overnight fast were collected to measure glucose (mg/dl) and lipid profile with colorimetricmethods. sRAGE was determined in serum using the enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription (RT-qPCR)was performed to analyze RAGE transcripts in peripheral blood mononuclear cells isolated by Ficoll®-Hypaque.Results: we found higher RAGE (p = 0.0315) and lower sRAGE (p = 0.0305) levels in the obesity group. sRAGE level showed a negative correlation with RAGE (r = -0.35) and BMI (r = -0.24), and positive with HDL-cholesterol (r = 0.29). Regression analysis suggests that HDL-C andRAGE levels are predictors of sRAGE levels.Conclusions: expression of RAGE is associated with lower sRAGE levels in childhood obesity. Moreover, obese children show higher cardiometabolic risk markers, and a positively associated with sRAGE. (AU)

Introducción: los productos finales de glicación avanzada (AGE) interactúan con el receptor de AGE (RAGE). El RAGE de longitud completaestá asociado con la transducción de señales intracelulares y el RAGE soluble (sRAGE) carece de los dominios transmembrana y citoplásmico,actuando como un inhibidor competitivo de la unión de AGE-RAGE. Los niveles de sRAGE en niños sanos están asociados con la expresión deRAGE en la superficie celular. Sin embargo, la expresión de RAGE no se ha explorado en la obesidad infantil.Objetivo: el objetivo del estudio fue evaluar los niveles de sRAGE y la expresión génica de RAGE en niños y su asociación con marcadorescardiometabólicos.Métodos: se trata de un estudio transversal con niños de seis a once años, 20 con sobrepeso y 20 con obesidad. Las medidas antropométricasincluyeron la circunferencia de la cintura (cm) (CC), la circunferencia del cuello (NC), el peso (kg), la masa grasa (%), la grasa del tronco (kg),la masa muscular (kg), la altura (cm) y el índice de masa corporal (IMC) (kg/m2). Se tomaron muestras de sangre después de una noche deayuno para medir glucosa (mg/dl) y el perfil de lípidos con métodos colorimétricos. Los sRAGE se determinaron en suero utilizando un ensayoinmunoabsorbente ligado a enzimas (ELISA). Se realizó una transcripción inversa cuantitativa (RT-qPCR) para analizar los transcritos de RAGE encélulas mononucleares de sangre periférica aisladas por Ficoll®-Hypaque.Resultados: encontramos niveles más altos de RAGE (p = 0,0315) y más bajos de sRAGE (p = 0,0305) en el grupo de obesidad. El nivel de sRAGE mostró una correlación negativa con RAGE (r = -0,35) e IMC (r = -0,24), y positiva con el colesterol HDL (r = 0,29). El análisis de regresión sugiere que los niveles de HDL-C y RAGE predicen los niveles de sRAGE.Conclusiones: la expresión de RAGE se asocia con niveles más bajos de sRAGE en la obesidad infantil. ... (AU)

Soluble receptor for advanced glycation end-products (sRAGE) in childhood obesity: association with gene expression of RAGE and cardiometabolic markers.

Introduction: Introduction: advanced glycation end-products (AGEs) interact with the receptor for AGEs (RAGE). Full-length RAGE is associated with intracellular signal transduction, and soluble-RAGE (sRAGE) lacks the transmembrane and cytoplasmic domains, acting as a competitive inhibitor of AGEs-RAGE binding. sRAGE levels in healthy children are associated with cell surface expression of RAGE. However, the expression of RAGE has not been explored in childhood obesity. Objective: the study aim was to evaluate the sRAGE levels and the gene expression of RAGE in children and its association with cardiometabolic markers. Methods: this is a cross-sectional study with 6-11-year children, 20 with overweight and 20 with obesity. Anthropometric measurements included waist circumference (cm) (WC), neck circumference (NC), weight (kg), fat mass (%), trunk fat (kg), muscular mass (kg), height (cm), and body mass index (BMI) (kg/m2). Blood samples following an overnight fast were collected to measure glucose (mg/dl) and lipid profile with colorimetric methods. sRAGE was determined in serum using the enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription (RT-qPCR) was performed to analyze RAGE transcripts in peripheral blood mononuclear cells isolated by Ficoll®-Hypaque. Results: we found higher RAGE (p = 0.0315) and lower sRAGE (p = 0.0305) levels in the obesity group. sRAGE level showed a negative correlation with RAGE (r = -0.35) and BMI (r = -0.24), and positive with HDL-cholesterol (r = 0.29). Regression analysis suggests that HDL-C and RAGE levels are predictors of sRAGE levels. Conclusions: expression of RAGE is associated with lower sRAGE levels in childhood obesity. Moreover, obese children show higher cardiometabolic risk markers, and a positively associated with sRAGE.

