[Outcomes of respiratory rehabilitation program in lung transplant recipients: a quasi experimental study]. / Resultados de un programa de rehabilitación respiratoria en pacientes receptores de trasplante pulmonar: estudio cuasiexperimental.

INTRODUCTION: Lung transplant (LT) is the ultimate option for end-stage lung diseases. Malnutrition and sarcopenia, common in LT recipients, can be reversible with adequate exercise and nutrition. This study aims to assess changes in physical performance and aerobic capacity after a 10-week rehabilitation program (RP) in LT recipients, as well as to describe the prevalence of sarcopenia and malnutrition before and after RP and their influence on clinically relevant outcomes. MATERIALS AND METHODS: Quasi-experimental study, before and after a 10-week PR in first-time TP recipients, aged over 18 years, from January 2022 to September 2023. Aerobic exercise capacity was assessed through the 6-minute walking test (6MWT) and peak oxygen consumption (VO2peak); and physical performance was measured using the Short Physical Performance Battery (SPPB). Additionally, the prevalence of sarcopenia was described according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) and malnutrition according to the criteria of the Global Leadership Initiative on Malnutrition (GLIM). RESULTS: Of the 41 patients, 56% had sarcopenia and 80% had malnutrition. After RP, the distance walked in the 6MWT increased by 66.3m (p=0.004) in men and 61m (p=0.001) in women. VO2peak increased in men by a mean of 3.1ml/min/kg (p=0.024). Physical performance improved significantly in both men and women according to the Short Physical Performance Battery (SPPB), with clinically relevant differences of 1.6 pts (p<0.001) and 1.2 pts (p=0.012), respectively. The prevalence of sarcopenia decreased to 24% and malnutrition to 61%. CONCLUSIONS: RP proved to be an effective and safe intervention for LT recipients. In addition to improvements in skeletal muscle strength and exercise capacity, a reduction in the prevalence of sarcopenia and malnutrition was also observed.

"Vascular tuft sign" in neuroendocrine tumors of the pancreas.

The often well-developed microvasculature in pancreatic neuroendocrine tumors (PanNETs) has been studied from different perspectives. However, some detailed structural findings have received less attention. Our objective is to study an overlooked event in PanNETs: "enclosed vascular tufts" (EVTs). For this purpose, 39 cases of PanNETs were examined with conventional (including serial sections) and immunochemistry procedures. In typical EVTs, the results show: 1) an insulated terminal vascular area, with a globular (glomeruloid) aspect, formed by a cluster of coiled microvessels, presenting CD31-, CD34-positive endothelial cells, αSMA-positive pericytes, and perivascular CD34-positive stromal cells/telocytes, separated by a pseudoglandular space from the surrounding trabeculae of tumor neuroendocrine cells; and 2) a pedicle joining the insulated terminal vascular area, with connective tissue tracts around the enclosing tumor trabeculae. EVTs predominate in the trabecular and nested gyriform pattern of PanNETs, with tumor trabeculae that follow a ribbon coil (winding ribbon pattern) around small vessels, which acquire a tufted image. In EVTs, secondary modifications may occur (fibrosis, hyalinization, myxoid changes, and calcification), coinciding or not with those of the connective tracts. In conclusion, the typical characteristics of unnoticed EVTs allow them to be considered as a morphological sign of PanNETs (a vascular tuft sign). Further in-depth studies are required, mainly to assess the molecular pathways that participate in vascular tuft formation and its pathophysiological implications.

Barriers and facilitators in self-care and management of chronic kidney disease in dialysis patients: A systematic review of qualitative studies.

