Scleromyositis: A Novel Entity Beyond Systemic Sclerosis and Autoimmune Myositis.

Scleromyositis is a new clinical entity, which not only has clinical and histopathological components of systemic sclerosis and inflammatory myopathy but is also characterized by presenting unique characteristics, which may not be in the previously mentioned diseases. Up until now, there are no specific classification criteria proposed by the American College of Rheumatology or the European League Against Rheumatism (ACR/EULAR). This paper presents a case report of a female patient in her 60s who was admitted to our institution due to muscle weakness in her legs and dysphagia. Within her diagnosis approach, clinical characteristics compatible with autoimmune myopathy were found; however, she presented with anti-PM/Scl75 antibody-positive results. In this paper, we emphasized the clinical characteristics and forms of presentation of scleromyositis, additionally discussing the available treatment for this entity.

Plant Fibers as Composite Reinforcements for Biomedical Applications.

Plant fibers possess high strength, high fracture toughness and elasticity, and have proven useful because of their diversity, versatility, renewability, and sustainability. For biomedical applications, these natural fibers have been used as reinforcement for biocomposites to infer these hybrid biomaterials mechanical characteristics, such as stiffness, strength, and durability. The reinforced hybrid composites have been tested in structural and semi-structural biodevices for potential applications in orthopedics, prosthesis, tissue engineering, and wound dressings. This review introduces plant fibers, their properties and factors impacting them, in addition to their applications. Then, it discusses different methodologies used to prepare hybrid composites based on these widespread, renewable fibers and the unique properties that the obtained biomaterials possess. It also examines several examples of hybrid composites and their biomedical applications. Finally, the findings are summed up and some thoughts for future developments are provided. Overall, the focus of the present review lies in analyzing the design, requirements, and performance, and future developments of hybrid composites based on plant fibers.

Hydrogel for the Controlled Delivery of Bioactive Components from Extracts of Eupatorium glutinosum Lam. Leaves.

This research reported a hydrogel loaded with the ethanolic and methanolic extracts of Eupatorium glutinosum Lam. The E. glutinosum extracts were characterized by phytochemical screening, Fourier-transform infrared spectroscopy (FTIR), thin-layer chromatography (TLC), and UV/Vis profile identification. This research also evaluated the pharmacological activity of the extracts using antimicrobial, antioxidant, and anti-inflammatory assays prior to polymeric encapsulation. Results indicate that extracts inhibit the Escherichia colii DH5-α (Gram negative) growth; excellent antioxidant activity was evaluated by the ferric reducing power and total antioxidant activity assays, and extracts showed an anti-hemolytic effect. Moreover, the cotton and microcrystalline cellulose hydrogels demonstrate successful encapsulation based on characterization and kinetics studies such as FTIR, extract release, and swelling degree. Moreover, effective antibacterial activity was registered by the loaded hydrogel. The overall results encourage and show that Eupatorium glutinosum-loaded hydrogel may find a wide range of bandage and wound healing applications in the biomedical area.

Comorbilidades en pacientes con infección por Covid-19 grave posvacunación en el Hospital Juárez de México.

No disponible.

Antimicrobial Properties of Plant Fibers.

Healthcare-associated infections (HAI), or nosocomial infections, are a global health and economic problem in developed and developing countries, particularly for immunocompromised patients in their intensive care units (ICUs) and surgical site hospital areas. Recurrent pathogens in HAIs prevail over antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. For this reason, natural antibacterial mechanisms are a viable alternative for HAI treatment. Natural fibers can inhibit bacterial growth, which can be considered a great advantage in these applications. Moreover, these fibers have been reported to be biocompatible and biodegradable, essential features for biomedical materials to avoid complications due to infections and significant immune responses. Consequently, tissue engineering, medical textiles, orthopedics, and dental implants, as well as cosmetics, are fields currently expanding the use of plant fibers. In this review, we will discuss the source of natural fibers with antimicrobial properties, antimicrobial mechanisms, and their biomedical applications.

