International consensus for a dissection room quality system (DRQS): A Delphi panel study.

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered "essential" or "important" by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

El farmacéutico comunitario y el edema de Reinke: caso clínico / The community pharmacist and Reinke's oedema: a case report

ANTECEDENTES Y EVALUACIÓN: el edema de Reinke afecta a ambas cuerdas vocales, y aunque está relacionado con el consumo de tabaco, puede deberse al reflujo o alteraciones hormonales. Produce displasia epitelial leve y carcinoma microinvasor, ronquera y empeoramiento del tono, que a veces presenta cierto grado de aspereza. Mujer de 55 años, fumadora y padece EPOC. Se encuentra en tratamiento con Vilanterol y Bromuro de umeclidinio. Ninguna otra alergia, enfermedad o situación clínica reseñable. Refiere acudir al médico por padecer tos y ronquera, pareciendo su voz más grave de lo habitual. Le prescriben acetilcisteina, que no retira de la farmacia porque tenía un envase en su domicilio. Al día siguiente de comenzar el tratamiento acude a consultar a su farmacia comunitaria ya que refiere empeoramiento de la situación clínica, pareciendo una intensa disnea. INTERVENCIÓN: tras entrevista clínica y registro en la herramienta SEFAC e_XPERT se decide derivar al médico de familia con un informe por escrito, solicitando nueva valoración médica y en el que se recomienda suspender el tratamiento con la acetilcisteína por sospecha de que un incremento de la fluidez de las secreciones puede estar dando lugar a una obstrucción de las vías respiratorias, ya que la expectoración no es adecuada. También realizamos una primera intervención para lograr que la paciente abandone el consumo del tabaco. La paciente lo rechaza. EL médico de familia realiza una nueva valoración prescribiendo amoxicilina con clavulánico y prednisona. Realizamos seguimiento telefónico encontrando empeoramiento clínico a los 5 días de inicio del tratamiento antibiótico y antinflamatorio. La paciente refiere ronquera y tos intensa, aunque mejora de la disnea. Volvemos a insistir sobre la necesidad de dejar de fumar. Un familiar del paciente acude a la farmacia a recoger un nuevo informe por escrito donde recomendamos de nuevo valoración por parte del médico especialista. (AU)

Origin and population structure of Brazilian hair sheep breeds.

Brazilian hair sheep constitute a genetic diversity hotspot. These animals are found in the harsh environments of the Brazilian Northwest (semi-arid) region. Genotypes (50K SNP chip) from seven Brazilian sheep breeds (five hair and two coarse wool types) and 87 worldwide breeds were used to test for population structure, admixture and genetic diversity. Moreover, phylogenetic trees evaluating migration events between genetic groups were built. Brazilian Somali, a fat-tailed breed, had a close relationship with East African breeds and clustered distinctly from other Brazilian breeds. Brazilian Blackbelly and Barbados Blackbelly had a close relationship. The Morada Nova breed did not show close relationships with European or African breeds, revealing a single migration event from an Algerian hair breed. Brazilian Fat-tail and Morada Nova share a common ancestor, but the former showed introgressions from Brazilian Somali and Afrikaner breeds, explaining the fat-tail phenotype. The Santa Inês breed received a substantial contribution from Brazilian Bergamasca and showed an admixed origin with recent introgressions from other breeds, mainly from Suffolk. Furthermore, Brazilian Somali and Brazilian Fat-tail are the most endangered sheep genetic resources in Brazil and should be the focus for ex situ conservation programs. In conclusion, Brazilian hair sheep show an African origin and are characterized by diverse genetic composition, reinforcing the need for conservation of these genetic resources, and at the same time, this highly diverse group has variability that can be used in breeding programs.

Kinetics of peripheral blood neutrophils in severe coronavirus disease 2019.

OBJECTIVES: Emerging evidence of dysregulation of the myeloid cell compartment urges investigations on neutrophil characteristics in coronavirus disease 2019 (COVID-19). We isolated neutrophils from the blood of COVID-19 patients receiving general ward care and from patients hospitalised at intensive care units (ICUs) to explore the kinetics of circulating neutrophils and factors important for neutrophil migration and activation. METHODS: Multicolour flow cytometry was exploited for the analysis of neutrophil differentiation and activation markers. Multiplex and ELISA technologies were used for the quantification of protease, protease inhibitor, chemokine and cytokine concentrations in plasma. Neutrophil polarisation responses were evaluated microscopically. Gelatinolytic and metalloproteinase activity in plasma was determined using a fluorogenic substrate. Co-culturing healthy donor neutrophils with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) allowed us to investigate viral replication in neutrophils. RESULTS: Upon ICU admission, patients displayed high plasma concentrations of granulocyte-colony-stimulating factor (G-CSF) and the chemokine CXCL8, accompanied by emergency myelopoiesis as illustrated by high levels of circulating CD10-, immature neutrophils with reduced CXCR2 and C5aR expression. Neutrophil elastase and non-metalloproteinase-derived gelatinolytic activity were increased in plasma from ICU patients. Significantly higher levels of circulating tissue inhibitor of metalloproteinase 1 (TIMP-1) in patients at ICU admission yielded decreased total MMP proteolytic activity in blood. COVID-19 neutrophils were hyper-responsive to CXCL8 and CXCL12 in shape change assays. Finally, SARS-CoV-2 failed to replicate inside human neutrophils. CONCLUSION: Our study provides detailed insights into the kinetics of neutrophil phenotype and function in severe COVID-19 patients, and supports the concept of an increased neutrophil activation state in the circulation.

