sEMG-controlled forearm bracelet and serious game-based rehabilitation for training manual dexterity in people with multiple sclerosis: a randomised controlled trial.

BACKGROUND: Muscle strength and dexterity impairments are common among patients with multiple sclerosis (MS) producing limitations in activities of daily living related to the upper limb (UL). This study aimed to evaluate the effectiveness of serious games specifically developed for the MYO Armband® capture sensor in improving forearm and wrist mobility, UL muscle strength, dexterity, fatigue, functionality, quality of life, satisfaction, adverse effects and compliance. METHODS: A double-blinded (allocation concealment was performed by a blinded investigator and by blinding for assessors) randomised controlled trial was conducted. The sample was randomised into two groups: an experimental group that received treatment based on UL serious games designed by the research team and controlled by the MYO Armband® gesture capture sensor, along with conventional rehabilitation and a control group that received the same conventional rehabilitation for the UL. Both groups received two 60-min sessions per week over an eight-week period. Wrist range of motion (goniometry), grip muscle strength (Jamar® dynamometer), coordination and gross UL dexterity (Box and Block Test), fatigue (Fatigue Severity Scale), functionality (ABILHAND), quality of life (Multiple Sclerosis Impact Scale-29), adverse effects (Simulator Sickness Questionnaire, SSQ), perceived workload (NASA-Task load index), satisfaction (Client Satisfaction Questionnaire-8 (CSQ-8), Satisfaction with Technology Scale, System Usability Scale (SUS) and QUEST 2.0) and compliance (attendance) were assessed in both groups pre-treatment, post-treatment and during a follow-up period of 2 weeks without receiving any treatment. RESULTS: Significant differences were observed in the experimental group compared to the control group in the assessment of forearm supination (p = .004) and grip strength (p = .004). Adverse effects were minimal (SSQ: 7/100 points) and perceived workload was low (NASA-Task Load Index: 25/100 points) in the experimental group. The MYO Armband® technology proved to be useful for the participants (SUS: 80.66/100) and the satisfaction scales received high scores (QUEST 2.0: 59.4/70 points; Satisfaction with Technology: 84.36/100 points). There were significant differences between the groups in terms of attendance percentage (p = .029). CONCLUSIONS: An experimental protocol using MYO Armband®-based serious games designed for UL rehabilitation showed improvements in active wrist range of motion and handgrip strength in patients with MS, with high satisfaction, minimal adverse effects and workload and excellent compliance. TRIAL REGISTRATION NUMBER: This randomised controlled trial has been registered at ClinicalTrials.gov Identifier: NCT04171908.

A simple and efficient synthesis of N-[3-chloro-4-(4-chlorophenoxy)-phenyl]-2-hydroxy-3,5-diiodobenzamide, rafoxanide.

A method for the synthesis of rafoxanide 6, a halogenated salicylanilide used as an efficient anthelmintic in sheep and cattle, is presented. Rafoxanide 6 was synthesized in only three steps from readily available 4-chlorophenol with 74% overall yield. The synthesis has two key stages: the first was salicylic acid iodination, adding iodine in the presence of hydrogen peroxide, which allowed obtaining a 95% yield. The second key stage was the reaction of 3,5-diiodosalicylic acid 5 with aminoether 4, where salicylic acid chloride was formed in situ with PCl3 achieving 82% yield. Chemical characterization of both intermediates and final product was achieved through physical and spectroscopic (IR, NMR and MS) techniques. Supplementary Information: The online version contains supplementary material available at 10.1007/s11696-023-02846-9.

Presence of Differences in the Radiofrequency Parameters Applied to Complex Pressure Ulcers: A Secondary Analysis.