AIM: To identify and synthesise qualitative studies on barriers and facilitators perceived by dialysis patients in relation to self-care and disease management. DESIGN: Systematic review of qualitative studies. DATA SOURCES: Qualitative study articles were extracted from PUBMED, MEDLINE, COCHRANE, WEB OF SCIENCE (WOS), CINAHL PsycINFO and EMBASE and electronic journals of the Spanish Society of Nephrology and Spanish Society of Nephrological Nursing until May 2022. Studies on barriers and/or facilitators affecting self-care and disease management expressed by people undergoing haemodialysis or peritoneal dialysis were included. REVIEW METHODS: The SPICE (Setting, Perspective, Intervention, Comparison and Evaluation) strategy was used to develop issues and subissues through the thematic synthesis of the qualitative findings. GRADE-CERQual was used to evaluate the articles. RESULTS: From 172 articles, 15 qualitative articles about barriers and facilitators perceived by patients concerning self-care and disease management were finally included. Identified eight facilitators and four barriers. CONCLUSION: Patients perceived a significant number of barriers and facilitators. It is possible to identify which aspects facilitate self-management of their disease and to understand that the processes are individualised. This is why therapeutic strategies should be designed to foster the participation and empowerment of the person in the management of the disease. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying the barriers and facilitators concerning the management of chronic kidney disease furnishes us with knowledge for individualised clinical practice and improved care processes. IMPACT: This review is the first to synthesise barriers and facilitators in haemodialysis patients about the management of their disease and treatment. The results enable the proposal of improvements in the training of healthcare personnel, clinical practice guidelines and action protocols to improve the daily life and management of the disease by patients. No patient or public contribution due to this is a systematic review.

Parallel prediction of dengue cases with different risks in Mexico using an artificial neural network model considering meteorological data.

In 2022, Mexico registered an increase in dengue cases compared to the previous year. On the other hand, the amount of precipitation reported annually was slightly less than the previous year. Similarly, the minimum-mean-maximum temperatures recorded annually were below the previous year. In the literature, it is possible to find studies focused on the spread of dengue only for some specific regions of Mexico. However, given the increase in the number of cases during 2022 in regions not considered by previously published works, this study covers cases reported in all states of the country. On the other hand, determining a relationship between the dynamics of dengue cases and climatic factors through a computational model can provide relevant information on the transmission of the virus. A multiple-learning computational approach was developed to simulate the number of the different risks of dengue cases according to the classification reported per epidemiological week by considering climatic factors in Mexico. For the development of the model, the data were obtained from the reports published in the Epidemiological Panorama of Dengue in Mexico and in the National Meteorological Service. The classification of non-severe dengue, dengue with warning signs, and severe dengue were modeled in parallel through an artificial neural network model. Five variables were considered to train the model: the monthly average of the minimum, mean, and maximum temperatures, the precipitation, and the number of the epidemiological week. The selection of variables in this work is focused on the spread of the different risks of dengue once the mosquito begins transmitting the virus. Therefore, temperature and precipitation were chosen as climatic factors due to the close relationship between the density of adult mosquitoes and the incidence of the disease. The Levenberg-Marquardt algorithm was applied to fit the coefficients during the learning process. In the results, the ANN model simulated the classification of the different risks of dengue with the following precisions (R2): 0.9684, 0.9721, and 0.8001 for non-severe dengue, with alarm signs and severe, respectively. Applying a correlation matrix and a sensitivity analysis of the ANN model coefficients, both the average minimum temperature and precipitation were relevant to predict the number of dengue cases. Finally, the information discovered in this work can support the decision-making of the Ministry of Health to avoid a syndemic between the increase in dengue cases and other seasonal diseases.

Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring.

Background: Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study.

INTRODUCTION: Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. OBJECTIVES: To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. METHODS: A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses' narratives and discourses. RESULTS: Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. CONCLUSIONS: The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama / Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment

Introducción: El cuestionario DASH está diseñado para la valoración funcional del miembro superior en enfermedad musculoesquelética. El objetivo de este trabajo es verificar las principales propiedades instrumentales (validez y fiabilidad) del cuestionario para su aplicación en mujeres españolas con linfedema secundario a tratamiento de cáncer de mama. Métodos: Cohorte prospectiva de 65 mujeres con linfedema secundario a tratamiento de cáncer de mama, en las que se estudió la fiabilidad de la puntuación del DASH mediante la consistencia interna (coeficiente alfa de Cronbach) y test-retest en un intervalo de 15 días (coeficiente de correlación intraclase), y la validez mediante la correlación con las puntuaciones del SF-36v2 y de la FACT-B+4 (r o τ b de Kendall). Resultados: La consistencia interna y fiabilidad test-retest fueron alfa de Cronbach 0,969 y coeficiente de correlación intraclase 0,861, respectivamente. Existía correlación entre las puntuaciones del DASH y las del SF-36v2, sobre todo con los dominios de función física, dolor corporal y rol físico (r de 0,800, 0,738 y 0,682, respectivamente; p<0,001), y menos con el rol emocional y social. Se correlacionaba con la puntuación FACT-B+4 (r=0,836; p<0,001) y la subescala miembro superior (r=0,816; p<0,001) y no existe correlación con la subescala social/familiar (r=0,193; p=0,216). Conclusión: El cuestionario DASH es una herramienta fiable y válida para ser utilizada en la valoración funcional de miembro superior de mujeres españolas con linfedema secundario a tratamiento de cáncer de mama.(AU)

Introduction: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. Methods: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test–retest reproducibility 15 days’ interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. Results: The internal consistency and the test–retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). Conclusion: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.(AU)

Older forests function as energetic and demographic refugia for a climate-sensitive species.

