Design of an Intelligent Decision Support System Applied to the Diagnosis of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA), characterized by recurrent episodes of partial or total obstruction of the upper airway during sleep, is currently one of the respiratory pathologies with the highest incidence worldwide. This situation has led to an increase in the demand for medical appointments and specific diagnostic studies, resulting in long waiting lists, with all the health consequences that this entails for the affected patients. In this context, this paper proposes the design and development of a novel intelligent decision support system applied to the diagnosis of OSA, aiming to identify patients suspected of suffering from the pathology. For this purpose, two sets of heterogeneous information are considered. The first one includes objective data related to the patient's health profile, with information usually available in electronic health records (anthropometric information, habits, diagnosed conditions and prescribed treatments). The second type includes subjective data related to the specific OSA symptomatology reported by the patient in a specific interview. For the processing of this information, a machine-learning classification algorithm and a set of fuzzy expert systems arranged in cascade are used, obtaining, as a result, two indicators related to the risk of suffering from the disease. Subsequently, by interpreting both risk indicators, it will be possible to determine the severity of the patients' condition and to generate alerts. For the initial tests, a software artifact was built using a dataset with 4400 patients from the Álvaro Cunqueiro Hospital (Vigo, Galicia, Spain). The preliminary results obtained are promising and demonstrate the potential usefulness of this type of tool in the diagnosis of OSA.

Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.

OBJECTIVE: Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation. METHODS: A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process. RESULTS: A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary. CONCLUSION: The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.

Depressive symptomatology in adults during the COVID-19 pandemic.

Depression entails changes in the mental health of individuals worldwide. Episodes of depression lead to mood swings and changes in the motivational dimension. Our research focused on the prevalence of depression in the adult population and on how it affected the social and affective dimensions. Owing to the current pandemic, we deemed it necessary to explore how protective measures against COVID-19 infection, such as quarantines, could be related to mental health. Moreover, we found it important to determine the prevalence of depressive and anxious symptomatology in adults from the Valle del Cauca region in Colombia during the social isolation connected to COVID-19. Our study was descriptive, analytical and cross-sectional, and involved 1248 subjects. As tools, we used the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. The data demonstrated that women were more likely to display symptoms of depression and that individuals aged between 24 and 29 were less likely to reveal symptoms of anxiety than those aged between 18 and 23. Moreover, childless or economically dependent individuals proved to be more likely to display symptoms of depression during the pandemic.

In vitro antimicrobial effect of chloroaluminum phthalocyanine nanoemulsion on periodontal bacteria.

CONTEXT: Nowadays, complementary therapies are necessary for a major removal of microbial subgingival biofilm in the conventional treatment of periodontitis. Research has suggested the use of photodynamic therapy (PDT) as a promising therapy to manage oral cavity infections. This project proposes a new combination of photosensitizer chloroaluminum phthalocyanine and nanoemulsion as a strategy for improving bioactivity. The main purpose of this in vitro study was to evaluate the antimicrobial activity of nanoemulsion ClAlPc (ClAlPc-NE) on relevant periodontal bacteria before and after PDT. MATERIALS AND METHODS: The phototoxic and antibacterial effect of ClAlPc-NE was evaluated against epithelial cells derived from an African green monkey kidney using the colorimetric method with salt tetrazolium 3-(4.5-dimethylthiazolyl-2)-2.5-Diphenyltetrazolium bromide (Merck) and periodontopathogen bacteria (Porphyromonas gingivalis (ATCC 33277), Aggregatibacter actinomycetemcomitans (ATCC 33384), and Prevotella intermedia (ATCC 25611) using the plate microdilution method according to Tavares et al., 2018, respectively. The light source used for the PDT was a LED laser (400-700 nm); the cells were irradiated for 2 min using 4.83 joules/cm2. RESULTS: Antibacterial effect of NE-PcAlCl against P. intermedia with minimum inhibitory concentration (MIC) 0.63 µM after TFD was determined. In the case of P. gingivalis and A. actinomycetemcomitans, no biological activity was found after PDT (MIC > 20 µM) under-evaluated experimental conditions. On the other hand, the ClAlPc-free and ClAlPc-NE cells were phototoxic on epithelial cells. CONCLUSION: The results helped to identify the potential use of ClAlPc-NE to inhibit the periodontal bacterial and additional studies are being developed.

Genetic and toxigenic diversity of Bacillus cereus group isolated from powdered foods.