Background: Pressure ulcers are a public health problem given the impact that they have on morbidity, mortality and the quality of life and participation of patients who suffer from them. Therefore, the main objective of this study was to evaluate the presence of differences in the radiofrequency parameters applied to complex pressure ulcers throughout the sessions and between the right and left leg. As a secondary objective, the subjective perceptions of the effects of the treatment by both the patients and the practitioner were analyzed. Methods: We performed a secondary analysis of data from a prospective study involving 36 patients from the Hospital de Guadarrama in Madrid, Spain, who presented ulcers in the lower limbs. Ten treatment sessions of radiofrequency were administered with a frequency of one session/week, collecting the data referring to the variables in each of the sessions. The main outcome variables were the radiofrequency parameters automatically adjusted in each session and that referred to the frequency (Hz), maximum and average power (W), absorbed energy by the ulcer (J/cm2) and temperature (°C) reached by the tissues. On the other hand, the subjective perception of the results was evaluated using the Global Response Assessment (GRA), a Likert-type scale that scores the treatment results from 1 (significantly worse) to 5 (significantly better). Likewise, the satisfaction of both the patients and the professional were evaluated using a 10-point numerical scale. Results: The ANOVA test showed significant differences (p < 0.05) throughout the sessions except in patient satisfaction. The ANOVA test showed significant differences (p < 0.05) between both legs and over time in all parameters except for frequency. The presence of significant differences (p < 0.05) was observed over time between legs compared to the initial values in the absorbed energy and in temperature, with higher final values in the absorbed energy in the left leg compared to the right (26.31 ± 3.75 W vs. 17.36 ± 5.66 W) and a moderate effect on both (R2 = 0.471 and 0.492, respectively). The near absence of changes in the satisfaction of both the patients and the professional was observed, while the score in the GRA decreased continuously throughout the sessions. Conclusions: Radiofrequency parameters are indicative of an improved clinical response to ulcers. In addition, higher radiofrequency exposure increases healing capacity. However, the subjective perception of treatment outcomes worsened, which may be related to the chronic nature of the ulcers, leading to patients' expectations not being met.

Multicomponent Exercise Program to Improve the Immediate Sequelae of COVID-19: A Prospective Study with a Brief Report of 2-Year Follow-Up.

COVID-19 placed teams of professionals in a hostile and unfamiliar environment where the lack of knowledge of its pathology led to the adaptation of programs used so far for other conditions to try to address the immediate sequelae of COVID-19 infection. That is why the aim of this study was to assess the effects of a multicomponent exercise program (MEP) in improving cardio-respiratory performance, health status, disability due to dyspnea, aerobic capacity and endurance, and the immediate sequelae of COVID-19. Thirty-nine patients referred from different hospital services were included in this study. An intervention of seven weeks with sessions twice a week was carried out, where patients underwent intervallic training sessions followed by strengthening exercises and individualized respiratory physiotherapy exercises. The results of this study show a significant improvement in cardio-respiratory performance, health status, disability due to dyspnea, and aerobic capacity and endurance after intervention; and an increase in health status and reduction in disability due to dyspnea at the 2-year follow-up. In addition, none of the patients had any adverse effects either pre-post treatment or at the 2-year follow-up. Individualized and monitored MEP in survivors of COVID-19 showed positive effects in a pre-post evaluation and the 2-year follow up, improving the immediate sequelae of post-COVID-19 patients. This highlights the importance of the professional background of the rehabilitation teams in adapting to an unknown clinical environment.

Environmental risk factors of airborne viral transmission: Humidity, Influenza and SARS-CoV-2 in the Netherlands.

OBJECTIVE: The relationship between specific humidity and influenza/SARS-CoV-2 in the Netherlands is evaluated over time and at regional level. DESIGN: Parametric and non-parametric correlation coefficients are calculated to quantify the relationship between humidity and influenza, using five years of weekly data. Bayesian spatio-temporal models-with a Poisson and a Gaussian likelihood-are estimated to find the relationship between regional humidity and the daily cases of SARS-CoV-2 in the municipalities and provinces of the Netherlands. RESULTS: An inverse (negative) relationship is observed between specific humidity and the incidence of influenza between 2015 and 2019. The space-time analysis indicates that an increase of specific humidity of one gram of water vapor per kilogram of air (1 g/kg) is related to a reduction of approximately 5% in the risk of COVID-19 infections. CONCLUSIONS: The increase in humidity during the outbreak of the SARS-CoV-2 in the Netherlands may have helped to reduce the risk of regional COVID-19 infections. Policies that lead to an increase in household specific humidity to over 6g/Kg will help reduce the spread of respiratory viruses such as influenza and SARS-CoV-2.