More frequent and extreme heat waves threaten climate-sensitive species. Structurally complex, older forests can buffer these effects by creating cool microclimates, although the mechanisms by which forest refugia mitigate physiological responses to heat exposure and subsequent population-level consequences remain relatively unexplored. We leveraged fine-scale movement data, doubly labeled water, and two decades of demographic data for the California spotted owl (Strix occidentalis occidentalis) to (1) assess the role of older forest characteristics as potential energetic buffers for individuals and (2) examine the subsequent value of older forests as refugia for a core population in the Sierra Nevada and a periphery population in the San Bernardino Mountains. Individuals spent less energy moving during warmer sampling periods and the presence of tall canopies facilitated energetic conservation during daytime roosting activities. In the core population, where tall-canopied forest was prevalent, temperature anomalies did not affect territory occupancy dynamics as warmer sites were both less likely to go extinct and less likely to become colonized, suggesting a trade-off between foraging opportunities and temperature exposure. In the peripheral population, sites were more likely to become unoccupied following warm summers, presumably because of less prevalent older forest conditions. While individuals avoided elevated energetic expenditure associated with temperature exposure, behavioral strategies to conserve energy may have diverted time and energy from reproduction or territory defense. Conserving older forests, which are threatened due to fire and drought, may benefit individuals from energetic consequences of exposure to stressful thermal conditions.

Spectral signatures of symmetry-breaking dynamical phase transitions.

Large deviation theory provides the framework to study the probability of rare fluctuations of time-averaged observables, opening new avenues of research in nonequilibrium physics. Some of the most appealing results within this context are dynamical phase transitions (DPTs), which might occur at the level of trajectories in order to maximize the probability of sustaining a rare event. While macroscopic fluctuation theory has underpinned much recent progress on the understanding of symmetry-breaking DPTs in driven diffusive systems, their microscopic characterization is still challenging. In this work we shed light on the general spectral mechanism giving rise to continuous DPTs not only for driven diffusive systems, but for any jump process in which a discrete Z_{n} symmetry is broken. By means of a symmetry-aided spectral analysis of the Doob-transformed dynamics, we provide the conditions whereby symmetry-breaking DPTs might emerge and how the different dynamical phases arise from the specific structure of the degenerate eigenvectors. In particular, we show explicitly how all symmetry-breaking features are encoded in the subleading eigenvectors of the degenerate subspace. Moreover, by partitioning configuration space into equivalence classes according to a proper order parameter, we achieve a substantial dimensional reduction which allows for the quantitative characterization of the spectral fingerprints of DPTs. We illustrate our predictions in several paradigmatic many-body systems, including (1) the one-dimensional boundary-driven weakly asymmetric exclusion process (WASEP), which exhibits a particle-hole symmetry-breaking DPT for current fluctuations, (2) the three- and four-state Potts model for spin dynamics, which displays discrete rotational symmetry-breaking DPTs for energy fluctuations, and (3) the closed WASEP which presents a continuous symmetry-breaking DPT into a time-crystal phase characterized by a rotating condensate.

Scipion Flexibility Hub: an integrative framework for advanced analysis of conformational heterogeneity in cryoEM.

Understanding how structure and function meet to drive biological processes is progressively shifting the cryoEM field towards a more advanced analysis of macromolecular flexibility. Thanks to techniques such as single-particle analysis and electron tomography, it is possible to image a macromolecule in different states, information that can subsequently be extracted through advanced image-processing methods to build a richer approximation of a conformational landscape. However, the interoperability of all of these algorithms remains a challenging task that is left to users, preventing them from defining a single flexible workflow in which conformational information can be addressed by different algorithms. Therefore, in this work, a new framework integrated into Scipion is proposed called the Flexibility Hub. This framework automatically handles intercommunication between different heterogeneity software, simplifying the task of combining the software into workflows in which the quality and the amount of information extracted from flexibility analysis is maximized.

[Translated article] Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels.

Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our centre, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analysed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS: One hundred and one patients (25 women and 76 men), 55 years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10 years (between 5 and 17 years). The mean head diameter was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5 years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3 patients with HHS 100 who presented unacceptable elevation of cobalt >20µm/l (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10µm/l (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.

[Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment]. / Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama.

INTRODUCTION: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. METHODS: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test-retest reproducibility 15 days' interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. RESULTS: The internal consistency and the test-retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). CONCLUSION: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.

Bacteria associated with apical periodontitis promotes in vitro the differentiation of macrophages to osteoclasts.

OBJECTIVE: To analyze the possible in vitro effect of the cytokine RANKL and bacteria involved in apical periodontitis on the differentiation of macrophages into osteoclasts. MATERIAL AND METHODS: Bacteria were isolated (mainly E. faecium and E. faecalis) from the root canal of fifty patients with apical periodontitis, the possible effect of these bacteria on the phagocytic activity of the monocyte cell line THP-1 was analyzed by flow cytometry. Furthermore, the effect of these bacteria (alone or in combination with the cytokine RANKL) on the differentiation of THP-1 macrophages into osteoclasts was analyzed through the expression of the receptor RANK and the tartrate-resistant acid phosphatase TRAP. Finally, the release of different cytokines (IL-1ß, TNF-α, IL-6, IL-8, IL-10, and IL-12p70) by THP-1 cells induced to differentiate into osteoclasts was also analyzed. RESULTS: We observed a significant proportion of THP-1 cells were able to internalize E. faecium and E. faecalis. Furthermore, these bacteria were able to induce (alone or in combination with RANKL) a significant expression of RANK by THP-1 macrophages; accordingly, E. faecium and E. faecalis induced very significant levels of TRAP in these cells. Finally, during the differentiation of THP-1 macrophages induced by RANKL or bacteria, a significant release of the pro-inflammatory cytokines IL-6 and TNF-α was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Our data suggest that the causative agents of apical periodontitis can induce the differentiation of osteoclasts as well as the release of pro-inflammatory cytokines, phenomena that may have an important role in the bone damage observed in this condition.

Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels. / Artroplastias metal-metal en cadera: correlación entre el aumento de iones y el ángulo del componente acetabular.

Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our center, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analyzed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS: One hundred and one patients (25 women and 76 men), 55years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10years (between 5 and 17years). The mean head diameters was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3patients with HHS100 who presented unacceptable elevation of cobalt >20µm/L (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10µm/L (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.

Calidad de las prescripciones de medicamentos opioides posterior a una intervención educativa en médicos residentes / [Quality of opioid medication prescriptions after an educational intervention in resident doctors]

Objetivo: Evaluar el impacto de una intervención educativa en la calidad de las prescripciones de medicamentos opioides. Métodos: Se aplicó el instrumento IAM (Índice de Adecuación de la Medicación) a 10 médicos residentes de la subespecialidad de medicina paliativa y del dolor para determinar la calidad de las prescripciones de analgésicos opioides, antes y después de haber realizado una intervención educativa (IE) en farmacoterapia racional. Resultados: Se analizaron un total de 181 prescripciones, 55 antes y 126 después de la IE. Se mejoraron las puntuaciones del nivel de acuerdo en todos los ítems del perfil descriptivo de los médicos participantes. La calidad de la prescripción aumentó del 14,5% al 73%, mejorando en todas las áreas, excepto la duplicidad de tratamientos. Conclusiones: La IE mejoró la calidad de las prescripciones y el perfil prescriptivo de los médicos participantes. El instrumento IAM es útil para determinar la calidad de las prescripciones de opioides. (AU)

Objective: To assess the impact of an educational intervention on the quality of opioid drug prescriptions. Methods: The MAI (Medication Adequacy Index) instrument was applied to 10 resident physicians of the Palliative and Pain Medicine Subspeciality to determine the quality of opioid analgesic prescriptions before and after an educational intervention (EI) in rational pharmacotherapy. Results: A total of 181 prescriptions were analyzed, 55 before and 126 after the EI. The level of agreement scores improved for all items of the physicians’ descriptive profile. Prescription quality increased from 14.5% to 73%, improving in all areas except for duplicity of treatment. Conclusions: The EI improved the quality of the prescriptions and the physicians’ prescribing profile. The MAI instrument is useful to determine the quality of opioid prescriptions. (AU)

Plastic energy allocation toward life-history functions in a consumer-resource interaction : Analyzing the temporal patterns of the consumer-resource dynamics.

