Cymbopogon citratus Essential Oil: Extraction, GC-MS, Phytochemical Analysis, Antioxidant Activity, and In Silico Molecular Docking for Protein Targets Related to CNS.

This study analyzed the chemical composition of Cymbopogon citratus essential oil from Puebla, México, assessed its antioxidant activity, and evaluated in silico protein-compound interactions related to central nervous system (CNS) physiology. GC-MS analysis identified myrcene (8.76%), Z-geranial (27.58%), and E-geranial (38.62%) as the main components, with 45 other compounds present, which depends on the region and growing conditions. DPPH and Folin-Ciocalteu assays using the leaves extract show a promising antioxidant effect (EC50 = 48.5 µL EO/mL), reducing reactive oxygen species. The bioinformatic tool SwissTargetPrediction (STP) shows 10 proteins as potential targets associated with CNS physiology. Moreover, protein-protein interaction diagrams suggest that muscarinic and dopamine receptors are related to each other through a third party. Molecular docking reveals that Z-geranial has higher binding energy than M1 commercial blocker and blocks M2, but not M4 muscarinic acetylcholine receptors, whereas ß-pinene and myrcene block M1, M2, and M4 receptors. These actions may positively affect cardiovascular activity, memory, Alzheimer's disease, and schizophrenia. This study highlights the significance of understanding natural product interactions with physiological systems to uncover potential therapeutic agents and advanced knowledge on their benefits for human health.

Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial.

Background:Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes.Introduction:We performed a 12-month randomized controlled trial to evaluate the impact of an online, collaborative connected health (CCH) model for psoriasis management on access to specialty care.Materials and Methods:The 300 enrolled patients were randomized to online or in-person care. We compared distance traveled as well as transportation and in-office waiting time between the two groups and obtained patient and provider perspectives on CCH.Results:At baseline, no differences existed between the groups in difficulties obtaining specialty care. Over 12 months, the mean (standard deviation [SD]) distance traveled to and from appointments was 174.8 (±577.4) km/person for the in-person group and 2.2 (±14.2) km/person for the online group (p = 0.0003). The mean (SD) time spent on transportation and in-office waiting for in-person appointments was 4.0 (±4.5) h/person for the in-person group and 0.1 (±0.4) h/person for the online group (p = 0.0001). Patients found CCH to be safe, accessible, equitable, efficient, effective, and patient-centered. Providers found CCH to be useful for providing psoriasis care.Discussion:The CCH model resulted in significantly less distance traveled as well as transportation and in-office waiting time compared to in-person care. Both patients and providers were highly satisfied with CCH.Conclusions:The CCH model resulted in increased access to specialty care and enabled patient-centered, safe, and effective management of psoriasis patients.

Using qualitative methods to understand factors contributing to patient satisfaction among dermatology patients: a systematic review.

PURPOSE: In this systematic review, we aimed to synthesize data that identify factors contributing to patient satisfaction in dermatology care using qualitative methods. MATERIALS AND METHODS: We performed a comprehensive search of the literature using the PubMed database for articles published between January 1, 2000 and February 9, 2015. The initial search yielded 186 articles, of which 13 were included after applying inclusion and exclusion criteria. RESULTS: The systematic review of 13 articles included a total of 330 patients. Using in-field observations and semistructured interviews, studies found that qualitative methods and analysis increased the provider's sensitivity to patient needs and enhanced patient care. Analyses using qualitative methods found increased patient satisfaction in their healthcare provider is associated with (1) confidence in the provider's diagnosis, (2) perception of patient-centered, individualized recommendations and (3) quality of patient education and provider explanation during a visit. CONCLUSIONS: Patient satisfaction is measured using either quantitative or qualitative methods. Quantitative methods result in standardized data that often does not capture the nuances of patient experience. In contrast, qualitative methodology is integral to gathering patient perspectives on patient care and satisfaction and should be included in future research models.

Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial.