Evaluación del Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial. Santa Clara. 2016 / Evaluation of the Prevention, Diagnosis and Control Program of Arterial Hypertension. Santa Clara. 2016

RESUMEN Introducción: La hipertensión arterial es la más común de las enfermedades que afectan la salud de los individuos en las poblaciones mundiales. Objetivo: Evaluar el cumplimiento del Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial en el municipio Santa Clara, en el año 2016. Métodos: Se realizó una investigación observacional, descriptiva, de corte transversal en sistemas y servicios de salud. Se definieron criterios y variables, escala de clasificación, descripción operacional con indicadores y estándar, en tres dimensiones. Resultados: La dimensión estructura fue evaluada de no satisfactorio solo en el 30,76 %. En las dimensiones proceso y resultado todos los indicadores examinados resultaron no satisfactorios. Conclusiones: El Programa de Prevención, Diagnóstico y Control de la Hipertensión Arterial en el municipio de Santa Clara fue evaluado de no satisfactorio.

ABSTRACT Introduction: arterial hypertension is the most common of the diseases affecting individuals' health in world populations. Objective: to evaluate compliance with the Prevention, Diagnosis and Control Program of Arterial Hypertension in Santa Clara municipality, in 2016. Methods: an observational, descriptive and cross-sectional study was carried out in health systems and services. Criteria and variables, rating scale, operational description with indicators and standards were defined in three dimensions. Results: the structure dimension was evaluated as unsatisfactory only in 30.76%. All indicators examined in the result and process dimensions were unsatisfactory. Conclusions: the Prevention, Diagnosis and Control Program of Arterial Hypertension in Santa Clara municipality was evaluated as unsatisfactory.

Community Participation and Multidimensional Child Growth: Evidence from the Vietnam Young Lives Study.

Background: Community participation has the potential to improve the effects of interventions and reduce inequalities in child growth. Multidimensional indicators capture such effects and inequalities. Objectives: The objective of this study was to measure the association between multidimensional child growth and community participation in 2 nutrition-sensitive interventions. Methods: A Multidimensional Index of Child Growth was calculated with the 5-y-old cohort of the Vietnam Young Lives Survey. Young Lives is a unique dataset that has information on community participation in the design and implementation stages of 2 interventions: a health and a water, sanitation, and hygiene (WASH) intervention. Community participation during the interventions was recorded retrospectively with interviews at the household level. Ordinary least-squares and quantile regressions were estimated using data on 240 children. A Multidimensional Index of Child Advantage, sex, and location (urban/rural) were included as control covariates. Results: A positive association (post hoc statistical power = 0.859) was estimated for community participation during the design stage of the WASH intervention, particularly for the most deprived children (P < 0.05). Negative effects were estimated for the health intervention during the design stage (P < 0.05) and no significant effects were found for community participation during the implementation stage of the interventions. Instead of the physical dimension, the significant associations in the design stage were related to the nonphysical dimension of child growth. Inequalities in multidimensional growth were found for children living in rural areas, but not for girls. Conclusions: The association between community participation and multidimensional child growth is indicative of the importance of community participation during the design phase of interventions, in particular for the nonphysical dimensions of child growth related to social and psychological factors. The benefits of participation were greater for urban children compared with rural children, which deserves further attention.

Work-related and personal predictors of COVID-19 transmission: evidence from the UK and USA.

OBJECTIVE: To develop evidence of work-related and personal predictors of COVID-19 transmission. SETTING AND RESPONDENTS: Data are drawn from a population survey of individuals in the USA and UK conducted in June 2020. BACKGROUND METHODS: Regression models are estimated for 1467 individuals in which reported evidence of infection depends on work-related factors as well as a variety of personal controls. RESULTS: The following themes emerge from the analysis. First, a range of work-related factors are significant sources of variation in COVID-19 infection as indicated by self-reports of medical diagnosis or symptoms. This includes evidence about workplace types, consultation about safety and union membership. The partial effect of transport-related employment in regression models makes the chance of infection over three times more likely while in univariate analyses, transport-related work increases the risk of infection by over 40 times in the USA. Second, there is evidence that some home-related factors are significant predictors of infection, most notably the sharing of accommodation or a kitchen. Third, there is some evidence that behavioural factors and personal traits (including risk preference, extraversion and height) are also important. CONCLUSIONS: The paper concludes that predictors of transmission relate to work, transport, home and personal factors. Transport-related work settings are by far the greatest source of risk and so should be a focus of prevention policies. In addition, surveys of the sort developed in this paper are an important source of information on transmission pathways within the community.

Addressing post-COVID-19 musculoskeletal symptoms through pulmonary rehabilitation and telemedicine: A study protocol.