Bacillus cereus is a human pathogenic bacterium that produces emetic and diarrheal foodborne diseases. This study evaluated the genetic and toxigenic diversity in B. cereus group isolates from powdered foods collected in public educational institutions, bakeries and powdered food companies located in Medellín, Colombia. B. cereus was detected in 35 of 305 (11%) powdered food samples and 52 B. cereus were isolated. The presence of ten toxin genes, hblCDAB, nheABC, cytK2, entFM and cesB, was evaluated in the isolates by multiplex PCR. The nheABC operon was found in all isolates (100%), hblCDAB in 22 (42%), hblCDA in 8 (15%) and hblCD in 3 (6%); the cytK2 gene was detected in 32 isolates (62%) and entFM in 32 (62%). Notably, the cesB gene was not detected. According to the presence of toxin genes, fifteen profiles were identified. The predominant toxigenic profile contained all toxin genes but cesB. A large genetic diversity was observed by GTG5 fingerprinting with 46 isolates grouped in seven clusters and the remaining six clustering individually. There was no relationship between toxigenic profiles and genetic clusters, but some genetic clusters seemed to be related to particular powdered food types. In general, the results evidenced high genetic and enterotoxigenic diversity among the B. cereus group isolates.

What's Eating You? Black Butterfly (Hylesia nigricans).

Lepidopterism refers to the adverse medical effects of contact with insects of the order Lepidoptera, which includes both moths and butterflies. These effects typically result from contact with an insect during the caterpillar (larval) stage. Lepidopterism involves multiple pathologic mechanisms, including direct toxicity of venom and mechanical irritant effects. Clinical patterns associated with contact with lepidoptera include localized stinging reactions, papular urticaria and dermatitis, urticarial wheals, and hemorrhagic diathesis. Accurate diagnosis of symptoms associated with contact with caterpillars, butterflies, or moths is nearly impossible without a reliable history of exposure, as the histology of exposure is nonspecific. Treatment is largely empiric and should be based on symptoms. We report a case of lepidopterism in a patient with acute cutaneous lesions following exposure to an adult-stage black butterfly (Hylesia nigricans).

Enterotoxin Gene Distribution and Genotypes of Bacillus cereussensu lato Isolated from Cassava Starch.

Bacillus cereus is a human pathogenic bacterium found in foods with the potential to cause emesis and diarrhea. This study estimated the presence, toxigenic and genomic diversity of B. cereus s.l. obtained from cassava starch samples collected in bakeries and powdered food companies in Medellín (Colombia). Bacillus cereuss.l. was found in 43 of 75 (57%) cassava starch samples and 98 isolates were obtained. The nheABC, hblCDAB, cytK2, entFM and cesB toxin genes were detected by multiplex PCR and the most frequent operon was nheABC, whereas cesB gene was not found. Twelve toxigenic profiles were determined by the detection of toxin genes, and the most frequent profiles harbored all enterotoxin genes. A broad genomic diversity was detected according to GTG5-PCR fingerprinting results with 76 B. cereus s.l. grouped in sixteen clusters and the 22 isolates clustering separately. No relationship was observed between genomic background and toxigenic profiles. In general, the results showed a high genomic and enterotoxigenic diversity in B. cereus s.l. found in cassava starch. These results should incentive future studies to understand the distribution of B. cereus s.l. isolated on raw materials in comparison with finished products.

A dysfunctional family environment and a high body fat percentage negatively affect telomere length in Mexican boys aged 8-10 years.

AIM: The aim of this study was to determine whether a direct relationship existed between absolute telomere length (aTL), obesity and familial functionality in a group of Mexican children. METHODS: We recruited 134 children (52% boys) aged 8-10 years during regular primary care check-ups in 2016 and evaluated physical activity (PA), feeding practices, anthropometrics, body fat percentage (BF%) and family dysfunction. Optimised quantitative PCR determined aTL from genomic deoxyribonucleic acid isolated from saliva samples. RESULTS: Boys with a healthy BF% showed a higher aTL than their high BF% counterparts (P < .01). aTL was higher in children who performed PA than their sedentary counterparts (P < .05). Alarmingly, 90% of the children belonged to dysfunctional families and a dysfunctional family was correlated with a higher BF% (r = -.57). Negative correlations between the BF% and aTL (r = -.1765) and the BF% and time dedicated to PA (r = -.031) were observed in boys. On the contrary, we found a positive correlation between the aTL and weekly PA (r = .1938). These correlations were not observed in girls. CONCLUSION: Telomere shortening was associated with a high BF% in boys, but not girls. Dysfunctional families were also a key factor. School PA programmes should be mandatory.