Introducción: Introducción: los productos finales de glicación avanzada (AGE) interactúan con el receptor de AGE (RAGE). El RAGE de longitud completa está asociado con la transducción de señales intracelulares y el RAGE soluble (sRAGE) carece de los dominios transmembrana y citoplásmico, actuando como un inhibidor competitivo de la unión de AGE-RAGE. Los niveles de sRAGE en niños sanos están asociados con la expresión de RAGE en la superficie celular. Sin embargo, la expresión de RAGE no se ha explorado en la obesidad infantil. Objetivo: el objetivo del estudio fue evaluar los niveles de sRAGE y la expresión génica de RAGE en niños y su asociación con marcadores cardiometabólicos. Métodos: se trata de un estudio transversal con niños de seis a once años, 20 con sobrepeso y 20 con obesidad. Las medidas antropométricas incluyeron la circunferencia de la cintura (cm) (CC), la circunferencia del cuello (NC), el peso (kg), la masa grasa (%), la grasa del tronco (kg), la masa muscular (kg), la altura (cm) y el índice de masa corporal (IMC) (kg/m2). Se tomaron muestras de sangre después de una noche de ayuno para medir glucosa (mg/dl) y el perfil de lípidos con métodos colorimétricos. Los sRAGE se determinaron en suero utilizando un ensayo inmunoabsorbente ligado a enzimas (ELISA). Se realizó una transcripción inversa cuantitativa (RT-qPCR) para analizar los transcritos de RAGE en células mononucleares de sangre periférica aisladas por Ficoll®-Hypaque. Resultados: encontramos niveles más altos de RAGE (p = 0,0315) y más bajos de sRAGE (p = 0,0305) en el grupo de obesidad. El nivel de sRAGE mostró una correlación negativa con RAGE (r = -0,35) e IMC (r = -0,24), y positiva con el colesterol HDL (r = 0,29). El análisis de regresión sugiere que los niveles de HDL-C y RAGE predicen los niveles de sRAGE. Conclusiones: la expresión de RAGE se asocia con niveles más bajos de sRAGE en la obesidad infantil. Además, los niños obesos muestran marcadores de riesgo cardiometabólico más elevados y una asociación positiva con sRAGE.

Elimination of E. faecalis and C. albicans Biofilm: A comparison between single and multiple file systems in an Ex Vivo study

To evaluate whether the WaveOne Gold and Reciproc single file instrumentation systems, are effective in reducing the microbial load of a mixed biofilm and the cleaning of apical third compared to the Twisted File Adaptive system (multiple- file system). Seventy mesial roots of the first and second molars were included and randomly divided into three experimental groups (n=20, n=10 controls). Biofilms were formed inside canals over 31 days. After instrumentation with the unique file systems, WaveOne Gold and Reciproc and the multiple file system Twisted File Adaptive, using 2.25% sodium hypochlorite as an irrigant in all cases, a count of colony forming units was performed using serial dilutions, cleaning of the apical third was evaluated using scanning electron microscopy. Comparisons amongst groups were made by using parametric and non-parametric statistics, according to a normal or non-normal data distribution, respectively. No significant differences in the reduction of the microbial load after employing a single-file system in comparison to the multiple-file system were found; in addition, the cleaning of the apical third was similar for the three different instrumentation systems. The single-file system is equal in effectiveness compared with the multiple-file system in reducing the microbial load.

Evaluar si los sistemas de instrumentación de lima única, como WaveOne Gold y Reciproc son efectivos para reducir la carga microbiana de un biofilm mixto y la limpieza del tercio apical, comparado con los sistemas de limas múltiples, como Twisted File Adaptive. Setenta raíces mesiales de primeros y segundos molares fueron incluidos y divididos de forma aleatoria en tres grupos experimentales (n=20, n=10 controles). El biofilm fue formado en el interior de los conductos durante 31 días. Después se instrumentó con los sistemas de lima única (WaveOne Gold y Reciproc) y el sistema de limas múltiples Twisted File Adaptive, usando hipoclorito de sodio al 2.5% en todos los casos. El conteo de unidades formadoras de colonias se realizó usando diluciones seriales, la limpieza del tercio apical se evaluó empleando el microscopio electrónico de barrido. La comparación entre grupos se realizó con pruebas paramétricas y no paramétricas, de acuerdo con la distribución normal y no normal de los datos, respectivamente. No hubo una diferencia significativa en la reducción de la carga microbiana después de emplear los sistemas de lima única en comparación a los de limas múltiples, además, la limpieza del tercio apical fue similar en los 3 diferentes sistemas de instrumentación. Los sistemas de lima única son igual de efectivos para reducir la carga microbiana comparados con los sistemas de limas múltiples.