Objective: The purpose of the study will be to evaluate the effect of pulmonary rehabilitation on the improvement of patients with post-COVID-19 musculoskeletal symptoms, as well as to quantify the impact of telemedicine that evaluates the evolution of pain, functionality, and quality of life. Methods: We will carry out a case-control study in post-COVID-19 musculoskeletal symptoms patients who will undergo pulmonary rehabilitation, together with an intervention and a follow-up using programmed telemedicine sessions. Data will be collected on the improvement of functional capacity and quality of life, in addition to assessing the evolution of musculoskeletal symptomatology, as well as pain and psychological variables. The approaches of face-to-face rehabilitation and telerehabilitation will also be compared. The telemedicine sessions will improve user adherence and follow-up, and the results are expected to be disseminated to the scientific community during and after the end of the study.

Glucagonoma del páncreas: la piel puede llevarnos al diagnóstico / Pancreatic glucagonoma: observing the skin can lead to diagnosis

Resumen Presentamos el caso de una paciente que tenía un tumor del páncreas -denominado glucagonoma- y cuyo diagnóstico se sospechó por las manifestaciones cutáneas, las cuales nos condujeron realizar una tomografía axial computarizada (TAC). En ella se halló una masa. La paciente se remitió a cirugía y presentó una buena evolución.

Abstract This is a case report of a patient with a pancreatic tumor, known as glucagonoma, whose diagnosis was suspected because of skin manifestations which led to performing a CT scan, finding the mass. She underwent surgery with satisfactory results.

Synthesis and In Vitro Growth Inhibition of 2-Allylphenol Derivatives Against Phythopthora cinnamomi Rands.

Phytophthora cinnamomi is a phytopathogen that causes extensive damage in different crops, and therefore, produces important economic losses all around the world. Chemical fungicides are a key factor for the control of this disease. However, ecological and environmental considerations, as well as the appearance of strains that are resistant to commercial fungicides, have prompted the quest for new antifungal agents which are of low ecological impact. In this work, a series of new 2-allylphenol derivatives was synthesized, and their structures were confirmed by FT-IR, NMR, and MS. Some of the synthesized compounds, more specifically nitro derivatives, exhibit strong growth inhibition of P. cinnamomi with EC50 as low as 10.0 µg/mL. This level of activity is similar to that exhibited by METALAXYL MZ 58 WP, a commonly-used commercial fungicide; therefore, these compounds might be of agricultural interest due to their potential use as fungicides against P. cinnamomi. The results indicate that this activity depends on the chemical structures of the 2-allylphenol derivatives, and that it is strongly enhanced in molecules where nitro and hydroxyl groups adopt a -para configuration. These effects are discussed in terms of the electronic distribution of the aromatic ring induced by substituent groups.

Antifungal Activity of Eugenol Derivatives against Botrytis Cinerea.

Botrytis cinerea is a worldwide spread fungus that causes the grey mold disease, which is considered the most important factor in postharvest losses in fresh fruit crops. Consequently, the control of gray mold is a matter of current and relevant interest for agricultural industries. In this work, a series of phenylpropanoids derived from eugenol were synthesized and characterized. Their effects on the mycelial growth of a virulent and multi-resistant isolate of B. cinerea (PN2) have been evaluated and IC50 values for the most active compounds range between 31⁻95 ppm. The antifungal activity exhibited by these compounds is strongly related to their chemical structure, i.e., increasing activity has been obtained by isomerization of the double bond or introduction of a nitro group on the aromatic ring. Based on the relationship between the fungicide activities and chemical structure, a mechanism of action is proposed. Finally, the activity of these compounds is higher than that reported for the commercial fungicide BC-1000 that is currently employed to combat this disease. Thus, our results suggest that these compounds are potential candidates to be used in the design of new and effective control with inspired natural compounds of this pathogen.

Influencia de las estaciones del año en los perfiles de morbilidad y mortalidad en una Unidad de Cuidados Intensivos / Influência das estações do ano nos perfis de morbidade e mortalidade em uma Unidade de Terapia Intensiva / Influence of seasons of the year on morbidity and mortality profiles in an Intensive Care Unit