Genomic and Toxigenic Heterogeneity of Bacillus cereus sensu lato Isolated from Ready-to-Eat Foods and Powdered Milk in Day Care Centers in Colombia.

Bacillus cereus sensu lato (s.l.) is a group of bacteria commonly found in diverse environments, including foods, with potential to cause emesis and diarrhea. In Colombia, it is one of the main foodborne pathogens. The aim of this study was to determine the genomic and toxigenic heterogeneity of B. cereus s.l. isolated from ready-to-eat foods and powdered milk collected in day care centers of Medellin, Colombia. Of 112 B. cereus s.l. isolates obtained, 94% were ß-hemolytic. Toxigenic heterogeneity was established by the presence of nheABC, hblCDAB, cytK2, entFM, and cesB toxigenic genes. The nheABC operon and entFM gene were most frequently detected in the isolates, whereas the cesB gene was not found. According to the toxin genes content, nine toxigenic profiles were identified. A 44% of isolates had profiles with all genes for nonhemolytic enterotoxin, hemolysin BL, and enterotoxin FM production (profiles II and IV). Pulsed-field gel electrophoresis analysis indicated a high genomic heterogeneity among the B. cereus s.l., with 68 isolates grouping into 16 clusters and 33 placed separately in the dendrogram. This study provides useful information on the safety of ready-to-eat foods and powdered milk in day care centers where children, a susceptible population, are exposed and it should incentive for more studies to understand the distribution of different toxin-encoding genes among B. cereus s.l. isolates, enabling detailed risk assessment.

Semisynthetic eugenol derivatives as antifungal agents against dermatophytes of the genus Trichophyton.

PURPOSE: Eugenol, the main component of clove bud essential oil (Eugenia caryophyllus), has been linked to antimicrobial, anti-inflammatory, insecticidal and immunomodulatory properties. The purpose of this study was to evaluate the antifungal and cytotoxic activity of eugenol, the essential oil of Eugenia caryophyllus, and some semisynthetic derivatives of eugenol against dermatophytes of the genus Trichophyton. METHODOLOGY: We evaluated the antifungal effect of the compounds, determining the minimum inhibitory concentrations (MICs) by the microdilution method and the minimum fungicidal concentrations by cultures from the inhibitions. Additionally, the inhibition of the radial growth of the mycelium of the dermatophyte fungi was tested by poisoned substrate. Cytotoxicity was measured by the colorimetric method on Vero cells. RESULTS: All of the eugenol compounds tested exhibited antifungal properties, showing MICs of 62.5-500 µg ml-1 , determined within three dermatophyte species: Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. Among these derivatives, methyl isoeugenol, at concentrations of 300 and 100 µg ml-1, was found to completely inhibit (100 %) radial growth of the mycelium of all three species after 20 days of treatment. Additionally, phenotypic variations related to the decrease in pigment production of T. rubrum were observed after treatment with O-ethyl and O-butyl isoeugenol derivatives. Meanwhile, all of the tested (iso)eugenol molecules exhibited moderate toxicity in Vero cells [50 % cytotoxic concentration (the concentration required for a 50 % reduction in cell viability; CC50): 54.06-265.18 µg ml-1 ). CONCLUSION: The results suggest that the semisynthetic eugenol derivatives (SEDs) show promising antifungal activity and selectivity against dermatophyte fungi.

Effects of chlorpyrifos on cell death and cellular phenotypic specification of human neural stem cells.

Chlorpyrifos (CPF) is an organophosphate pesticide widely used in agriculture, whose traditional and well-known mechanism of action is the inhibition of the enzyme Acetylcholinesterase (AChE). Subacute exposures to CPF have been associated with alterations different from the inhibition of AChE. Because of the vulnerability of the developing nervous system, prenatal and early postnatal exposures are of special concern. Human neural stem cells (hNSC) provide the opportunity to study early stages of neural development and may be a valuable tool for developmental neurotoxicology (DNT). In the current work, the cell line hNS1 was used as a model system with the aim of validating this cell line as a reliable testing method. To evaluate the effects of CPF on early developmental stages, hNS1 cells were exposed to different concentrations of the pesticide and cell death, proliferation and cell fate specification were analyzed under differentiation conditions. Since hNS1 cells responded to CPF in a similar way to other human cell lines, we consider it may be a valid model for DNT chemical assessment. CPF induced apoptotic cell death only at the highest doses tested, suggesting that it is not toxic for the specific developmental stage here addressed under short term exposure. In addition, the higher doses of CPF promoted the generation of astroglial cells, without affecting neurogenesis.

