Insulin resistance induced by long-term hyperinsulinemia abolishes the effects of acute insulin exposure on cell-surface nicotinic acetylcholine receptor levels and actin cytoskeleton morphology.

Using CHO-K1/A5 cells, a clonal cell line that robustly expresses adult muscle-type nicotinic acetylcholine receptor (nAChR), we explored whether insulin resistance in these mammalian cells affects cell-surface expression of the nAChR, its endocytic internalization, and actin cytoskeleton integrity. Acute nanomolar insulin stimulation resulted in a slow increase in nAChR cell-surface levels, reaching maximum levels at ∼1 h. Long periods of insulin incubation caused CHO-K1/A5 cells to become insulin resistant, as previously observed with several other cell types. Furthermore, long-term insulin treatment abolished the effects of short-term insulin exposure on cell-surface nAChR levels, suggestive of a desensitization phenomenon. It also affected the kinetics of ligand-induced nAChR internalization. Since the integrity of the cortical actin cytoskeleton affects nAChR endocytosis, we also studied the effects of long-term insulin treatment on this meshwork. We found that it significantly affected the cortical actin morphology of CHO-K1/A5 cells and the response of the actin cytoskeleton to a subsequent short-term insulin stimulus. Overall, the present results show for the first time the effects of insulin signaling on cell-surface nAChR expression and actin cytoskeleton-associated internalization.

Oral health status and coverage of oral health care: A five-country comparison.

Oral health has received increased attention in health services research and policy. This study aims to assess oral health outcomes and public coverage of oral health services in Belgium, Denmark, Germany, the Netherlands, and Spain. Various indicators were used to compare oral health outcomes concerning the most common disorders by age group. Coverage of oral health services was analyzed according to the dimensions of the WHO Universal Coverage Cube. The results showed major differences in the coverage of services for the adult population: coverage was most comprehensive in Germany, followed by Belgium and Denmark. In Spain and the Netherlands, public coverage was limited. Except in Spain, coverage of oral health services for children was high, although with some differences between countries. Regarding oral health outcomes measured by the T-Health index, no country showed outstanding results across all age groups. While Denmark, the Netherlands, and Spain performed above average among 5- to 7-year-olds, Denmark and Germany performed above average among 12- to 14-year-olds, the Netherlands, Spain, and Belgium among 35- to 44-year-olds, and Belgium and the Netherlands among 65- to 74-year-olds. The selection of countries of this study was limited due to the availability and quality of oral health data demonstrating the urgent need for the European member states to establish corresponding databases.

Postlaunch evidence-generation studies for medical devices in Spain: the RedETS approach to integrate real-world evidence into decision making.

The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.

Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process.

INTRODUCTION: Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS: The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS: Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS: Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.

Trombocitopenia grave y agranulocitosis por metamizol / Severe thrombocytopenia and agranulocytosis associated with metamizole

No disponible

Psychometric Properties of the EATQ-R Among a Sample of Catalan-Speaking Spanish Adolescents / Propiedades psicométricas del EATQ-R en una muestra de adolescentes españoles de habla catalana

The few studies that have been conducted into the psychometric properties of the EATQ-R, even fewer for the longer version, highlight the fact that its structure differs from that of the original. The aim of this study is to translate and adapt the long version of the EATQ-R to Catalan, study its internal consistency and convergent and factorial validity, and compare differences in the EATQ-R by age and gender. The EATQ-R was administered to a sample of 1481 secondary school students ranging in age from 11 to 17 years. After eliminating 40 items from the 86 comprising the EATQ-R, an adjusted model was obtained with acceptable fit indices comprising 8 of the original 11 factors.

Los pocos estudios realizados sobre las propiedades psicométricas del EATQ-R, todavía más escasos en la versión larga, señalan una estructura diferente de la original. El objetivo de este estudio es traducir y adaptar al catalán la versión larga del EATQ-R, estudiar su consistencia interna y validez factorial y analizar las diferencias de género y edad en el EATQ-R. Para ello se han administrado el EATQ-R a una muestra de 1481 alumnos de Enseñanza Secundaria Obligatoria de edades comprendidas entre 12 y 17 años. Una vez eliminados un total de 40 ítems, de los 86 que componen el EATQ-R, se ha obtenido un modelo corregido, con unos índices de ajuste aceptables, formado por 8 de los 11 factores originales.

Alkyne-azide cycloaddition catalyzed by silver chloride and "abnormal" silver N-heterocyclic carbene complex.

A library of 1,2,3-triazoles was synthesized from diverse alkynes and azides using catalytic amounts of silver chloride instead of copper compounds. In addition, a novel "abnormal" silver N-heterocyclic carbene complex was tested as catalyst in this process. The results suggest that the reaction requires only 0.5% of silver complex, affording 1,2,3-triazoles in good yields.

[Cocaine abuse and multiple use of psychoactive substances in university students]. / Consumo de cocaína y policonsumo de sustancias psicoactivas en jóvenes universitarios.