Polymorphisms -374 T/A and -429 T/C of the Receptor for Advanced Glycation End-Products (RAGE) and Serum Levels of RAGE (sRAGE) Are Not Associated with Metabolic Syndrome.

RAGE is a multi-ligand transmembrane glycoprotein that promotes biological signals associated with inflammatory responses and degenerative diseases. sRAGE is a soluble variant, proposed as an inhibitor of RAGE activity. -374 T/A and -429 T/C polymorphisms of the advanced glycation end products receptor AGER gene are associated with the development of some diseases, such as type of cancer, cardiovascular disease, and micro and macrovascular disease in diabetes among others but their role in metabolic syndrome (MS) is still unknown. We studied 80 healthy men without MS, and 80 men with MS according to the harmonized criteria. -374 T/A and -429 T/C polymorphisms were genotyped by RT-PCR, and sRAGE was measured by ELISA. Allelic and genotypic frequencies did not differ between Non-MS and MS groups (-374 T/A p = 0.48, p = 0.57 and -429 T/C p = 0.36, p = 0.59). Significant differences were found in fasting glucose levels and diastolic blood pressure among the genotypes of the -374 T/A polymorphism in the Non-MS group (p < 0.01 and p = 0.008). Glucose levels were different between -429 T/C genotypes in the MS group (p = 0.02). sRAGE levels were similar in both groups, but in the Non-MS group showed a significant difference between individuals with only 1 or 2 components of the metabolic syndrome (p = 0.047). However, no associations of any SNP with MS were found (recessive model p = 0.48, dominant model p = 0.82 for -374 T/A; recessive model p = 0.48, dominant model p = 0.42 for -429 T/C). -374 T/A and -429 T/C polymorphisms are not associated with MS in Mexican population and have no influence on serum sRAGE levels.

Competencia en cuidado espiritual en enfermería: Revisión integrativa de literatura / Spiritual Care Competence in Nursing: Integrative Literature Review

Introducción: El cuidado espiritual puede considerarse un elemento central de la filosofía del cuidado holístico. Objetivo: Identificar investigaciones de intervención con perspectivas y estrategias educativas para el desarrollo de competencias en cuidado espiritual. Materiales y métodos: Revisión de la literatura en el período 2001-2021 de las bases de datos PubMed, ProQuest, Scopus, Lilacs y BVS (Biblioteca Virtual en Salud). Se siguieron las recomendaciones PRISMA y se basaron en parámetros definidos por Whittemore y Knafl para la identificación de problemas, búsqueda bibliográfica, evaluación y análisis de datos. Resultados: se encontraron 10 artículos de intervención publicados. Los entrenamientos relacionados con el desarrollo de habilidades para el cuidado espiritual fueron realizados en programas de formación superior del personal de enfermería. Las estrategias de instrucción son cursos específicos, sesiones cortas o programas a lo largo del plan de estudios. Las intervenciones muestran efectos sobre las habilidades y conocimientos. La espiritualidad individual de los estudiantes predice la capacidad de brindar atención espiritual. Conclusiones: Hay evidencia de estrategias para desarrollar la competencia de estudiantes y profesionales de enfermería en cuidado espiritual, aún son escasas las publicaciones sobre el tema, por lo que se necesitan nuevas y más rigurosas estrategias para desarrollar competencia en este enfoque de la disciplina de enfermería.

Introduction: Spiritual care can be considered a basic component of the philosophy of holistic care. Objective: Identify intervention studies with educational perspectives and strategies for developing spiritual care competencies in nurses and nursing students. Materials and methods: Integrative review of literature conducted in the period 2001-2021, in the databases PubMed, ProQuest, Scopus, LILACS, and VHL (Virtual Health Library). PRISMA statement guidelines were followed for the review, and it was based on Whittemore and Knafl's stages for integrative reviews: problem formulation, literature search, evaluation of data, data analysis, and presentation of results. Results: Ten published intervention articles were found. Education for the development of spiritual care competencies has been provided by educational programs and activities in undergraduate nursing programs and with professional nurses in practice. Instructional strategies include specific courses, short sessions, or programs throughout the curriculum. Interventions have an impact on skills and knowledge. Students' individual spirituality is a predictor of the competence to provide spiritual care. Conclusions: There is evidence of strategies to develop spiritual care competencies in nursing students and professionals, but publications on the subject are scarce. Therefore, implementing new and more rigorous strategies that allow the development of competencies for approaching spirituality in nursing is required.