Introducción: en la Unidad de Cuidados Intensivos del Hospital General Docente Dr. Agostinho Neto no se ha esclarecido la influencia de las estaciones del año en el perfil de la morbilidad y mortalidad. Objetivo: determinar la influencia de la variabilidad de las estaciones del año en el perfil de morbilidad y mortalidad de la UCI del HospitalGeneral Docente Dr Agostinho Neto durante el año 2018. Método: se hizo un estudio retrospectivo del total de pacientes ingresados (n=549) y seleccionó una muestra aleatoria de 365 pacientes. Las variables estudiadas fueron: edad, sexo, motivo de ingreso, índice de gravedad, estancia en la unidad, necesidad de ventilación mecánica, estado al egreso. Todas se relacionaron con las estaciones del año. Resultados: el mayor número de pacientes ingresó durante el verano (31,8 por ciento). No hubo relación significativa entre la estación del año y la variable sexo (p < 0,05), pero sí con la edad, APACHE II, estancia en la unidad y necesidad de ventilación mecánica (p < 0,05). En primavera y verano la enfermedad más común fue la cerebrovascular, mientras que en otoño e invierno la más común fue la neumonía grave adquirida en la comunidad. Las variables estancia en la unidad, ingreso de pacientes por enfermedades de carácter clínico según tipo de paciente clínico y mortalidad se relacionaron significativamente con la estación del año (p < 0,05). Conclusiones: la variabilidad climática del contexto guantanamero influyó en el perfil de morbilidad de la unidad de cuidados intensivos y midió el pronóstico de los pacientes que ingresan con enfermedad crítica(AU)

Introduction: in the intensive care unit of the General Teaching Hospital Dr Agostinho Neto the influence of the seasons of the year on the profile of morbidity and mortality has not been clarified. Objective: to determine the influence of the variability of season of the year on the morbidity and mortality profile of the ICU of the General Teaching Hospital Dr Agostinho Neto during the year 2018. Method: a retrospective study was made of the total number of admitted patients (n = 549) and a random sample of 365 patients was selected. The variables studied were: age, sex, reason for admission, severity index, stay in the unit, need for mechanical ventilation, discharge status. All were related to the weather. Results: the largest number of patients admitted during the summer (31.8per cent). There was no significant relationship between the weather station and the sex variable (p <0.05), but with age, APACHE II, stay in the unit and need for mechanical ventilation (p <0.05). In spring and summer the most common disease was cerebrovascular, while in autumn and winter the most common was community-acquired severe pneumonia. Thevariables stay in the unit, patient entry for diseases of a clinical nature according to the type of clinical patient and mortality were significantly related to the weather station (p <0.05). Conclusions: the climatic variability of the Guantanamo context influenced the morbidity profile of the intensive care unit and measured the prognosis of patients admitted with critical illness(AU)

Introdução: na unidade de terapia intensiva do Hospital Universitário Dr Agostinho Neto a influência das estações do ano sobre o perfil de morbidade e mortalidade ainda não foi esclarecida. Objetivo: determinar a influência da variabilidade das estações do ano no perfil de morbimortalidade da UTI do Hospital Universitário de General Dr Agostinho Neto durante o ano de 2018. Método: estudo retrospectivo do número total de pacientes internados (n = 549) e uma amostra aleatória de 365 pacientes foi selecionada. As variáveis estudadas foram: idade, sexo, motivo da internação, índice de gravidade, permanência na unidade, necessidade de ventilação mecânica, estado de descarga. Todos estavam relacionados com a estação do ano. Resultados: o maior número de pacientes internados no verão (31,8 por cento). Não houve relação significativa entre a estação do ano e a variável sexo (p <0,05), mas com a idade, APACHE II, permanecer na unidade e necessidade de ventilação mecânica (p <0,05). Na primavera e no verão, a doença mais comum era a cerebrovascular, enquanto no outono e no inverno a mais comum era pneumonia grave adquirida na comunidade. As variáveis permaneceram na unidade, a entrada do paciente para doenças de natureza clínica de acordo com o tipo de paciente clínico e a mortalidade foram significativamente relacionadas com o clima (p <0,05). Conclusões: a variabilidade climática do contexto de Guantánamo influenciou o perfil de morbidade da unidade de terapia intensiva e mediu o prognóstico de pacientes internados com doença crítica(AU)

Meningioma de las vainas del nervio óptico / Meningioma of the optic nerve sheaths