Blood Feeding Status, Gonotrophic Cycle and Survivorship of Aedes (Stegomyia) aegypti (L.) (Diptera: Culicidae) Caught in Churches from Merida, Yucatan, Mexico.

Blood-feeding status, gonotrophic cycle, and survival rates of Aedes (Stegmyia) aegypti (L.) was investigated in catholic churches from Merida, Yucatan. Female Ae. aegypti were caught using backpack aspirator during 25 consecutive days in rainy (2015) and dry season (2016). Blood-feeding status was determined by external examination of the abdomen and classified as unfed, fed, and gravid. Daily changes in the parous-nulliparous ratio were recorded, and the gonotrophic cycle length was estimated by a time series analysis. Also, was observed the vitellogenesis to monitoring egg maturity. In total, 408 females Ae. aegypti were caught, and there was a significant difference in the number of females collected per season (Z = -6.729, P ≤ 0.05). A great number was caught in the rainy season (n = 329). In the dry season, 79 females were caught, which the fed females were twice greatest than the unfed. The length of gonotrophic cycle was estimated on the base of a high correlation coefficient value appearing every 4 days in rainy at 26.7 ± 1.22°C, and 3 days in dry season at 29.8 ± 1.47°C. The daily survival rate of the Ae. aegypti population was higher in both seasons, 0.94 and 0.93 for the rainy and dry season, respectively. The minimum time estimated for developing mature eggs after blood feeding was similar in both seasons (3.5 days in rainy versus 3.25 days in dry). The measurement of the vectorial capacity of Ae. aegypti in catholic churches could help to understand the dynamics of transmission of arboviruses in sites with high human aggregation.

A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children.

The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).

Community Based Participatory Research to Reduce Oral Health Disparities in American Indian Children.

Community based participatory research is an approach aimed to equitably involve community members, representatives, and academic researchers in all aspects of the research process. Using this methodology can help integrate cultural knowledge into interventions, supporting researchers to effectively partner with communities in addressing health disparities. The Center for Native Oral Health Research (CNOHR) collaborates with two American Indian (AI) tribes to advance oral health knowledge and practice, including the conduct of randomized controlled clinical trials of culturally sensitive behavioral interventions for primary prevention of early childhood caries (ECC). This manuscript describes the development of researcher-community partnership, and the development and implementation of the two clinical trial in the community. It also gives a detailed account of the strategies developed through the community input in recruitment and retention of the study participants and finally the lessons learnt during the study implementation.

Resistencia antibiótica del Estafilococo Aureus en muestras purulentas

La resistencia antibiótica no ha podido ser detenida por barreras locales, nacionales e internacionales. Afecta a todos los individuos y poblaciones alrededor del mundo. Prácticamente desde el comienzo del uso de los antibióticos de la década del 40, se comenzó a detectar resistencia a drogas y tórpida evolución de los casos tratados.[AU]

Tarjeta de E/S con BUS PCI para un monitor de parámetros fisiológicos

Entre las partes de diseño específico de un monitor de parámetros fisiológicos se encuentra la tarjeta de Entrada/Salida (E/S), la cual permite el acople del teclado, de los módulos intercambiables, del registrador y de la bocina. Esta tarjeta se sitúa en la “motherboard” mediante un conector de bus ISA, pero en la actualidad se hace difícil adquirir “motherboards” que tengan estos conectores. Para resolver este problema se diseñó una tarjeta de E/S para bus PCI, con las mismas funciones y conexiones externas que su predecesora para bus ISA. Un componente esencial en este desarrollo es el Agente de Bus S5920, el cual de forma sencilla conecta el bloque de entrada/salida al Bus PCI. El uso del S5920 en esta aplicación facilita la compleja tarea de cumplir con los requisitos de tiempo y compatibilidad del Bus PCI, ya que es un Bus rigurosamente especificado. Se fabricó la maqueta de esta tarjeta, se puso en marcha, se pusieron a punto los programas y se confeccionó la documentación correspondiente. Se realizaron Ensayos de Maqueta, con resultados satisfactorios. Actualmente se halla en la fase de Prototipo, para su introducción a producción. Los resultados obtenidos satisfacen plenamente los objetivos planteados y sirven para asegurar la continuidad de producción y de servicio técnico de estos monitores de parámetros fisiológicos(AU)