Introdução: o cuidado espiritual pode ser considerado um componente básico da filosofia do cuidado holístico. Objetivo: determinar estudos de intervenção com perspectivas e estratégias educativas para o desenvolvimento da competência em cuidado espiritual em profissionais e estudantes de enfermagem. Materiais e Métodos: Revisão integrativa da literatura realizada no período de 2001-2021, nas bases de dados PubMed, ProQuest, Scopus, Lilacs e BVS (Biblioteca Virtual em Saúde). As recomendações do PRISMA foram seguidas e baseadas nos parâmetros estabelecidos por Whittemore e Knafl para identificação do problema, busca na literatura, avaliação dos dados, análise dos dados e apresentação dos resultados. Resultados: foram encontrados 10 artigos de intervenção publicados. A educação para o desenvolvimento de competências no cuidado espiritual tem sido realizada a partir de programas e atividades educativas, na graduação e nos profissionais de enfermagem durante sua prática. As estratégias de ensino são cursos específicos, sessões curtas ou programas ao longo do currículo. As intervenções mostram impactos nas habilidades e competências de conhecimento. A espiritualidade individual nos alunos é um preditor da capacidade de fornecer cuidados espirituais. Conclusões: Existem evidências de estratégias para desenvolver competências no cuidado espiritual em enfermagem em estudantes e profissionais, as publicações sobre o assunto são escassas, pelo que é necessária a implementação de estratégias inovadoras e mais rigorosas que permitam o desenvolvimento de competências para a abordagem em Enfermagem.

Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey.

BACKGROUND: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and nonadherence to immune-modifying therapy during the pandemic. OBJECTIVES: To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence. METHODS: Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and nonadherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity) and country of residence. RESULTS: Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07-1.76]. Specifically, anxiety was associated with nonadherence to targeted therapy (OR 1.41, 95% CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95% CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with nonadherence to overall systemic (OR 1.20, 95% CI 0.92-1.56) or targeted (OR 1.33, 95% CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with nonadherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49). CONCLUSIONS: These data indicate substantial nonadherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment nonadherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimize adherence and disease outcomes.

Response to Comment on "Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes".

This letter aims to reply to Bratchenko and Bratchenko's comment on our paper "Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes." Our paper analyzed the feasibility of using in vivo Raman measurements combined with machine learning techniques to screen diabetic and prediabetic patients. We argued that this approach yields high overall accuracy (94.3%) while retaining a good capacity to distinguish between diabetic (area under the receiver-operating curve [AUC] = 0.86) and control classes (AUC = 0.97) and a moderate performance for the prediabetic class (AUC = 0.76). Bratchenko and Bratchenko's comment focuses on the possible overestimation of the proposed classification models and the absence of information on the age of participants. In this reply, we address their main concerns regarding our previous manuscript.

Riesgo de Trastornos de Conductas Alimentarias Asociados al Estado Nutricional de los Adolescentes / Risco de transtornos alimentares associados ao estado nutricional de adolescentes / Risk of eating disorders associated with the nutritional status of adolescents

Introduction: Eating disorders are described as complex disorders comprising two typesof behavioral alterations: some directly related to food and weight and others derived from therelationship with oneself and others. Objective: To describe the risks of eating behaviors associatedwith the nutritional status of adolescents from public schools in Bucaramanga. Materials and methods: Observational, descriptive, cross-sectional study. The population corresponds to 471 adolescents between 10 and 19 years of age, from 19 educational institutions of the public network ofBucaramanga, multistage probabilistic sampling, the eating attitudes test (EAT26) was used, theperception of body image, comparisons were made according to sex and nutritional status with theX2 test. Results: Discussion and conclusions: Participants with eating behavior disorders havehigher percentages in those with altered nutritional status (severe malnutrition, overweight andobesity) and differences were identified regarding body image according to nutritional status.(AU)

Los trastornos de la conducta alimentaria son descritos como desórdenes complejos quecomprenden dos tipos de alteraciones conductuales: unos directamente relacionados con la comiday el peso y otros derivados de la relación consigo mismo y con los demás. Objetivo: Describir losriegos de las conductas alimentarias asociados al estado nutricional de adolescentes de colegios públicos de Bucaramanga Materiales y métodos: estudio observacional, descriptivo, de corte transversal. La población corresponde 471 adolescentes entre los 10 y 19 años de edad, de 19 InstitucionesEducativas de la red pública de Bucaramanga, muestreo probabilístico polietápico, se utilizó el testactitudes alimentarias (EAT26), la percepción de la imagen corporal, se realizaron comparación según el sexo y el estado nutricional con la Prueba de X2. Resultados: Discusión y conclusiones: Losparticipantes con trastornos de conductas alimenticias tienen porcentajes mas altos en los que tienenalteración del estado nutricional (desnutrición severa, sobrepeso y obesidad) y se identificó diferencias respecto de la imagen corporal según el estado nutricional.(AU)