RESUMEN Introducción: los meningiomas de la vaina del nervio óptico son tumores meningoteliales originados de células aracnoideas que producen disminución de la visión y proptosis con un compromiso ocular variable. Presentación del caso: se trata de una paciente de 65 años de edad con antecedentes de hipertensión arterial que ingresó por proptosis, disminución de la visión y quemosis conjuntival del ojo derecho, evidenciándose en el examen del fondo de ojo la presencia de disco óptico pequeño de bordes definidos de coloración normal, sin compromiso del grosor de la capa de fibras nerviosas de la retina con dilatación vascular moderada a predominio venoso sin evidencia de alteraciones maculares, hemorragias ni exudados. Los estudios campimétricos evidenciaron la presencia de escotoma altitudinal con toma del cuadrante temporal inferior y el estudio de los potenciales evocados visuales mostró caída de su amplitud. Mediante el estudio de resonancia magnética nuclear se observó la existencia de una imagen isointensa homogénea de bordes bien definidos, que no comprometía la estructura axonal del nervio óptico y que respeta la porción intracanalicular e intracraneal, confirmándose el diagnóstico de meningioma de las vainas del nervio óptico. Conclusiones: Se confirma el diagnóstico de meningioma de las vainas del nervio óptico del ojo derecho en una paciente con proptosis unilateral y quemosis conjuntival, lo que constituye una inusual forma de presentación con manifestaciones oftalmológicas.

ABSTRACT Introduction: meningiomas of the optic nerve sheath are meningothelial tumors originating from arachnoid cells that produce decrease of vision and proptosis with variable ocular involvement. Case report: a 65-year-old female patient with a history of hypertension who was admitted due to proptosis, decrease of vision and conjunctival chemosis of the right eye; fundus of the eye examination revealed the presence of a small optic disc of defined edges of normal coloration, without compromise of the thickness of the layer of nervous fibers of the retina with moderate vascular dilatation to venous predominance without evidence of macular alterations, hemorrhages or exudates. The campimetric studies showed the presence of altitudinal scotoma with lower temporal quadrant capture, and the study of the visual evoked potentials showed fall of its amplitude. Through the study of nuclear magnetic resonance (NMR, the existence of a homogeneous isointense image of well-defined edges was observed, which did not compromise the axonal structure of the optic nerve and which respects the intracanalicular and intracranial portion that confirmed the diagnosis of meningioma of the optic nerve sheaths. Conclusions: the diagnosis of meningioma of the optic nerve sheaths on the right eye was confirmed in a patient with unilateral proptosis and conjunctival chemosis, which constitutes an unusual presentation with ophthalmological manifestations.

Full Atrioventricular Block Secondary to Acute Poisoning Mercury: A Case Report.

Background: The biological behaviour and clinical significance of mercury toxicity vary according to its chemical structure. Mercury differs in its degree of toxicity and in its effects on the nervous, digestive and immune systems as well as on organs such as the lungs, kidneys, skin, eyes and heart. Human exposure occurs mainly through inhalation of elemental mercury vapours during industrial and artisanal processes such as artisanal and small-scale gold mining. Case presentation: A 52-years-old female, housewife, with a body mass index of 25.3 kg/cm², without smoking or alcohol habits or any important clinical or chronic cardiovascular history, was admitted to the emergency room due to probable accidental poisoning by butane gas. Clinical manifestations with a headache, dizziness, cough, and dyspnoea of medium to small efforts. An initial physical exploration with Glasgow scored at 15, with arrhythmic heart sounds, pulmonary fields with bilateral subcrepitant rales and right basal predominance. Electrocardiographic findings were as follows: a cardiac frequency of 50 beats per minute and atrioventricular dissociation. Laboratory parameters were: white blood cells at 15.8 × 108/L; aspartate aminotransferase at 38 U/L; lactate dehydrogenase at 1288 U/L; creatine-kinase at 115 U/L; CK-MB fraction at 28 U/L; and other biochemical parameters were within the reference values. A radiographic evaluation showed flow cephalization, diffuse bilateral infiltrates with right basal predominance. In addition, the patient presented data of low secondary expenditure to third-degree atrioventricular (AV) block for which the placement of a transvenous pacemaker was decided, substantially improving the haemodynamic parameters. Subsequently, after a family interrogation, the diagnosis of mercury inhalation poisoning was established. An initial detection of mercury concentration (Hg(0)) was carried out, reporting 243.5 µg/L. In view of this new evidence, mercury chelation therapy with intravenous calcium disodium ethylenediamine tetraacetic acid (CaNa2·EDTA) was initiated. After 8-days of hospital stay, she presented a favourable evolution with both clinical and radiological improvements, so that the mechanical ventilation progressed to extubating. Subsequently, she was referred for cardiology because of her persistent 3rd-degree atrioventricular block, deciding to place a definitive bicameral pacemaker. The patient was discharged from the hospital 14 days after admission due to clinical improvements with mercury plasma levels at 5 µmol/L and a heart rhythm from the pacemaker. Conclusions: We show evidence that acute exposure to elemental mercury can affect the heart rhythm, including a complete atrioventricular blockage.

