Dolor y alteración de la imagen corporal en adolescentes con escoliosis idiopática / Pain and body image alteration in adolescents with idiopathic scoliosis

Objetivo: explorar la vivencia del dolor y de la autopercepción corporal en jóvenes afectados de escoliosis idiopática atendidos en la Unidad del Raquis del Hospital de Traumatología y Rehabilitación de Vall d'Hebron (Barcelona).Método: estudio cualitativo fenomenológico realizado en 2011. Se incluyeron, mediante muestreo por conveniencia, jóvenes de 15 a 24 años diagnosticados de escoliosis idiopática ingresados para cirugía correctora en la unidad. Se realizaron entrevistas semiestructuradas una semana tras la cirugía, en la habitación del paciente y con una duración de entre 15 y 25 minutos, que fueron grabadas y transcritas. Un análisis preliminar determinó saturación del discurso. Se llevó a cabo análisis temático.Resultados: participaron 13 mujeres y dos hombres. Las categorías encontradas fueron: “sentimientos y emociones”, “enfermedad y anormalidad”, “adolescencia”, además de las dos descritas en este artículo “Escoliosis” (sintomatología y descubrimiento) e “Imagen corporal y belleza”. El dolor estuvo presente solo en algunas personas con una intensidad variable y no fue clave en el descubrimiento de la enfermedad (que se asociaba más a la presencia de deformidad o a un hallazgo casual), ni en la elección de cirugía correctora (que derivaba más de la preocupación estética). Las personas buscaban ocultar la deformidad mediante el vestido, modificación postural o restricciones sociales, conductas que mantenían, aunque supusiesen un esfuerzo considerable.Conclusión: existe una gran preocupación estética, la deformidad altera la autopercepción corporal y genera comportamientos de ocultación y adaptaciones sociales. Esta preocupación parece más determinante que el dolor a la hora de tomar decisiones, si bien este resulta muy limitante en algunos casos.(AU)

Objective: to explore the experience of pain and body self-perception in young patients with idiopathic scoliosis managed at the Rachis Unit from the Orthopedic Surgery and Rehabilitation Hospital Vall d´Hebron (Barcelona).Method: a qualitative phenomenological study conducted in 2011. Through convenience sampling, the study included young patients, from 15 to 24 years of age, who had been diagnosed with idiopathic scoliosis and admitted to the hospital unit for corrective surgery. Semi-structured interviews were conducted one week after surgery, in the patient’s room and with a duration between 15 and 25 minutes, which were recorded and transcribed. A preliminary analysis determined speech saturation; thematic analysis was conducted.Results: the participants were 13 women and two men. The categories found were: “feelings and emotions”, “disease and abnormality”, “adolescence”, alongside those two described in this article “Scoliosis (symptomatology and discovery)” and “Body image and beauty”. Pain was only present in some patients, with varying intensity, and it was not a key factor in the discovery of the disease (which was mainly associated with the presence of deformity or a casual finding), or with the choice of corrective surgery, which derived mostly from esthetic concerns. Patients tried to hide their deformity through clothes, posture modification or social restrictions, and they maintained these behaviours even if they entailed a major effort.Conclusion: there is a great esthetic concern; deformity alters the body self-perception and generates concealment behaviours and social adaptations. This concern seems to be a greater driver than pain at the time of making decisions; however, it can be very limiting in some cases.(AU)

The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19.

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2-28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31-1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11-2.04), pneumonia (HR 1.74, 95% CI: 1.10-2.73) and admission to hospital (HR 4.00, 95% CI: 1.83-8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48-0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.