In vitro susceptibility of Microsporum spp. and mammalian cells to Eugenia caryophyllus essential oil, eugenol and semisynthetic derivatives.

BACKGROUND: Microsporum spp. are keratinophilic dermatophytes that mainly invade the stratum corneum of the skin and hair causing clinical symptoms associated with tinea. Its treatment has several limitations, and the search for new active molecules is necessary. OBJECTIVE: To evaluate the antifungal and cytotoxic potential of Eugenia caryophyllus essential oil (EO), eugenol, isoeugenol and methylisoeugenol against Microsporum canis, M. gypseum and Vero cells. METHODS: The EO was extracted by conventional heating-assisted hydrodistillation, the eugenol obtained commercially and the derivatives through Williamson synthesis. Minimal inhibitory concentration (MICs), minimum fungicidal concentration, inhibition of radial mycelial growth and germination inhibition were used to evaluate the antifungal activity. In addition, a colorimetric test was conducted to evaluate cytotoxic activity. RESULTS: MIC and MFC values for all compounds were 62.5-500 µg/mL for both of the species of Microsporum evaluated. Also, concentrations of 300 µg/mL of the compounds inhibited 100% of M. canis mycelium. The inhibition of germination was observed after 6 hours of treatment (11.86 ± 3.46-85.31 ± 0%). No cytotoxicity was observed in Vero cells (CC50  > 105 µg/mL), whereas terbinafine showed CC50 31.00 ± 0.61 µg/mL. CONCLUSIONS: Our study indicates an interesting bioactivity of isoeugenol and methylisoeugenol against M. canis, M. gypseum and mammalian cells.

Use of Nitrous Oxide in Dermatology: A Systematic Review.

BACKGROUND: Many dermatologic procedures are painful and can be distressing to patients. OBJECTIVE: To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures. METHODS: A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology. RESULTS: Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures. CONCLUSION: Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.

Nasal Valve Reconstruction Using a Titanium Implant: An Outcomes Study.

Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow. This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients with nasal valve collapse. This is a single-center retrospective study that consisted of a telephone questionnaire of 37 quality-of-life measures and questions related to the surgical procedure and recovery process to evaluate postsurgical outcomes. Fifteen patients completed the survey. There was a significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, breathing through nose during exercise, the need to blow nose, sneezing, facial pain/pressure, fatigue, productivity, and restlessness/irritability after surgery. Overall, 100% of patients were satisfied with the results and would recommend this procedure. The most common postoperative complaints were pain (33%) and difficulty breathing (33%). Patients noticed no increase (20%) or a slight increase (73%) in the size of their nose. Sixty percent of patients cannot see the implant and 13% report the implant is barely noticeable. Nasal valve repair with a titanium implant was successful at improving symptoms of nasal obstruction and other quality-of-life issues. Satisfaction was high among all patients. The implants are palpable, thought to be visible by some patients, yet accepted by the majority of patients. This approach may be especially important in patients with prior nasal surgery but continue to experience refractory symptoms.

Relación entre teoría y praxis en la formación de profesionales de enfermería: revisión integradora de literatura / Theory-praxis relationship in education of nursing professionals: an integrative literature review

El presente artículo es una revisión integradora de publicaciones de revistas indexadas inscritas en las bases de datos Scielo, MEDLINE, CINAHL, LILACS, CUIDEN, OVID, pub Med, y TESEO, entre 2000-2014 escritas en español, portugués e inglés. El estudio tuvo como objetivo identificar en las producciones científicas la problematización de la relación entre teoría y praxis en la formación de los profesionales de enfermería. Se seleccionaron 35 documentos, con base en criterios de inclusión y exclusión. Para el análisis, los estudios fueron ordenados de acuerdo a aspectos comunes como: tipo de documento, país de origen, autor, año de publicación, conceptos clave y/o definiciones. El estudio posibilitó la agrupación de los datos en unidades temáticas, emergiendo tres categorías: Estudios relacionados con los profesores y el currículo, estudios relacionados con los estudiantes y los estudios relacionados con los enfermeros asistenciales a partir de su práctica profesional. Los resultados indican que la complejidad de la relación entre la teoría y la práctica es evidente, demostrando que no existe una transferencia del conocimiento teórico de las aulas, a la realidad de la práctica asistencial. Adicionalmente, se resalta la discreta productividad de estudios relacionados con esta temática, más teniendo en cuenta la importancia del tema y la preocupación constante que genera tanto en los profesores, estudiantes, como en los enfermeros asistenciales (AU)