OBJECTIVES: To identify the prevalence of cocaine consumption among university students and to analyse the use of other drugs among the regular cocaine consumers. METHOD: An observational, descriptive and cross-sectional study performed within the Education, Sciences and Psychology Faculties and the Nursing and Polytechnic Schools belonging to the University of Girona. The selected sample included 2139 first year university students. A self-constructed questionnaire was used to obtain the information regarding gender, age, Faculty, and the status of consume. RESULTS: The participants were 47.2% males and 52.8% females, with an age range between 17 and 35 years old (median=21 years, SD=3.14). One per-cent of the participants considered themselves usual cocaine consumers. Nine out of every 10 students also use alcohol (95.2%) and cannabis (90.5%). CONCLUSIONS: It has been shown that university students have health threatening habits, such as cocaine abuse. It is more common the use of other drugs among cocaine users than among non-consumers. Preventive and educational programs at the university may be required to reduce and prevent toxic substances abuse among university students.

Consumo de cocaína y policonsumo de sustancias psicoactivas en jóvenes universitarios / Cocaine abuse and multiple use of psychoactive substances in university students

Objetivos Conocer la prevalencia de consumo de cocaína en una muestra de estudiantes universitarios y analizar el uso de otras sustancias por parte de los consumidores habituales de esta droga. Método Estudio observacional, descriptivo y transversal realizado en las Facultades de Educación, Psicología y Ciencias y las Escuelas de Enfermería y Politécnica Superior de la Universidad de Girona. La muestra analizada fue de 2.139 estudiantes de primer ciclo. Las variables de estudio fueron demográficas y específicas sobre el consumo de drogas. Para la recogida de datos se utilizó un cuestionario de elaboración propia que agrupa información sobre el género, la edad y la facultad de procedencia de los participantes, así como su estatus de consumo. Resultados El 47,2% son chicos y el 52,8% son chicas de edades comprendidas entre los 17 y los 35 años (media=21 años y DE=3,14). Un 1% de los participantes informan que son consumidores habituales de cocaína. Nueve de cada diez estudiantes consumen, además, alcohol (95,2%) y (..) (AU)

Objectives To identify the prevalence of cocaine consumption among university students and to analyse the use of other drugs among the regular cocaine consumers. Method An observational, descriptive and cross-sectional study performed within the Education, Sciences and Psychology Faculties and the Nursing and Polytechnic Schools belonging to the University of Girona. The selected sample included 2139 first year university students. A self-constructed questionnaire was used to obtain the information regarding gender, age, Faculty, and the status of consume. Results The participants were 47.2% males and 52.8% females, with an age range between 17 and 35 years old (median=21 years, SD=3.14). One per-cent of the participants considered themselves usual cocaine consumers. Nine out of every 10 students also use alcohol (95.2%) and cannabis (..) (AU)

Isolation of a C5-deprotonated imidazolium, a crystalline "abnormal" N-heterocyclic carbene.

The discovery two decades ago of metal-free stable carbenes, especially imidazol-2-ylidenes [N-heterocyclic carbenes (NHCs)], has led to numerous breakthroughs in organic and organometallic catalysis. More recently, a small range of complexes has been prepared in which alternative NHC isomers, namely imidazol-5-ylidenes (also termed abnormal NHCs or aNHCs, because the carbene center is no longer located between the two nitrogens), coordinate to a transition metal. Here we report the synthesis of a metal-free aNHC that is stable at room temperature, both in the solid state and in solution. Calculations show that the aNHC is more basic than its normal NHC isomer. Because the substituent at the carbon next to the carbene center is a nonbulky phenyl group, a variety of substitution patterns should be tolerated without precluding the isolation of the corresponding aNHC.

Trastornos de la conducta alimentaria y personalidad: un estudio comparativo / Eating disorders and personality: a comparative study

Los trastornos de personalidad asociados a trastornos del Eje I se han erigido como unos de los principales tópicos actuales en la investigación psicológica. Se diseñó un estudio descriptivo, comparativo y transversal cuyos objetivos fueron comparar las escalas de personalidad en una muestra clínica de 67 pacientes con TCA frente a un grupo control a través del MCMI-II y analizar la existencia de agregación de estilos de personalidad en función de la topografía del TCA. No se encontraron diferencias significativas en la agregación de estilos de personalidad entre grupos clínicos, aunque si respecto al grupo control en la mayoría de las escalas patológicas. Se discute sobre las escalas en las que no se encontró diferencia entre ambos grupos (dependiente, histriónica, narcisista y compulsiva) y sobre la posibilidad de que ello se deba a la influencia de ciertos valores sociales imperantes y por tanto comunes a ambas muestras (AU)