As perturbações alimentares são descritas como perturbações complexas que compreen-dem dois tipos de alterações comportamentais: algumas directamente relacionadas com a alimenta-ção e o peso e outras derivadas da relação consigo próprio e com os outros. Objectivo: Descrever osriscos dos comportamentos alimentares associados ao estado nutricional dos adolescentes nas esco-las públicas de Bucaramanga Materiais e métodos: Estudo observacional, descritivo, transversal. Apopulação corresponde a 471 adolescentes entre os 10 e 19 anos de idade, de 19 instituições educa-tivas da rede pública de Bucaramanga, foi utilizada a amostragem probabilística em várias fases, oteste de atitude alimentar (EAT26), a percepção da imagem corporal, foram feitas comparações deacordo com o sexo e o estado nutricional com o teste X2. Resultados: Discussão e conclusões: Osparticipantes com distúrbios alimentares têm percentagens mais elevadas naqueles com estado nu-tricional alterado (desnutrição grave, excesso de peso e obesidade) e foram identificadas diferençasrelativamente à imagem corporal de acordo com o estado nutricional.(AU)

Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium.

Objective: To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Methods: Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. Results: The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. Conclusion: The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.

Cuidado espiritual en estudiantes de enfermería: estudio cualitativo / Spiritual Care in Nursing Students: Qualitative Study / Cuidado espiritual em estudantes de enfermagem: um estudo qualitativo

Introducción. La atención de la dimensión espiritual en pacientes y familias es fundamental como parte del papel activo de los profesionales de enfermería en la satisfacción de las necesidades espirituales de los pacientes. Objetivo. Comprender las actitudes frente al cuidado espiritual de los profesionales de enfermería en formación. Metodología. Estudio de abordaje cualitativo, con análisis de contenido, con población de 20 estudiantes de educación superior de Enfermería, con un muestreo por conveniencia. Se realizaron entrevistas semiestructuradas y dos grupos focales para indagar sobre el autoconocimiento espiritual y las concepciones del cuidado espiritual, tomando como referencia los conceptos teóricos propuestos por McSherry. El análisis de los datos inicialmente se hizo de forma inductiva, con ayuda del software Iramuteq. Resultados. La espiritualidad se considera una dimensión intrapersonal donde se reconoce la necesidad de explorar su propia espiritualidad para acercarse a la percepción espiritual del paciente. Aprender de las crisis para el desarrollo de la espiritualidad personal y encontrarse desde la naturaleza fueron parte de las categorías encontradas. Discusión. La concepción del cuidado espiritual para los estudiantes como dimensión intrapersonal, les permite distinguir entre la espiritualidad y la religiosidad. Este es un aspecto que se ha podido ver durante el desarrollo de las prácticas formativas, ya que se han encontrado personas muy religiosas, así como otras que no lo son. Conclusiones. Se hace referencia a la relación entre lo espiritual y lo corpóreo y aunque existe una diferencia entre religión y espiritualidad, los dos conceptos deben ser valorados a nivel personal.

Introduction. Attention to the spiritual dimension of patients and families is fundamental as part of the active role of nursing professionals in satisfying the spiritual needs of patients. Objective. To understand the attitudes towards spiritual care of nursing professionals in training. Methodology. Qualitative study with content analysis, with a population of 20 higher education Nursing students, with convenience sampling. Semi-structured interviews and two focus groups were held to explore spiritual self-knowledge and the conceptions of spiritual care, using the theoretical concepts proposed by McSherry as a reference. Data was initially analyzed inductively, with help from the Iramuteq software. Results. Spirituality is considered an intrapersonal dimension in which the need to explore one's own spirituality in recognized, in order to approach the spiritual perception of the patient. Learning about crises for the development of a personal spirituality and finding oneself through nature were part of the observed categories. Discussion. The conception of spiritual care as an intrapersonal dimension helps students differentiate between spirituality and religion. This aspecto has been observable during educational practice, since there were some very religious people and others who were not. Conclusions. Reference is made to the relationship between that which is spiritual and corporeal, and though there is a difference between spirituality and religion, both concepts must be assessed personally.

Introdução. A atenção à dimensão espiritual em pacientes e familiares é essencial como parte do papel ativo dos profissionais de enfermagem no atendimento às necessidades espirituais dos pacientes. Objetivo. Compreender as atitudes em relação aos cuidados espirituais dos profissionais de enfermagem em formação. Metodologia. Estudo de abordagem qualitativa, com análise de conteúdo, com uma população de 20 estudantes do ensino superior de Enfermagem, com amostragem por conveniência. Foram realizadas entrevistas semiestruturadas e dois grupos focais para indagar sobre autoconhecimento espiritual e concepções de cuidado espiritual, tomando como referência os conceitos teóricos propostos por McSherry. A análise dos dados foi feita inicialmente de forma indutiva, com o auxílio do software Iramuteq. Resultados. A espiritualidade é considerada uma dimensão intrapessoal onde se reconhece a necessidade de explorar a própria espiritualidade para se aproximar da percepção espiritual do paciente. Aprender com as crises para o desenvolvimento da espiritualidade pessoal e encontrar-se com a natureza foram algumas das categorias encontradas. Discussão. A concepção de cuidado espiritual para os alunos como uma dimensão intrapessoal, permite-lhes distinguir entre espiritualidade e religiosidade. Este é um aspecto que se tem visto ao longo do desenvolvimento das práticas formativas, uma vez que foram encontradas pessoas muito religiosas e outras não. Conclusões. É feita referência à relação entre o espiritual e o corpóreo e, embora haja uma diferença entre religião e espiritualidade, os dois conceitos devem ser valorizados a nível pessoal.