This article presents an integrative review of studies written in Spanish, Portuguese and English, which have been published in journals indexed in the databases Scielo, MEDLINE, CINAHL, lilacs, CUIDEN, Ovid, Pub Med and TESEO, between 2000 and 2014. This study aimed to identify, in scientific literature, the problems of the theory-praxis relationship in the education of nursing professionals. 35 documents were selected, based on inclusion and exclusion criteria. In order to analyze them, the studies were arranged according to common aspects such as: document type, country of origin, author, year of publication, key concepts and/or definitions. This study made it possible to group the data into thematic units according to three categories: studies related to teachers and the curriculum, studies related to students, and studies related to care nurses, from their professional practice. Results indicate that complexity of the theory-praxis relationship is evident, demonstrating that there is no transfer of classroom-imparted theoretical knowledge to the actual care practice. Moreover, we highlight the inconspicuous production of studies related to this subject, considering its importance and its constant concern to teachers, students, and care nurses (AU)

An Aggressive Microcystic Adnexal Carcinoma Infiltrating the Sternum.

Microcystic adnexal carcinoma is a rare cutaneous tumor that is often misdiagnosed and has the potential to be aggressive. Mohs surgery is the treatment of choice to prevent recurrences. We present a case of a large recurrent microcystic adnexal carcinoma on the sternum, initially diagnosed as a basal cell carcinoma. This tumor infiltrated the muscle and bone and was unresectable with Mohs surgery.

J Drugs Dermatol. 2017;16(2):180-181.

Inhibition of Listeria monocytogenes in Fresh Cheese Using Chitosan-Grafted Lactic Acid Packaging.

A chitosan from biologically obtained chitin was successfully grafted with d,l-lactic acid (LA) in aqueous media using p-toluenesulfonic acid as catalyst to obtain a non-toxic, biodegradable packaging material that was characterized using scanning electron microscopy, water vapor permeability, and relative humidity (RH) losses. Additionally, the grafting in chitosan with LA produced films with improved mechanical properties. This material successfully extended the shelf life of fresh cheese and inhibited the growth of Listeria monocytogenes during 14 days at 4 °C and 22% RH, whereby inoculated samples with chitosan-g-LA packaging presented full bacterial inhibition. The results were compared to control samples and commercial low-density polyethylene packaging.

Use of Bacillus thuringiensis supernatant from a fermentation process to improve bioremediation of chlorpyrifos in contaminated soils.

The aim of this research was to investigate the potential of a nutrient-rich organic waste, namely the cell-free supernatant of Bacillus thuringiensis (BtS) gathered from fermentation, as a biostimulating agent to improve and sustain microbial populations and their enzymatic activities, thereby assisting in the bioremediation of chlorpyrifos-contaminated soil at a high dose (70 mg kg(-1)). Experiments were performed for up to 80 d. Chlorpyrifos degradation and its major metabolic product, 3,5,6-trichloro-2-pyridinol (TCP), were quantified by high-performance liquid chromatography (HPLC); total microbial populations were enumerated by direct counts in specific medium; and fluorescein diacetate (FDA) hydrolysis was measured as an index of soil microbial activity. Throughout the experiment, there was higher chlorpyrifos degradation in soil supplemented with BtS (83.1%) as compared to non-supplemented soil. TCP formation and degradation occurred in all soils, but the greatest degradation (30.34%) was observed in soil supplemented with BtS. The total microbial populations were significantly improved by supplementation with BtS. The application of chlorpyrifos to soil inhibited the enzymatic activity; however, this negative effect was counteracted by BtS, inducing an increase of approximately 16% in FDA hydrolysis. These results demonstrate the potential of B. thuringiensis supernatant as a suitable biostimulation agent for enhancing chlorpyrifos and TCP biodegradation in chlorpyrifos-contaminated soils.