Antifungal Effect of Polygodial on Botrytis cinerea, a Fungal Pathogen Affecting Table Grapes.

The antifungal activity of polygodial, a secondary metabolite extracted from Canelo, on mycelial growth of different Botrytis cinerea isolates has been evaluated. The results show that polygodial affects growth of normal and resistant isolates of B. cinerea with EC50 values ranging between 117 and 175 ppm. In addition, polygodial markedly decreases the germination of B. cinerea, i.e., after six hours of incubation the percentage of germination decreases from 92% (control) to 25% and 5% in the presence of 20 ppm and 80 ppm of polygodial, respectively. Morphological studies indicate that conidia treated with polygodial are smaller, with irregular membrane border, and a lot of cell debris, as compared to conidia in the control. The existence of polygodial-induced membrane damage was confirmed by SYTOX® Green uptake assay. Gene expression studies confirm that the effect of polygodial on B. cinerea is mainly attributed to inhibition of germination and appears at early stages of B. cinerea development. On the other hand, drimenol, a drimane with chemical structure quite similar to polygodial, inhibits the mycelial growth efficiently. Thus, both compounds inhibit mycelial growth by different mechanisms. The different antifungal activities of these compounds are discussed in terms of the electronic density on the double bond.

Effect of drimenol and synthetic derivatives on growth and germination of Botrytis cinerea: Evaluation of possible mechanism of action.

The aim of this study was to determine the antifungal activity of Drimenol (1) and its synthetic derivatives, nordrimenone (2), drimenyl acetate (3), and drimenyl-epoxy-acetate (4), and to establish a possible mechanism of action for drimenol. For that, the effect of each compound on mycelial growth of Botrytis cinerea was assessed. Our results showed that compounds 1, 2, 3 and 4 are able to affect Botrytis cinerea growth with EC50 values of 80, 92, 80 and 314ppm, respectively. These values suggest that the activity of these compounds is mainly determined by presence of the double bond between carbons 7 and 8 of the drimane ring. In addition, germination of B. cinerea in presence of 40 and 80ppm of drimenol is reduced almost to a half of the control value. Finally, in order to elucidate a possible mechanism by which drimenol is affecting B. cinerea, the determination of membrane integrity, reactive oxygen species production and gene expression studies of specific genes were performed.

Trabajo metodológico: reclamo para lograr interdisciplinariedad desde el colectivo año de la carrera de Medicina / Methodological work: a claim to achieve interdisciplinarity through the year teaching staff of the medicine career

Fundamento: el trabajo metodológico con enfoque interdisciplinario es una fortaleza para realizar una labor integral desde los colectivos de año de la carrera de Medicina. Objetivo: identificar las necesidades para acometer un trabajo metodológico que sustente la interdisciplinariedad desde el colectivo de año de primer año de la carrera de Medicina en la Universidad de Ciencias Médicas de Villa Clara. Métodos: se realizó una investigación descriptiva con enfoque cualitativo, durante tres cursos (2013-2015). Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción, y empíricos: el análisis documental para la determinación de los núcleos teóricos de contenidos y sus posibilidades de interrelación, y el trabajo grupal para obtener una información homogénea sobre la problemática analizada. Resultados: se delimitaron las necesidades para lograr la interdisciplinariedad, tanto en su dimensión de proyecto como en la de proceso desde el trabajo metodológico del colectivo de año de primer año de la carrera de Medicina. En los documentos no se evidencia cómo alcanzar la integración disciplinar e interdisciplinar, no se precisa cómo deben integrarse las asignaturas del ciclo entre ellas y entre ciclos, ni se orienta metodológicamente cómo lograrlo. La discusión grupal confirmó estas limitaciones. Conclusiones: la identificación de estas necesidades sirve de diagnóstico y evaluación constante y gradual para lograr la efectividad deseada a través de la planificación y realización de un trabajo metodológico que tribute a la interdisciplinariedad; es un reto a enfrentar en un proceso docente educativo pertinente para contribuir a la formación del médico general desde el primer año de la carrera.