Conocimiento de la enfermedad asmática como factor protector de neumonía / Knowledge of asthmatic disease as a pneumonia protective factor

Objetivo: Evaluar si el conocimiento de la enfermedad asmática puede ser un factor protector frente al riesgo de neumonía adquirida en la comunidad (NAC) en las personas con asma mayores de 18 años que reciben tratamiento inhalado. Método: Estudio observacional de casos y controles en población con asma. Se reclutaron 123 personas con asma diagnosticadas de neumonía por criterios clínicos y radiológicos (casos) y 246 personas con asma no diagnosticados de neumonía durante el último año (controles), apareados por edad. El principal factor de estudio fue la valoración del conocimiento sobre la enfermedad asmática mediante un cuestionario ad hoc, de 7 preguntas con 2 posibles respuestas (conoce, no conoce). Resultados: El análisis bivariado muestra que el conocimiento de la enfermedad asmática tiene una asociación estadísticamente significativa como factor protector de NAC. En el análisis multivariante muestra una asociación del conocimiento de la enfermedad asmática como factor protector de NAC (OR = 0,24), independientemente de la edad, nivel de estudios, funcionalidad y gravedad del asma. Conclusiones: Un buen conocimiento de la enfermedad asmática permite reducir el riesgo de NAC en pacientes asmáticos con tratamiento inhalado

Objective: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. Method: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). Results: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. Conclusions: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment

Knowledge of asthmatic disease as a pneumonia protective factor. / Conocimiento de la enfermedad asmática como factor protector de neumonía.

OBJECTIVE: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. METHOD: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). RESULTS: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. CONCLUSIONS: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

Circadian gating of dark-induced increases in chloroplast- and cytosolic-free calcium in Arabidopsis.

Changes in the spatiotemporal concentration of free Ca2+ ([Ca2+ ]) in different organelles of the cell contribute to responses of plants to physiological and environmental stimuli. One example are [Ca2+ ] increases in the stroma of chloroplasts during light-to-dark transitions; however, the function and mechanisms responsible are unknown, in part because there is a disagreement in the literature concerning whether corresponding dark-induced changes in cytosolic [Ca2+ ] ([Ca2+ ]cyt ) can be detected. We have measured changes in [Ca2+ ]cyt upon darkness in addition to the already known dark-induced increases in [Ca2+ ]stroma in the aerial part of the Arabidopsis thaliana plant. These [Ca2+ ]cyt transients depend on the photoperiod and time of day, peaking at anticipated dusk, and are superimposed on daily 24 h oscillations in [Ca2+ ]cyt . We also find that the magnitude of the dark-induced increases in Ca2+ in both the cytosol and chloroplasts are gated by the nuclear circadian oscillator. The modulation of the magnitude of dark-induced increases in [Ca2+ ]stroma and [Ca2+ ]cyt by transcriptional regulators in the nucleus that are part of the circadian oscillator demonstrates a new role for the circadian system in subcellular Ca2+ signalling, in addition to its role in driving circadian oscillations of [Ca2+ ] in the cytosol and chloroplasts.

Circadian oscillations of cytosolic free calcium regulate the Arabidopsis circadian clock.

In the last decade, the view of circadian oscillators has expanded from transcriptional feedback to incorporate post-transcriptional, post-translational, metabolic processes and ionic signalling. In plants and animals, there are circadian oscillations in the concentration of cytosolic free Ca2+ ([Ca2+]cyt), though their purpose has not been fully characterized. We investigated whether circadian oscillations of [Ca2+]cyt regulate the circadian oscillator of Arabidopsis thaliana. We report that in Arabidopsis, [Ca2+]cyt circadian oscillations can regulate circadian clock function through the Ca2+-dependent action of CALMODULIN-LIKE24 (CML24). Genetic analyses demonstrate a linkage between CML24 and the circadian oscillator, through pathways involving the circadian oscillator gene TIMING OF CAB2 EXPRESSION1 (TOC1).

Using mixed-methods research to study the quality of life of coeliac women.