Competencia en cuidado espiritual en enfermería: Revisión integrativa de literatura / Spiritual Care Competence in Nursing: Integrative Literature Review

Introducción: El cuidado espiritual puede considerarse un elemento central de la filosofía del cuidado holístico. Objetivo: Identificar investigaciones de intervención con perspectivas y estrategias educativas para el desarrollo de competencias en cuidado espiritual. Materiales y métodos: Revisión de la literatura en el período 2001-2021 de las bases de datos PubMed, ProQuest, Scopus, Lilacs y BVS (Biblioteca Virtual en Salud). Se siguieron las recomendaciones PRISMA y se basaron en parámetros definidos por Whittemore y Knafl para la identificación de problemas, búsqueda bibliográfica, evaluación y análisis de datos. Resultados: se encontraron 10 artículos de intervención publicados. Los entrenamientos relacionados con el desarrollo de habilidades para el cuidado espiritual fueron realizados en programas de formación superior del personal de enfermería. Las estrategias de instrucción son cursos específicos, sesiones cortas o programas a lo largo del plan de estudios. Las intervenciones muestran efectos sobre las habilidades y conocimientos. La espiritualidad individual de los estudiantes predice la capacidad de brindar atención espiritual. Conclusiones: Hay evidencia de estrategias para desarrollar la competencia de estudiantes y profesionales de enfermería en cuidado espiritual, aún son escasas las publicaciones sobre el tema, por lo que se necesitan nuevas y más rigurosas estrategias para desarrollar competencia en este enfoque de la disciplina de enfermería.

Introduction: Spiritual care can be considered a basic component of the philosophy of holistic care. Objective: Identify intervention studies with educational perspectives and strategies for developing spiritual care competencies in nurses and nursing students. Materials and methods: Integrative review of literature conducted in the period 2001-2021, in the databases PubMed, ProQuest, Scopus, LILACS, and VHL (Virtual Health Library). PRISMA statement guidelines were followed for the review, and it was based on Whittemore and Knafl's stages for integrative reviews: problem formulation, literature search, evaluation of data, data analysis, and presentation of results. Results: Ten published intervention articles were found. Education for the development of spiritual care competencies has been provided by educational programs and activities in undergraduate nursing programs and with professional nurses in practice. Instructional strategies include specific courses, short sessions, or programs throughout the curriculum. Interventions have an impact on skills and knowledge. Students' individual spirituality is a predictor of the competence to provide spiritual care. Conclusions: There is evidence of strategies to develop spiritual care competencies in nursing students and professionals, but publications on the subject are scarce. Therefore, implementing new and more rigorous strategies that allow the development of competencies for approaching spirituality in nursing is required.

Introdução: o cuidado espiritual pode ser considerado um componente básico da filosofia do cuidado holístico. Objetivo: determinar estudos de intervenção com perspectivas e estratégias educativas para o desenvolvimento da competência em cuidado espiritual em profissionais e estudantes de enfermagem. Materiais e Métodos: Revisão integrativa da literatura realizada no período de 2001-2021, nas bases de dados PubMed, ProQuest, Scopus, Lilacs e BVS (Biblioteca Virtual em Saúde). As recomendações do PRISMA foram seguidas e baseadas nos parâmetros estabelecidos por Whittemore e Knafl para identificação do problema, busca na literatura, avaliação dos dados, análise dos dados e apresentação dos resultados. Resultados: foram encontrados 10 artigos de intervenção publicados. A educação para o desenvolvimento de competências no cuidado espiritual tem sido realizada a partir de programas e atividades educativas, na graduação e nos profissionais de enfermagem durante sua prática. As estratégias de ensino são cursos específicos, sessões curtas ou programas ao longo do currículo. As intervenções mostram impactos nas habilidades e competências de conhecimento. A espiritualidade individual nos alunos é um preditor da capacidade de fornecer cuidados espirituais. Conclusões: Existem evidências de estratégias para desenvolver competências no cuidado espiritual em enfermagem em estudantes e profissionais, as publicações sobre o assunto são escassas, pelo que é necessária a implementação de estratégias inovadoras e mais rigorosas que permitam o desenvolvimento de competências para a abordagem em Enfermagem.