Background: methodological work with interdisciplinary approach is a strength for a comprehensive collective work through the year teaching staff of the medical career. Objective: to identify the needs to undertake methodological work that supports interdisciplinary work through the first year teaching staff of the medical career at Villa Clara University of Medical Sciences. Methods: a descriptive study was carried out within the qualitative approach, for three years (2013-2015). Theoretical methods were used: analysis-synthesis and induction-deduction, and empirical ones documentary analysis for the determination of the theoretical core content and possibilities of interaction and group work to obtain homogeneous information on the issues discussed. Results: the needs to achieve interdisciplinarity through the methodological work were defined, either in its project dimension or in the process one of the first year teaching staff of the medical career. In the documents there is no evidence about how to achieve disciplinary and interdisciplinary integration; it's neither specified how subjects should be integrated among them and between cycles, nor methodologically orientations about how to achieve it. Group discussion confirmed these limitations. Conclusions: the identification of these needs is a diagnostic, steady and gradual assessment to achieve the desired effectiveness through the planning and implementation of a methodological work that tribute to interdisciplinarity; it is a challenge to face in a relevant educational process to contribute to the comprehensive formation of the general practitioner since the first year of the career.

Trabajo metodológico: reclamo para lograr interdisciplinariedad desde el colectivo año de la carrera de Medicina / Methodological work: a claim to achieve interdisciplinarity through the year teaching staff of the medicine career

Fundamento: el trabajo metodológico con enfoque interdisciplinario es una fortaleza para realizar una labor integral desde los colectivos de año de la carrera de Medicina. Objetivo: identificar las necesidades para acometer un trabajo metodológico que sustente la interdisciplinariedad desde el colectivo de año de primer año de la carrera de Medicina en la Universidad de Ciencias Médicas de Villa Clara. Métodos: se realizó una investigación descriptiva con enfoque cualitativo, durante tres cursos (2013-2015). Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción, y empíricos: el análisis documental para la determinación de los núcleos teóricos de contenidos y sus posibilidades de interrelación, y el trabajo grupal para obtener una información homogénea sobre la problemática analizada. Resultados: se delimitaron las necesidades para lograr la interdisciplinariedad, tanto en su dimensión de proyecto como en la de proceso desde el trabajo metodológico del colectivo de año de primer año de la carrera de Medicina. En los documentos no se evidencia cómo alcanzar la integración disciplinar e interdisciplinar, no se precisa cómo deben integrarse las asignaturas del ciclo entre ellas y entre ciclos, ni se orienta metodológicamente cómo lograrlo. La discusión grupal confirmó estas limitaciones. Conclusiones: la identificación de estas necesidades sirve de diagnóstico y evaluación constante y gradual para lograr la efectividad deseada a través de la planificación y realización de un trabajo metodológico que tribute a la interdisciplinariedad; es un reto a enfrentar en un proceso docente educativo pertinente para contribuir a la formación del médico general desde el primer año de la carrera(AU)

[P200 parameters in patients with diabetes mellitus type 2 (DM2)]. / Parámetros de la P200 en pacientes con diabetes mellitus tipo 2 (DM2).

INTRODUCTION: A complication underserved in diabetic patients is the cognitive deficits that can reach dementia. Studying the association between electrophysiological, neuropsychological, and biochemical measures could provide a breakthrough in the understanding of this phenomenon. OBJECTIVES: To compare P200 parameters between subjects with and without diabetes mellitus type 2 and to determine their relationship with biochemical and neuropsychological indicators. METHODS: This is an observational, prospective, transversal and analytical study. Seventy-four participants were divided into two groups: 37 with diabetes mellitus type 2, and 37 subjects as controls. P200 latency, amplitude, and rate of rise to somatosensory stimuli were measured and related to the Mini Mental State Examination (MMSE) test and blood glucose and glycosylated hemoglobin. RESULTS: Diabetics showed longer latency (p < 0.042, 1-tail) and lower MMSE score (p < 0.0001) than controls. Negative associations of amplitude and rising rate with glycosylated hemoglobin were observed in patients (p < 0.025); also, between amplitude and blood glucose (p < 0.038, 1-tail) and between MMSE score and time with diabetes mellitus type 2 (p < 0.007). CONCLUSIONS: The P200 parameters of the somatosensory system are sensitive to metabolic deterioration of diabetic patients, so its use in monitoring the cognitive state of patients is recommended.