Percepción de estudiantes de Enfermería sobre la adquisición de habilidades clínicas en tiempos de COVID-19 / Perception by Nursing students about clinical skill acquisition in times of COVID-19

Objetivo: identificar la percepción que tienen los estudiantes de Enfermería sobre la adquisición de habilidades clínicas durante la pandemia por COVID-19 y analizar si está asociada con el semestre que están cursando y con haber realizado práctica clínica en escenarios reales. Método: se llevó a cabo un estudio descriptivo transversal con estudiantes de Enfermería de una universidad pública de Zacatecas, México (N= 1.033). Se administró vía electrónica el segundo apartado del cuestionario Clinical Competency Questionnaire traducido al español con un alfa de Cronbach= 0,969. Se analizó la asociación de las habilidades clínicas con el semestre cursado y la experiencia mediante la prueba de Chi cuadrado con una significancia estadística de p≤ 0,05. Resultados: respondieron un total de N= 82 estudiantes. La media de edad fue de 20,7 (DE:1,40), el 87,8% era mujer en su mayoría del séptimo semestre (40,2%). Un 50% se percibió con habilidades clínicas deficientes; un 34,1%, sin habilidades clínicas y un 15,9%, con habilidades clínicas competentes. Los estudiantes de quinto semestre se percibieron con menores habilidades clínicas (p= 0,006), al igual que aquellos que no habían cursado práctica clínica antes de la pandemia (p= 0,005). Conclusiones: a partir de la pandemia, las habilidades en la práctica clínica son percibidas como nulas o deficientes por los estudiantes de Enfermería, por lo que se requiere implementar cambios en la metodología de enseñanza-aprendizaje, transitar a un modelo híbrido e integrador con intervenciones educativas efectivas y que demuestren el desarrollo de los dominios en este tipo de habilidades para cumplir con el perfil de egreso planteado.(AU)

Objective: to understand the perception by Nursing students about the acquisition of clinical skills during the COVID-19 pandemic, and to analyse if this is associated with the semester they are currently taking and with conducting clinical practice in real settings. Method: a cross-sectional descriptive study was conducted with Nursing students from a public university in Zacatecas, Mexico (N= 1,033). The second section of the Clinical Competency Questionnaire in its Spanish translation was administered online, with Cronbach’s alpha= 0.969. The association between the clinical skills and the semester studied and experience was analysed through Chi-squared test withp≤ 0.05 as statistical significance. Results: in total, N= 82 students participated. Their mean age was 20.7 (SD:1.40), 87.8% were female, and the majority were in their seventh semester (40.2%). 50% of them perceived that their clinical skills were poor, 34.1% stated they had no clinical skills, and 15.9% perceived that their clinical skills were proficient. Students in their fifth semester perceived their clinical skills as lower (p= 0.006), as well as those who had not had any clinical practice before the pandemic (p= 0.005). Conclusions: after the pandemic, clinical practice skills are perceived as non-existent or poor by Nursing students; therefore, it is necessary to implement changes in the teaching-learning methodology, to move to a hybrid and inclusive model with effective educational interventions which demonstrate the development of domains in this type of skills, in order to meet the proposed profile of graduation.

Tridimensional spatial distribution of manganese in a river impacted by metallurgical activity and mining.

A three-dimensional interpolation method based on a digital elevation model (DEM) was developed to assess the impact of mining and metallurgical activity on the Claro River (Hidalgo, Mexico). This method was used to analyze the spatial concentration of manganese in sediments, water, and fish (viscera and muscle). Input data correspond to chemical manganese (Mn) analysis of the aforementioned environmental matrices, mining discharge volumes, and rainfall data. The three-dimensional model made it possible to (a) define Mn dispersion (19 km for sediments and 13 km for viscera); (b) identify northern meanders of the Claro River as areas of Mn accumulation in sediments and fish; and (c) determine river features that influence Mn concentration in fish. Results indicate that Mn concentration increases in areas receiving industrial discharges, as well as in meanders located near Acuimantla village. Total Mn levels in the water are between < 0.01 and 6.57 mg/L, while soluble and colloidal Mn concentrations range from < 0.01 to 0.49 mg/L. The highest Mn values in the water (total Mn: 6.57 mg/L and soluble-colloidal Mn: 0.49 mg/L) were detected in tributary rivers near industrial discharge sites. The concentration in water compared with that in sediments (160-213,867 mg/kg) and fish (viscera: 5-5236 mg/kg and muscle: 10.7-398.8 mg/kg) indicates low solubility of this mineral. The geoaccumulation index (Igeo) and contamination factor (CF) show that sediment composition has been affected.