Calibración de transductores y sensores de presión diferencial / Calibration of differential pressure sensors and transducers

En el desarrollo de equipos biomédicos se utilizan transductores y sensores para obtener las señales primarias y convertirlas en voltajes analógicos y digitales para su procesamiento y tratamiento con ayuda de la electrónica digital. En el presente trabajo se tratan los aspectos relacionados con la calibración y modelación de transductores de flujo-presión diferencial y de sensores de presión diferencial utilizadosen el desarrollo de espirómetros. La calibración y modelación de dispositivos se realiza para verificar primeramente sus Especificaciones Técnicas, verificar la instalación experimental de laboratorio y probar losmismos en su total gama de trabajo, en condiciones análogas a las de explotación. Se sugiere una metodología para realizar las observaciones, para el procesami ento de las tablas de datos y su resumen para la obtención de las ecuaciones de trabajo, para incorporarlas al software (SW) del equipo(AU)

[Maintenance of logopedic orientation in a patient with oropharyngeal dysphagia of neurogenic origin]. / El mantenimiento de las orientaciones logopédicas en el paciente con disfagia orofaríngea de origen neurogénico.

INTRODUCTION: Speech therapy treatment on patients who have a neurogenically induced dysphagia begins at hospital, in the intensive rehabilitation units. This study shows some of the difficulties found dealing with and orienting the family and the patient from a therapy point of view, mainly during his return to home surroundings. DEVELOPMENT: To better understand the dysphagic situation, normal swallowing steps (oral, pharyngeal and esophageal) steps have been described. These were then related to the dysphagic problems, with their evaluation, classification and characteristics. Under dysphagia rehabilitation the therapeutic guidance should be lead by the appropriate nutritional demands, and prevent aspirations. Some of the therapeutic procedures for treating and controlling neurogenic dysphagia have been described (head posture control, tactile and thermal stimuli, etc.). The author questions the difficulties found controlling orientation and maintaining conduct outside the hospital environment, principally with patients at risk from aspirations.

El mantenimiento de las orientaciones logopédicas en el pacientecon disfagia orofaríngea de origen neurogénico / Maintenance of logopedic orientation in a patient with oropharyngeal dysphagia of neurogenic origin

Introducción. La actuación logopédica en los pacientes con disfagias de origen neurogénico se inicia en los hospitales, incluso dentro de las unidades de rehabilitación intensiva. El presente trabajo intentará señalar algunas de las dificultades encontradas en la atención y orientación logopédica a la familia y al paciente, principalmente durante su regreso al hogar. Desarrollo. Se describen las etapas de la deglución normal (oral, faríngea y esofágica) para la comprensión del cuadro disfágico. A continuación, se relacionan las causas de los trastornos disfágicos, con sus características, forma de valoración y clasificación. En la rehabilitación de la disfagia, las orientaciones logopédicas deben adecuarse para posibilitar la nutrición necesaria y, al mismo tiempo, evitar aspiraciones. Se describen también algunos procedimientos terapéuticos en el tratamiento y control de la disfagia orofaríngea de origen neurogénico (controles posturales de cabeza, estimulaciones térmicas y táctiles, etc.). El autor cuestiona las dificultades encontradas para el control de las orientaciones y conductas de mantenimiento fuera del ámbito hospitalario, principalmente en los pacientes con riesgos de aspiraciones (AU)

La espirometría como herramienta de diagnóstico / Spirometry as a diagnostic tool

Este trabajo trata los aspectos relacionados con la Espirometría, sus generalidades, aplicaciones e importancia como herramienta clínica utilizada ampliamente en la evaluación del estado funcional del sistema respiratorio. Se abordan asimismo los requerimientos de la American Thoracic Society (ATS) para el diseño de espirómetros y se tratan los aspectos relacionados con el desarrollo de un espirómetro computadorizado de flujo desarrollado por los autores y sus características técnicas, brindando una tablade comparación con espirómetros tanto de tipo obstructivos como restrictivos o la presencia de ambos (mixtos) en un individuo, con lo cual se pueden lograr diagnósticos más fiables y precisos [4, 5]. Un espirómetro es un equipo o dispositivo que mide elvolumen y flujo de aire que entra y sale de lospulmones durante la ventilación, permite obtener el trazado o registro volumen-tiempo y el de flujo volumen de la respiración [2]. El estudio de la función pulmonar basado en la Espirometría también es denominado Prueba Funcional Ventilatoria (PFV)(AU)

Anti-fungal and cytokine producing activities of CD8 + T lymphocytes from HIV-1 infected individuals.