AIMS AND OBJECTIVES: To research the quality of life of Spanish women with coeliac disease. BACKGROUND: Women with coeliac disease express lower quality of life than men with coeliac disease. DESIGN: Explanatory sequential approach using mixed methods and with a gender perspective. METHODS: The research was carried out between May and July 2015. In its quantitative stage, it aimed to determine the health-related quality of life in a representative sample (n = 1097) of Spanish adult women with coeliac disease using a specific questionnaire named Coeliac Disease-Quality of Life. In its qualitative phase, it aimed to describe the life experiences of a woman with coeliac disease in a qualitative manner by means of interviews (n = 19) with a semistructured script. Quantitative data were analysed using spss version 20 and presented in descriptive statistics. Qualitative data were analysed using the directed content analysis. RESULTS: The quantitative process gave us the values on the four aspects studied: dysphoria, disease limitations, health problems and inadequate treatment. These aspects allowed us to create a qualitative process, based on which we generated an interview, from which four larger categories emerged. These categories were feelings at diagnosis, limitations in day-to-day life, social perceptions of the disease and personal meanings of coeliac disease. Thus, both phases of our project are totally connected. There was a high level of congruence between quantitative scores and narratives. CONCLUSION: This study shows us the strong points of mixed-methods strategy in health sciences. The mixed-methods strategy gave us a wider view of the experience of women living with coeliac disease. In our case, a strength and not a limitation is having performed the quality of life study in women with coeliac disease using a mixed methodology, approaching the experience of being a woman with coeliac disease in Spain in two different but complementary ways. The quantitative and qualitative data allowed us to interpret the experiences of our participants.

Aspectos psicosociales de la enfermedad celíaca en España: una vida libre de gluten / Psychosocial aspects of celiac disease in Spain: A life free of gluten

RESUMEN Objetivo: La celiaquía como enfermedad crónica tiene una alta prevalencia en nuestra sociedad. El artículo analiza los aspectos psicosociales de la enfermedad celíaca en los diferentes entornos, valorando el impacto de la implantación de una dieta estricta libre de gluten. Métodos: Estudio cualitativo entre los meses de Enero del 2013 a Abril del 2013 en el cual, a través de la teoría fundamentada y el análisis de contenido, se ha profundizado en el análisis de las entrevistas semiestructuradas a personas con enfermedad celíaca en España. Se realizaron llamamientos a traves de las redes sociales y grupos de celíacos hasta llegar a la saturación teórica, que determinó el tamaño final de la muestra de 24 personas. Resultados: Educación Sanitaria, Aislamiento social, soledad y desconocimiento social emergieron como categorías centrales en la experiencia de adopción de la dieta libre de gluten a partir del diagnóstico de celiaquía. Conclusión: Los profesionales deben promover y apoyar estrategias de apoyo social basadas en una comprensión íntegra de las experiencias de desarraigo y marginación que los pacientes celíacos experimentan en sus relaciones sociales a través de la comida. Se requiere un aumento de la educación sanitaria para entender e integrar el impacto psicosocial del diagnóstico de celiaquía y la dieta libre de gluten.

ABSTRACT Objective: Celiac disease is a chronic disease which has a high prevalence in our society. The aim of this paper is to explore the process of adapting the celiac in different social environments, assessing the impact of the implementation of a strict gluten-free diet. Methods: A qualitative study was carried out in the months of January 2013 to April 2013 through which the grounded theory and content analysis have deepened the analysis of semi-structured interviews with people with celiac disease in Spain. Appeals via social networks and celiac groups were conducted in order to reach theoretical saturation, which determined the final sample size of 24 people. Results: Social isolation, loneliness and social ignorance are some of the categories that have emerged when we talk about celiac disease and the gluten-free diet. Conclusion: Professionals should promote and support social support strategies based on an integrated understanding of the experiences of displacement and marginalization that celiac patients experience in their social relationships through food. There should be increased health education to understand and integrate the psychosocial impact of the diagnosis of celiac disease and the gluten-free diet.

Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain

Background: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. Methods: An observational, cross-sectional study of a nonrandomized, representative sample of adult celiac patients throughout all of Spain’s Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the selfadministered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. Results: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. Conclusions: The HRQL level of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet (AU)

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Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain.

BACKGROUND: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. METHODS: An observational, transversal study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. RESULTS: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. CONCLUSIONS: The HRQL of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.