Feasibility of Raman spectroscopy as a potential in vivo tool to screen for pre-diabetes and diabetes.

In this article, we investigated the feasibility of using Raman spectroscopy and multivariate analysis method to noninvasively screen for prediabetes and diabetes in vivo. Raman measurements were performed on the skin from 56 patients with diabetes, 19 prediabetic patients and 32 healthy volunteers. These spectra were collected along with reference values provided by the standard glycated hemoglobin (HbA1c) assay. A multiclass principal component analysis and support vector machine (PCA-SVM) model was created from the labeled Raman spectra and was validated through a two-layer cross-validation scheme. Classification accuracy of the model was 94.3% with an area under the receiver operating characteristic curve AUC of 0.76 (0.65-0.84) for the prediabetic group, 0.86 (0.71-0.93) for the diabetic group and 0.97(0.93-0.99) for the control group. Our results suggest the feasibility of using Raman spectroscopy for the classification of prediabetes and diabetes in vivo.

Factors related to healthcare costs of road traffic accidents in Bucaramanga, Colombia.

OBJECTIVE: To determine the factors related to overall healthcare costs of road traffic accidents in Bucaramanga, Colombia. METHODS: A descriptive cross-sectional study was conducted through the analysis of road traffic accident records that took place in 2019 in Bucaramanga, Colombia. Cost quartiles in dollars were compared using Pearson's chi-squared and Fisher's exact tests. Odds ratios were also calculated in logistic regression. RESULTS: 3,150 road accidents were reported in 2019 involving 7,038 people, of which 812 had information related to healthcare costs in health care institutions. The median cost was 56.59 USD (RI = 29.35-140.15), average cost of 290.11 USD ± 731.22 (95%CI: 239.74-340.48). A higher possibility to be in the 4th quartile was found when persons were under 18 years of age (OR = 4.88; 95%CI: 1.30-18.32) or 46-60 years (OR = 3.66; 95%CI: 1.01-13.30), the type of vehicle involved is motorcycle (OR = 2.79; 95%CI: 1.25-6.24), bicycle (OR = 7.66; 95%CI: 2.70-21.68), having a head injury (OR = 4.50; 95%CI: 2.61-7.76) and hypothetical drunk driving (OR = 12.44; 95%CI: 2.01-76.87). CONCLUSIONS: Relevant factors in healthcare costs were riding a motorcycle or bicycle, having a head injury, being under 18 years of age or 46 to 60 years of age and hypothetical drunk driving. It is important to implement prevention measures based on identified factors to reduce road accident rate and therefore, its socioeconomic costs.

Efecto de una intervención educativa sobre la agencia de autocuidado en estudiantes de Enfermería / Impact of an educational intervention on the self-care agency among Nursing students

mediante el Aprendizaje Basado en Problemas (ABP) y basada en la Teoría de Autocuidado de Orem sobre la agencia de autocuidado en estudiantes de Enfermería de dos universidades colombianas. Método: estudio cuasiexperimental antes/después multicéntrico realizado en 2019. La población fueron los 56 estudiantes del primer semestre de Enfermería de dos universidades colombianas. Se realizó la intervención “Hacia el cuidado de la vida” con 12 sesiones de dos horas durante 13 semanas sobre autocuidado mental y espiritual, estilos de vida saludable, autocuidado corporal y autocuidado social mediante ABP. Se midieron variables sociodemográficas, académicas y de hábitos de consumo. La agencia de autocuidado se midió basal (B) y en la última sesión (P) mediante la escala ASA-B (muy baja: 1-24, baja: 25-48, buena: 49-72 o muy buena: 73-96 puntos). Se efectuó estadística descriptiva y bivariante. Resultados: completaron el estudio 40 personas. El 82,1% era mujer, con una edad mediana de 18. La puntuación global de la escala ASA-B se incrementó de manera estadísticamente significativa de manera global [B: X= 71,1 (DE= 0,73) y P: X= 75,6 (DE= 1,07); p< 0,001] y en las mujeres, de 18 a 20 años, solteras, con puntuación en Prueba Saber 11 en cuartil 1 o 2, antecedentes de ingesta de alcohol o de bebidas energizantes (p< 0,05). No varió la puntuación en función de la pertenencia a equipos deportivos, federaciones estudiantiles o grupos religiosos. Conclusión: la intervención educativa basada en la Teoría de Autocuidado y ABP aplicada a estudiantes de primer semestre de Enfermería mejoró su agencia de autocuidado.(AU)