Correction to: Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

Following publication, it was brought to the authors' attention by Dr. Julia Toscano-Garibay that she did not participate as a reviewer of the final version of this manuscript prior to its submission and publication in Clinical Rheumatology.

Endogenous stimulation is responsible for the high frequency of IL-17A-producing neutrophils in patients with rheumatoid arthritis.

BACKGROUND: Neutrophils play an important role in the pathogenesis of rheumatoid arthritis (RA). It has recently been reported that in addition to T helper (Th) 17 cells, other cells, including neutrophils, produce IL-17A, an important inflammatory cytokine involved in the pathogenesis of RA. The purpose of this study was to examine the presence of interleukin 17A-producing neutrophils in patients with RA. METHODS: We performed a cross-sectional study including 106 patients with RA and 56 healthy individuals. Whole peripheral blood cells were analyzed by flow cytometry to identify CD66b+ CD177+ IL-17A+ neutrophils and CD3+ CD4+ IL-17A+ T cells. Serum levels of IL-17A and IL-6 were measured by means of cytometry bead array (CBA). In purified neutrophils, mRNA levels of IL-17 and RORγ were measured by RT-PCR. In addition, purified neutrophils from patients and healthy controls were stimulated with the cytokines IL-6 and IL-23 to evaluate differences in their capacity to produce IL-17A. RESULTS: Neutrophils from RA patients expressed IL-17 and RORγ mRNA. Consequently, these cells also expressed IL-17A. Serum IL-17A levels but not Th17 cell numbers were increased in RA patients. Neutrophils positive for cytoplasmic IL-17A were more abundant in patients with RA (mean 1.2 ± 3.18%) than in healthy individuals (mean 0.07 ± 0.1%) (p < 0.0001). Although increased IL-17A+ neutrophil numbers were present in RA patients regardless of disease activity (mean 6.5 ± 5.14%), they were more frequent in patients with a more recent diagnosis (mean time after disease onset 3.5 ± 4.24 years). IL-6 and IL-23 induced the expression of RORγ but failed to induce IL-17A expression by neutrophils from RA patients and healthy individuals after a 3 h stimulation. CONCLUSION: IL-17A-producing neutrophils are increased in some RA patients, which are not related to disease activity but have an increased frequency in patients with recent-onset disease. This finding suggests that IL-17A-producing neutrophils play an early role in the development of RA.

Tumor necrosis factor (TNF) and TNFR1 polymorphisms are not risk factors for rheumatoid arthritis in a Mexican population.

Tumor necrosis factor (TNF) plays an important role in the pathogenesis of rheumatoid arthritis (RA). Different genetic variants including the TNF -308G/A polymorphism are associated with RA susceptibility. However, these findings have not been replicated in all populations. The aim of this study was to determine whether the TNF -1031T/C (rs1799964), -376G/A (rs1800750), -308G/A (rs1800629) -238G/A (rs361525), and TNFR1 -609G/T polymorphisms are associated with RA susceptibility in a sample of Mexican patients. Our study included 499 patients with RA and 492 healthy controls. The genotypes of the TNF polymorphisms were obtained using TaqMan assay. The genotype and allele frequencies of the TNF -1031T/C, -376G/A, -308G/A, -238G/A, and TNFR1 -609G/T polymorphisms were similar among RA cases versus healthy controls, and no association with RA susceptibility was identified. Our results suggest that the TNF -1031T/C, -376G/A, -308G/A, -238G/A, and TNFR1 -609G/T polymorphisms are not associated with RA susceptibility in a sample of Mexican patients.

Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

The aim of the is study is to examine the role of serum substance P (SP) levels as a simple biomarker for rheumatoid arthritis (RA) disease activity, its correlation with other markers of disease activity, and with selected clinical parameters. The study comprised 90 RA patients and 24 healthy controls. RA activity was assessed by means of the disease activity 28-C-reactive protein (DAS28-CRP) index and ultrasound power Doppler (USPD) by the German ultrasound score based on seven joints. SP serum values were obtained by means of an ELISA commercial kit. Statistics were achieved by the Student's t test and Spearman correlation analysis with Bonferroni correction. As a group, RA patients had significantly increased levels of SP compared with healthy controls (p < 0.0001). SP levels correlated with DAS28-CRP (r = 0.5050, p < 0.0001), number of tender joints (NTJ, r = 0.4668, p < 0.0001), number of swollen joints (NSJ, r = 0.4439, p < 0.0001), visual analogue scale (VAS, r = 0.5131, p < 0.0001). However, SP did not correlate with CRP levels (r = 0.0468, p = 0.6613), nor with the USPD (r = 0.1740, p = 0.1009). Elevated serum SP is a common feature of RA patients, which also appears to correlate with clinical measurements of disease activity and with subjective clinical data (NTJ and VAS). Thus, although SP is higher in RA patients with high disease activity, it also detects subtle RA disease activity even in patients in apparent remission, which suggests its usefulness for therapeutic decisions.

Ambroxol for fibromyalgia: one group pretest-posttest open-label pilot study.

A consistent line of investigation proposes that fibromyalgia is a sympathetically maintained neuropathic pain syndrome. Dorsal root ganglia sodium channels may play a major role in fibromyalgia pain transmission. Ambroxol is a secretolytic agent used in the treatment of various airway disorders. Recently, it was discovered that this compound is also an efficient sodium channel blocker with potent anti-neuropathic pain properties. We evaluated the add-on effect of ambroxol to the treatment of fibromyalgia. We studied 25 patients with fibromyalgia. Ambroxol was prescribed at the usual clinical dose of 30 mg PO 3 times a day × 1 month. At the beginning and at the end of the study, all participants filled out the Revised Fibromyalgia Impact Questionnaire (FIQ-R) and the 2010 ACR diagnostic criteria including the widespread pain index (WPI). At the end of the study, FIQ-R decreased from a baseline value of 62 ± 15 to 51 ± 19 (p = 0.013). Pain visual analogue scale decreased from 77 ± 14 to 56 ± 30 (p = 0.018). WPI diminished from 14.6 ± 3.1 to 10.4 ± 5.3 (p = 0.001). Side effects were minor. In this pilot study, the use of ambroxol was associated to decreased fibromyalgia pain and improved fibromyalgia symptoms. The open nature of our study does not allow extracting the placebo effect from the positive results. The drug was well tolerated. Ambroxol newly recognized pharmacological properties could theoretically interfere with fibromyalgia pain pathways. Dose escalating-controlled studies seem warranted.

Diagnostico y terapéutica agresiva en la esofagogastritis caustica: evaluación de 10 años de experiencia en el Hospital de Lidice / Aggressive diagnostic and therapeutic in the caustic esophagogastritis: evaluation of the ten years experience in the Lidice Hospital

Se presenta nuestra experiencia en el diagnóstico y tratamiento de esta condición realizada en 43 pacientes en el lapso comprendido entre los años 1978-1987. Se les aplico un protocolo de diagnóstico y tratamiento consistente: Radiología de Tórax y Abdomen, Esofagogramas con contrastes hidrosolubles, endoscopia digestiva superior y realización de dilataciones profilácticas precoses en los pacientes con quemaduras esofagicas de segundo y tercer grado. La endoscopia digestiva superior se llevó acabo en 39 pacientes, 20 de ellas correspondieron a esofagitis de primer grado, 11 de segundo grado y 8 de tercer grado ninguna complicación fue observada debido a la práctica de la endoscopia. Las dilataciones esofágicas precoses se llevaron acabo en 19 pacientes, comprovable consecuencia de las mismas se presentaron durante el curso de las primeras dilataciones 3 casos de perforación esofágica en pacientes con quemaduras a nivel del esófago clasificadas grado 3, 1 paciente evoluciono fatalmente, 2 evolucionaron satisfactoriamente; la morbilidad global del procedimiento fue de 15.78% y la mortalidad del 5.26%. Actualmente consideramos que la realización de estudios radiológicos, la práctica de esofagogramas con medios hidrosolubles y la realización de la endoscopia digestiva superior deben ser llevadas acabo de manera temprana; debido a la alta incidencia de perforación esofágica por la práctica de las dilataciones profilácticas precoses en quemaduras de tercer grado, proponemos que no sean llevadas acabo las mismas en este grupo particular de pacientes y optar por el uso de esteroides y antibióticos