Idiopathic adolescent scoliosis: living with a physical deformity / Escoliose idiopática do adolescente: a experiência de ter uma deformidade física / Escoliosis idiopática adolescente: la experiencia de padecer una deformidad física

ABSTRACT A qualitative, phenomenological, hermeneutical study with the aim of explaining the experience of having a body deformity diagnosed as idiopathic adolescent scoliosis. A semistructured interview conducted with scoliosis patients admitted to the unit of spinal cord at the Vall d'Hebron Hospital was used. The youth defined their scoliosis based on how they perceived their deformity. They spoke of pain and deformity as characteristic symptoms of suffering, and explained how this symptom affected their social relationships. Their deformity was associated with words such as "horrible", "shame", "complex" and "problem." It is concluded that the symptommost referred is pain and the biggest concern of the of the youth was their body aesthetic and feelings associated with it. They attempt to solve this problem by adapting the way they dress and through surgery. Surgery can resolve the body deformity but not self-perception of their body image.

RESUMO Estudo qualitativo, fenomenológico, localizado na hermenêutica, cujo objetivo é explicar a experiência de ter uma deformidade corporal diagnosticada em jovens com escoliose idiopática. Foi conduzida uma entrevista semiestruturada com pacientes portadores de escoliose, internadas na unidade de coluna vertebral do Hospital Vall d'Hebron. Os jovens definiram sua escoliose conforme percebem sua deformidade. Eles falam de dor e deformidade, como sintoma característico do sofrimento, e explicam como este sintoma afeta suas relações sociais. A deformidade é associada a palavras como "horrível", "vergonha", "complexo" e "problema". Conclui-se que o sintoma dor é o mais referido e a maior preocupação dos jovens é a estética corporal e os sentimentos associados. Tentam resolver este problema por adaptação das vestimentas e pela cirurgia. Esta pode corrigir a deformidade, mas não a autopercepção de sua imagen corporal.

RESUMEN Estudio cualitativo, fenomenológico, situado en la hermenéutica, cuyo objetivo es explicar la experiencia de padecer una deformidad corporal en jóvenes diagnosticadas de escoliosis idiopática. Se utiliza una entrevista semiestructurada y dirigida a pacientes con escoliosis, ingresadas en la unidad de raquis del Hospital Vall d´Hebron. Las jóvenes definen su escoliosis según perciben su deformidad. Hablan del dolor como síntoma característico de la deformidad que padecen, y explican cómo este síntoma influye en sus relaciones sociales. Asocian a su deformidad palabras como "horrible", "vergüenza", "complejo" y "problema". Se concluye que el síntoma por excelencia referido es el dolor y que la mayor preocupación de las jóvenes es la estética corporal y los sentimientos asociados a ella. Intentan solucionar este problema adaptando su forma de vestir y mediante cirugía. La cirugía puede solucionar la deformidad pero no la autosatisfacción corporal.

Human mesenchymal stem cells enhance the systemic effects of radiotherapy.

The outcome of radiotherapy treatment might be further improved by a better understanding of individual variations in tumor radiosensitivity and normal tissue reactions, including the bystander effect. For many tumors, however, a definitive cure cannot be achieved, despite the availablity of more and more effective cancer treatments. Therefore, any improvement in the efficacy of radiotherapy will undoubtedly benefit a significant number of patients. Many experimental studies measure a bystander component of tumor cell death after radiotherapy, which highlights the importance of confirming these observations in a preclinical situation. Mesenchymal stem cells (MSCs) have been investigated for use in the treatment of cancers as they are able to both preferentially home onto tumors and become incorporated into their stroma. This process increases after radiation therapy. In our study we show that in vitro MSCs, when activated with a low dose of radiation, are a source of anti-tumor cytokines that decrease the proliferative activity of tumor cells, producing a potent cytotoxic synergistic effect on tumor cells. In vivo administration of unirradiated mesenchymal cells together with radiation leads to an increased efficacy of radiotherapy, thus leading to an enhancement of short and long range bystander effects on primary-irradiated tumors and distant-non-irradiated tumors. Our experiments indicate an increased cell loss rate and the decrease in the tumor cell proliferation activity as the major mechanisms underlying the delayed tumor growth and are a strong indicator of the synergistic effect between RT and MSC when they are applied together for tumor treatment in this model.