Objective: to determine the impact of an educational intervention through Problem-Based Learning (PBL) and based on Orem’s Self-Care Theory on the self-care agency in Nursing students from two Colombian universities. Method: a multicentre quasi-experimental before-and-after study conducted on 2019. The population included the 56 students of the first Nursing semester from two Colombian universities. The “Hacia el cuidado de la vida” (“Towards Life Care”) intervention was conducted, with 12 two-hour sessions during 13 weeks on mental and spiritual self-care, healthy lifestyles, body self-care and social self-care through PBL. Sociodemographic and academic variables were measured, as well as consumer habits. The Self-Care Agency was measured at baseline (B) and at the last session (P) through the ASA-B scale (very low: 1-24, low: 25-48, good: 49-72 or very good: 73-96 scores). Descriptive and bivariate statistics were applied. Results: forty (40) persons completed the study; 82.1% were female, with 18 years as median age. The overall score in the ASA-B scale was increased overall in a statistically significant way [B: X= 71.1 (SD= 0.73) and P: X= 75.6 (SD= 1.07); p< 0.001] and in 18-to-20-year old single women, with a score of 11 in knowledge test in first or second quartile, past history of using alcohol or energy drinks (p< 0.05). There was no variation in score in terms of affiliation to sport teams, student federations or religious groups. Conclusion: the educational intervention based on the self-care theory and PBL applied to students in their first Nursing semester improved their self-care agency.(AU)

Aerosol box for intubation of patients with suspected COVID-19: simulation study / Caja de aerosol para la intubación de pacientes con sospecha de COVID-19: Un estudio de simulación

Abstract Introduction Endotracheal intubation is a procedure associated with a high level of exposure to the COVID-19 virus. This has led to the search of alternatives to reduce the risk of contamination, including the so-called aerosol box. Objective To compare time and difficulty of orotracheal intubation when using the aerosol box in a simulated setting. Methodology Observational study conducted with the participation of 33 anesthetist physicians and anesthesia residents; groups were compared in terms of time and intubation difficulty using a conventional Macintosh laryngoscope and the McGRATH™ MAC (Medtronic) videolaryngoscope with or without aerosol box. In order to determine performance with the intubation maneuver, crude hazard ratios were estimated, and a Cox multivariate regression model was built, adjusted by anesthetist years of experience and difficulties during the procedure. Results On average, the aerosol box increased intubation time by 7.57 seconds (SD 8.33) when the videolaryngoscope was used, and by 6.62 (SD 5.74) with the Macintosh. Overall, 132 intubations were performed, with 121 successful and 6 failed first-time attempts (4 with the use of the aerosol box); 16 participants (48.48%) reported difficulty handling the box. With the use of the Macintosh, intubation was found to be faster than with the videolaryngoscope (cHR: 1.36 [95% CI 0.64-2.88]; adjusted HR: 2.20 [95% CI 0.73-6.62]). Conclusions The use of the aerosol box and personal protective equipment in a simulation setting hinders the intubation maneuver and may result in protracted execution time.

Resumen Introducción La intubación endotraqueal es un procedimiento que se relaciona con alto nivel de exposición al virus de COVID-19, llevando a la búsqueda de alternativas para disminuir el riesgo de contaminación, entre ellas la llamada Caja de aerosoles. Objetivo Comparar el tiempo y dificultad en la intubación orotraqueal usando la caja de aerosoles en escenarios simulados. Metodología Estudio observacional, con participación de 33 médicos anestesiólogos y residentes de anestesia; se compararon los grupos en tiempo y dificultad de intubación con uso de laringoscopio convencional Macintosh y videolaringoscopio McGRATH™ MAC (Medtronic) utilizando la caja de aerosoles y sin ella. Para determinar el rendimiento en la maniobra de intubación se calcularon Hazard ratios crudos, se construyó modelo multivariado de Regresion de Cox ajustado por años de experiencia como anestesiólogo y dificultades durante el procedimiento. Resultados La caja de aerosoles aumentó en promedio el tiempo en segundos para la intubación con video-laringoscopio en 7,57 (DE: 8,33) y con Macintosh 6,62 (DE: 5,74). Se llevaron a cabo 132 intubaciones, 121 exitosas en el primer intento y 6 fallidas (4 con el uso de la caja de aerosoles). 16 participantes reconocieron alguna dificultad al manipular la caja (48,48 %). Con el uso de Macintosh se identificó tendencia a la intubación más rápido que con el videolaringoscopio (HRc: 1,36 [IC 95 %: 0,64-2,88]; HR ajustado: 2,20 [IC 95 %: 0,73-6,62]). Conclusiones Utilizar la caja de aerosoles y equipo de protección personal en un escenario simulado dificulta la maniobra de intubación y puede prolongar el tiempo de ejecución.

Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database.

BACKGROUND: Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. METHODS: We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. RESULTS: A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). CONCLUSIONS: This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.