Lymphokine activated killer (LAK) cells are capable of killing not only malignant cells but also hyphal form of Candida albicans in vitro. When peripheral blood mononuclear cells (PBMC) from normal healthy donors were cultured for 72-96 hrs with 1,500 international unit (IU)/ml interleukin-2 (IL-2), marked LAK activity was induced. However, even prior to IL-2 activation, PBMC isolated from some normal subjects and those from almost all individuals who are infected by human immunodeficiency virus type 1 (HIV-1) exhibited significant levels of anti-fungal activity. Such pre-activation ("in situ") antifungal activity of PBMC decreased during the initial 48 hrs of IL-2 activation. PBMC from HIV-1 seropositive subjects showed higher levels of "in situ" anti-fungal activity than normal PBMC did. After a decline of "in situ" activity during the initial 48 hours, LAK activity gradually increased and reached near maximal levels by day 4 and remained more or less constant until day 6. No significant difference was observed between the LAK activity of normal and HIV-1(+) PBMCs on days 4-6. In IL-2 activated normal and HIV-1(+) PBMC cultures, both CD4 and CD8 T cells produced IL-2, INF-gamma as well as TNF-alpha. Production of IL-2 by both CD4 and CD8 T cells was suppressed in HIV-1(+) PBMC cultures, but no significant suppression of INF-gamma production was noted. Meanwhile, TNF-alpha production by CD4 was very much suppressed but no significant changes in TNF-alpha production by CD8 T cells was noted in HIV-1(+) PBMC cultures.

Anti-fungal and cytokine producing activities of CD8 + T lymphocytes from HIV-1 infected individuals

Lymphokine activated killer (LAK) cells are capable of killing not only malignant cells but also hyphal form of Candida albicans in vitro. When peripheral blood mononuclear cells (PBMC) from normal healthy donors were cultured for 72-96 hrs with 1,500 international unit (IU)/ml interleukin-2 (IL-2), marked LAK activity was induced. However, even prior to IL-2 activation, PBMC isolated from some normal subjects and those from almost all individuals who are infected by human immunodeficiency virus type 1 (HIV-1) exhibited significant levels of anti-fungal activity. Such pre-activation in situ antifungal activity of PBMC decreased during the initial 48 hrs of IL-2 activation. PBMC from HIV-1 seropositive subjects showed higher levels of in situ anti-fungal activity than normal PBMC did. After a decline of in situ activity during the initial 48 hours, LAK activity gradually increased and reached near maximal levels by day 4 and remained more or less constant until day 6. No significant difference was observed between the LAK activity of normal and HIV-1(+) PBMCs on days 4-6. In IL-2 activated normal and HIV-1(+) PBMC cultures, both CD4 and CD8 T cells produced IL-2, INF-gamma as well as TNF-alpha. Production of IL-2 by both CD4 and CD8 T cells was suppressed in HIV-1(+) PBMC cultures, but no significant suppression of INF-gamma production was noted. Meanwhile, TNF-alpha production by CD4 was very much suppressed but no significant changes in TNF-alpha production by CD8 T cells was noted in HIV-1(+) PBMC cultures

Carcinoma de tiroides luego de radioterapia de cuello. / Thyroid carcinoma after radiotherapy of the neck

Se presenta una observacion de cancer de tiroides originado en una glandula previamente irradiada durante el tratamiento de un neuroblastoma dorsal. Se hacen consideraciones historicas, clinicas y terapeuticas. Se concluye que la cirugia de eleccion, debe ser seguida de terapeutica supresiva y de control clinico seriado; frente a la recidiva se hara tiroidectomia total

The course of pregnancy in patients with artificial heart valves.

Twenty-five women with prosthetic heart valves (PHV) became pregnant 28 times. Twenty-six of the pregnancies occurred while the patients were receiving oral anticoagulants and these were continued throughout in 25 pregnancies. Dipyridamole or dipyridamole and acetylsalicyclic acid were used in 22 pregnancies. Eighteen infants were delivered, one with a congenital corneal leukoma; none had hemorrhagic complications; their psychomotor development was normal. Nine women aborted 10 times, including patients with two PHV, pelvic trauma and self-induced abortion. We could not detect excess anticoagulation in eight of the nine who had spontaneous losses; excess anticoagulation occurred five weeks before an abortion. There were no maternal deaths despite numerous complications; in two women, brain embolism was related to short interruptions of anticoagulation. The details of management are mentioned. We lack enough evidence to suggest routine sterilization, routine interruption of coumarin therapy during pregnancy or routine interruption of pregnancy in women with certain types and models of PHV; however, pregnancy under such conditions, plus antithrombotic therapy, carries a high risk for the product and a potential teratogenic effect. Women with one or two PHV can have children if their management is closely supervised and if extreme care is taken with the use of oral anticoagulants.