[Perceived self-image in adolescent idiopathic scoliosis: an integrative review of the literature]. / Imagen percibida en la escoliosis idiopática adolesscente: revision integrative de la literatura.

OBJECTIVE: To learn about the experiences of adolescents diagnosed with idiopathic scoliosis. METHOD: Integrative review of the literature published within a specified time frame. RESULTS: For both sexes, the predominant clinical symptom of this condition appears to be the negative effect that the deformity exerts on perceived self-image. Quantitative studies used numerical scores to assess perceptions of body image but did not analyse emotional aspects. Patients treated surgically were found to have a better self-image than patients treated with a brace. Quality of life was improved by a reduction in the magnitude of the curve. CONCLUSION: Spinal deformity exerts a psychological effect on adolescent girls.

Perceived self-image in adolescent idiopathic scoliosis: an integrative review of the literature / Imagem percebida na escoliose idiopática do adolescente. Revisão da literatura / Imagen percibida en la escoliosis idiopática adolescente: revisión integrativa de la literatura

Objective: To learn about the experiences of adolescents diagnosed with idiopathic scoliosis. Method: Integrative review of the literature published within a specified time frame. Results: For both sexes, the predominant clinical symptom of this condition appears to be the negative effect that the deformity exerts on perceived self-image. Quantitative studies used numerical scores to assess perceptions of body image but did not analyse emotional aspects. Patients treated surgically were found to have a better self-image than patients treated with a brace. Quality of life was improved by a reduction in the magnitude of the curve. Conclusion: Spinal deformity exerts a psychological effect on adolescent girls.
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Objetivo: Conhecer as experiências vividas por adolescentes com diagnóstico de escoliose idiopática. Método: Revisão integrativa da literatura, estabelecendo limites no ano de publicação dos documentos. Resultados: Para ambos os sexos, o efeito negativo da deformidade na percepção da própria imagem é o sintoma clínico predominante; os estudos quantitativos apresentam uma classificação numérica para avaliar a percepção da imagem corporal, porém sem recolher os aspectos emocionais; a autoimagem é melhor em pacientes tratados cirurgicamente e pior em pacientes tratados com cinta e a diminuição da magnitude da curva proporciona uma melhor qualidade de vida. Conclusão: A deformidade da coluna vertebral afeta psicologicamente os adolescentes.


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Objetivo: Conocer las experiencias vividas por adolescentes diagnosticados con escoliosis idiopática. Método: Revisión integrativa de la literatura, estableciendo los límites de búsqueda en el año de publicación de los documentos. Resultados: El síntoma clínico predominante para ambos sexos es el efecto negativo de la deformidad en la percepción de la propia imagen; los estudios cuantitativos presentan una clasificación numérica para evaluar la percepción de la imagen corporal sin recoger los aspectos emocionales; la autoimagen es mejor en pacientes tratados quirúrgicamente y peor en pacientes tratados con corsé y la disminución de la magnitud de la curva proporciona una mejor calidad de vida. Conclusión: La deformidad de columna vertebral afecta psicológicamente a los adolescentes.
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Brazilian registered nurses' perceptions and attitudes towards adverse events in nursing care: a phenomenological study.

AIM: To describe the perceptions and attitudes of registered nurses (RNs) towards adverse events (AEs) in nursing care. BACKGROUND: The professionals' subjective perspectives should be taken into account for the prevention of AEs in care settings. METHOD: Schütz's social phenomenology was developed. Interviews were conducted with nine Intensive Care Unit RNs. RESULTS: The following five descriptive categories emerged: (1) the occurrence of AEs is inherent to the human condition but provokes a feeling of insecurity, (2) the occurrence of AEs indicates the existence of failures in health care systematization, (3) the professionals' attitudes towards AEs should be permeated by ethical principles; (4) the priority regarding AEs should be the mitigation of harm to patients, and (5) decisions regarding the communication of AEs were determined by the severity of the error. CONCLUSIONS: The various subjective perspectives related to the occurrence of AEs requires a health care systematization with a focus on prevention. Ethical behaviour is essential for the patients' safety. IMPLICATIONS FOR NURSING MANAGEMENT: Activities aimed at the prevention of AEs should be integrated jointly with both the professionals and the health care institution. A culture of safety, not punishment, and improvement in the quality of care provided to patients should be priorities.