Personality disorders associated to Axis I disorders have become ever-present topics in current psychological research. A descriptive, comparative and transversal study was designed to compare the personality scales in a clinical sample of 67 patients with TCA and a control group by means of the MCMI-II and to analyze the existence of aggregation of styles of personality depending on the topography of the TCA. We did not find significant differences in the aggregation of styles of personality among clinical groups, though differences did appear with regard to the control group in the majority of the pathological scales. we discuss the scales in which no differences were found between both groups (dependent, histrionic, narcissist and compulsive) and the possibility that it should be due to the influence of certain widely accepted social values common to both samples

Tratamiento de la asfixia perinatal con hipotermia corporal total (caso clínico) / Treatment of perinatal asphyxia with total body hypothermia: a clinical case

El manejo del RN de termino asfixiado, ha mejorado gracias a la mayor disponibilidad de terapia intensiva, sin embargo, es poco lo que se ha progresado en su neuroprotección. Caso clínico: Recién nacido (RN) gravemente asfixiado, sometido a hipotermia corporal total. Madre de 38 años, diabética, inducida a las 38 semanas, desarrolla signos de sufrimiento fetal agudo. Se extrae un recién nacido con un peso de 4.545 g. Apgar 1-3-5. Requiere intubación y ventilación mecánica por apnea, un gas arterial a los 30 min muestra acidosis metabólica severa. A las 2 h de vida presenta signos de encefalopatía hipóxica isquémica grave y depresión difusa del voltaje en el electroencefalograma. Se somete a hipotermia corporal total a una temperatura rectal de 33° C a 34° C, durante 72 h no hubo efectos colaterales importantes. Se da de alta a los 10 días en buenas condiciones neurológicas. El seguimiento se realiza por 2 años. El test de Bailey da un puntaje de 82 en la escala motora y 95 en la escala mental. Este caso demuestra que este tipo de tratamiento es factible de realizar, si se selecciona adecuadamente al paciente, se inicia precozmente y cuentan con las condiciones de equipamiento y enfermería especializadas.

Diagnostic, prognostic and pathogenic value of the direct immunofluorescence test in cutaneous leukocytoclastic vasculitis.

BACKGROUND: No precise studies have been performed on cutaneous leukocytoclastic vasculitis (LV) to establish whether it is better to obtain a skin biopsy from lesional or from perilesional skin for direct immunofluorescence (DIF). There is no agreement on the immunoglobulins most frequently detected and the value of DIF for the classification of cutaneous vasculitis. METHODS: A prospective study of DIF in lesional and perilesional skin was performed in 50 leukocytoclastic vasculitis patients and 15 nonvasculitis patients. RESULTS: We detected a higher level of positivity in involved skin than in uninvolved skin for IgG, IgA, IgM, C3 and fibrinogen but not for C1q. In vasculitic patients, IgA was the immunoglobulin most frequently detected in lesional (82%) and perilesional skin (68%), followed by IgM (56 and 34%, respectively) and IgG (20 and 8%, respectively). Only IgA deposits were associated with the diagnosis of vasculitis, with a sensitivity of 82% in lesional and 68% in perilesional skin, and with a specificity of 73 and 66.7%, respectively. The presence of IgA in lesional skin was associated with renal involvement but there was no association with severity. The presence of IgG or IgM, or the absence of IgA in perilesional skin was related to the presence of cryoglobulins. The absence of IgA in lesional and perilesional skin was also related to hepatitis C virus infection. CONCLUSIONS: DIF findings in involved skin are more closely related to the diagnosis of vasculitis and can give more information about overall renal involvement than findings in uninvolved skin. However, findings in uninvolved skin are more closely related to the pathogenic factors that trigger the development of vasculitis.

Peso e comprimento de recém-nascidos normais e de portadores de Hb AS / Weight and lengh of low income newborns and in sickle cell trait newborns (Hb AS)

A distribuição do peso e do comprimento de 1006 recém-nascidos vivos, de parturientes de classe sócio-econômica de baixa renda e residentes na região metropolitana de João Pessoa, Paraíba, foi comparado com os valores encontrados de peso e comprimento de recém-nascidos portadores de Hemoglobinopatias Estruturais. Os valores médios de peso (3.189g) e de comprimento (48,36cm) foram concordantes com os achados de NÓBREGA (1989) para a mesma população. Os recém-nascidos heterozigotos Hb AS tiveram peso e comprimento abaixo dos limites do Intervalo de Confiança para o peso médio e para o comprimento médio. Este fato reforça a hipótese de que apesar de os portadores do traço falcêmico apresentarem sinais e sintomas brandos da doença, fazem parte do grupo nosológico da Anemia Falciforme

Surto de infecçäo hospitalar meningites purulentas em um berçário

Os autores notificaram a ocorrência de um surto de infecçöes hospitalares (meningites purulentas) em um berçário. Adotaram medidas preventivas relacionadas ao ambiente, pacientes e pessoal e avaliaram os resultados ao longo de dois (2) anos e näo verificaram recorrência do surto