Various environmental alterations resulting from the current global change compromise the persistence of species in their habitual environment. To cope with the obvious risk of extinction, plastic responses provide organisms with rapid acclimatization to new environments. The premise of plastic rescue has been theoretically studied from mathematical models in both deterministic and stochastic environments, focusing on analyzing the persistence and stability of the populations. Here, we evaluate this premise in the framework of a consumer-resource interaction considering the energy investment towards reproduction vs. maintenance as a plastic trait according to positive/negative variation of the available resource. A basic consumer-resource mathematical model is formulated based on the principle of biomass conversion that incorporates the energy allocation toward vital functions of the life-cycle of consumer individuals. Our mathematical approach is based on the impulsive differential equations at fixed moments considering two impulsive effects associated with the instants at which consumers obtain environmental information and when energy allocation strategy change occurs. From a preliminary analysis of the non-plastic temporal dynamics, namely when the energy allocation is constant over time and without experiencing changes concerning the variation of resources, both the persistence and stability of the consumer-resource dynamic are dependent on the energy allocation strategies belonging to a set termed stability range. We found that the plastic energy allocation can promote a stable dynamical pattern in the consumer-resource interaction depending on both the magnitude of the energy allocation change and the time lag between environmental sensibility instants and when the expression of the plastic trait occurs.

Thermodynamic Study of Leaching Conditions of Galena with Citrate Ions and Hydrogen Peroxide as Oxidizing Agent.

Galena is the most important mineral for lead production, as it is the main source of lead in the world. Currently, the concentrates of this mineral are mainly treated using pyrometallurgical methods, creating several environmental problems, such as the generation of toxic and greenhouse gases. In addition, these processes involve high energy consumption, which limits their applicability. Hydrometallurgical routes are proposed as alternative processes for obtaining some metals such as silver, copper, gold, etc. The drawback of these processes is that the minerals tend to be passive in aqueous media. To mitigate this issue, researchers have used extreme conditions of pressure and temperature (6 atm. and 155 °C) or the use of very corrosive conditions. In this sense, the use of complexing agents that dissolve the metals of interest has been proposed. Citrate ion is one of the most promising complexing agents for galena leaching, obtaining high percentages of dissolution in relatively short times. Unfortunately, there has not been enough investigation about the concentration optimization of the complexing in the pH range from 5 to 9. In this sense, thermodynamic diagrams, such as the Pourbaix diagrams, are very useful for this purpose. Therefore, in this work, the effects of pH and temperature on the leaching of galena in citrate ion solutions are studied thermodynamically and experimentally. The experimental work was carried out with pure galena samples with a particle size of +149 - 74 µm (-100 + 200 mesh). The results show that higher recoveries were obtained working at a pH of 8 and at temperatures of 30 and 40 °C. The thermodynamic and experimental data demonstrated that the existence of an optimal concentration of citrate ion, due the extraction of lead from galena, has a greater reaction rate at a relatively low initial concentration of 0.3 M. This is due the formation of the complex lead citrate 1 (Pb(cit)-).

Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges.

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

The contribution of intermolecular spin interactions to the London dispersion forces between chiral molecules.

Dispersion interactions are one of the components of van der Waals (vdW) forces that play a key role in the understanding of intermolecular interactions in many physical, chemical, and biological processes. The theory of dispersion forces was developed by London in the early years of quantum mechanics. However, it was only in the 1960s that it was recognized that for molecules lacking an inversion center, such as chiral and helical molecules, there are chirality-sensitive corrections to the dispersion forces proportional to the rotatory power known from the theory of circular dichroism and with the same distance scaling law R-6 as the London energy. The discovery of the chirality-induced spin selectivity effect in recent years has led to an additional twist in the study of chiral molecular systems, showing a close relation between spin and molecular geometry. Motivated by it, we propose in this investigation to describe the mutual induction of charge and spin-density fluctuations in a pair A-B of chiral molecules by a simple physical model. The model assumes that the same fluctuating electric fields responsible for vdW forces can induce a magnetic response via a Rashba-like term so that a spin-orbit field acting on molecule B is generated by the electric field arising from charge density fluctuations in molecule A (and vice versa). Within a second-order perturbative approach, these contributions manifest as an effective intermolecular exchange interaction. Although expected to be weaker than the standard London forces, these interactions display the same R-6 distance scaling.