Synthesis of glycyrrhetinic acid derivatives for the treatment of metabolic diseases.

The effect of glycyrrhetinic acid (GA) and GA-derivatives towards 11beta-hydroxysteroid dehydrogenase (11beta-HSD) was investigated. Novel compounds with modifications at positions C-3, C-11 and C-29 of the GA skeleton were prepared. Single crystal X-ray diffraction data of selected substances are reported and discussed.

Efficient synthesis of glycyrrhetinic acid glycoside/glucuronide derivatives using silver zeolite as promoter.

3-O-Glycopyranosides of glycyrrhetinic acid have been synthesized in good to high yields and excellent stereoselectivity using glycosyl bromide donors and silver zeolite as promoter. In addition to the preparation of glycosides containing beta-linked glucosyl, 2-deoxy-2-trichloroacetamido-glucosyl, galactosyl, cellobiosyl and lactosyl residues, also the deactivated acetylated methyl glucopyranosyluronate bromide donor could be coupled to triterpene aglycon ester derivatives in good yields. The ester protecting group located at C-30 of the oleanolic acid scaffold exerted an influence on the overall yield, with the methylester-protected glycosyl acceptor giving better yields compared to the allyl, benzyl as well as diphenylmethyl ester aglycon. The acetyl-protected glucuronides were differently deblocked in high yields via Zemplén deacetylation or via hydrogenolysis followed by Zemplén deacetylation, and alkaline hydrolysis, respectively, to allow for a selective liberation of the ester groups from either the glucuronide or the glycyrrhetinic acid unit, respectively. The target glycosides/glucuronides serve as probes for pharmaceutical studies aimed at defining structure-activity relationships of glycoside/glucuronide triterpenes.

[Psoriasis]. / Psoriasis. Tipología, tratamiento y cuidados de enfermería.

The authors provide a review, description and synthesis of the diverse classes of psoriasis and the treatments which have been developed, from the most common ones to the most recent ones. The authors describe the most frequent nursing treatments. Bearing in mind the chronic nature of this disease, its evolution by outbreaks and the physical as well as psychological effects psoriasis has on its sufferers, the role of nurses is essential to help patients adapt to and develop some degree of independence while suffering from psoriasis.

Teste de hemaglutinaçäo na sorologia da malária humana empregando hemácias parasitadas pelo Plasmodium berghei / Hemaglutination test in human malaria serodiagnosis using erythrocytes infected by Plasmodium berghei

Foi padronizado um teste de hemaglutinaçäo para a sorologia da malária humana, com reagente constituído de suspensäo de hemácias de camundongos infectadas pelo Plasmodium berghei e preservadas por fixaçäo aldeídica. Em pacientes com parasitemia por P. falciparum ou P. vivax obteve-se uma sensibilidade de 98,9% nos 88 casos estudados, o teste apresentando títulos entre 40 e 640. Para o grupo de 476 soros de indivíduos näo-maláricos, obteve-se uma especificidade de 96,0%. O teste apresentou elevada reprodutibilidade, mesmo para diferentes lotes de antígenos. Nos 200 soros, obtidos ao acaso, de indivíduos de área endêmica, o teste apresentou positividade de 48,5%, contra 88,0% do teste de imunofluorescência-IgG. A baixa positividade pode ser devida a que o teste de hemaglutinaçäo detecta anticorpos IgM. Após tratamento com 2-mercaptoetanol, todos os soros de pacientes com parasitemia tornaram-se näo reagentes. Em relaçäo ao teste de imunofluorecência-IgG, o teste de hemaglutinaçäo apresentou índice de co-positividade de 0,989 para os soros de maláricos com parasitemia. Para os soros de näo-maláricos o teste de hemaglutinaçäo apresentou índice de co-negatividade de 0,969. Por outro lado, no grupo de soros de área endêmica, o índice de co-positividade foi de 0,528 e o de co-negatividade, de 0,833