Importance: Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes. Objective: To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care. Design, Setting, and Participants: The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis. Interventions: Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months. Main Outcomes and Measures: The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score. Results: Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was -0.27 (95% CI, -0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was -0.05% (95% CI, -1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was -0.11 (95% CI, -0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement. Conclusions and Relevance: The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases. Trial Registration: ClinicalTrials.gov Identifier: NCT02358135.

Hidradenitis suppurativa and diabetes mellitus: A systematic review and meta-analysis.

BACKGROUND: The relationship between hidradenitis suppurativa and diabetes mellitus is not well understood. OBJECTIVE: To compare the prevalence of diabetes mellitus between patients with and without hidradenitis suppurativa. METHODS: We conducted a systematic review and meta-analysis, which included primary observational studies that reported the prevalence of diabetes mellitus among patients with hidradenitis suppurativa in the PubMed, Embase, Cochrane Library, LILACS, and Scielo databases from 1947 to June 13, 2017. A random effects model for pooled odds ratio was used for data analysis. Publication bias was assessed by funnel plot and the Egger test. RESULTS: The systematic review included 107,050 patients from 14 studies; the meta-analysis included 104,373 patients from 7 studies. On the basis of meta-analysis, the prevalence of diabetes mellitus was 10.6% in patients with hidradenitis suppurativa and 3.8% in patients without hidradenitis suppurativa. Compared with the general population, patients with hidradenitis suppurativa were nearly 3 times more likely to have diabetes mellitus (pooled odds ratio, 2.78; 95% confidence interval, 1.79-4.31). LIMITATIONS: We were restricted by the quantity and quality of available data. CONCLUSION: Hidradenitis suppurativa is significantly associated with an increased prevalence of diabetes mellitus.

Are patients comprehending? A critical assessment of online patient educational materials.

PURPOSE: The primary aim of this study was to evaluate the readability, understandability, suitability and actionability of online psoriasis patient educational materials. A secondary aim was to identify areas for improvement. MATERIALS AND METHODS: We conducted an evaluation study to assess online psoriasis patient educational materials from the American Academy of Dermatology and National Psoriasis Foundation available in July 2017. We used two validated assessment tools specific to online healthcare materials. Outcomes were expressed as percentages, where higher percentages corresponded to higher quality materials. RESULTS: Overall, the educational materials had a mean understandability score (72.7%) that was understandable; a suitability score (58.8%) that was adequate; a reading grade level (10.5) that was not readable; and an actionability score (54.7%) that was not actionable. Areas of improvement include reading grade level, visual aids, word choice, specific steps for actions and cultural appropriateness. CONCLUSIONS: Online psoriasis patient educational materials are understandable and suitable, but they are written above the American Medical Association and National Institutes of Health's recommended 6th-8th grade reading level and are not actionable. Materials can benefit from decreasing reading grade level, including more visual elements, incorporating more actionable items and being culturally inclusive.

Patient-Reported Outcome Measures for Pediatric Psoriasis: A Systematic Review and Critical Appraisal from International Dermatology Outcome Measures (IDEOM).

Childhood onset psoriasis has a profound impact on the development and quality of life of pediatric patients. Consequently, validated patient-reported outcome measures (PROMs) for pediatric psoriasis are vital to patient care. We sought to critically appraise the literature on the measurement properties of PROMs used in the pediatric psoriasis population. We performed a 2-stage systematic literature synthesis in MEDLINE (1950-2017) and EMBASE (1947-2017) to identify PROMs and studies evaluating their measurement properties. Analysis of studies followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology to inform a best evidence synthesis. From 1,128 articles, we identified 29 PROMs. Subsequently, we identified 8 studies evaluating the measurement properties of 7 instruments. Among these instruments, the Simplified Psoriasis Index (SPI) achieved a positive rating for criterion validity, the Dutch version of the Children's Dermatology Life Quality Index (CDLQI) achieved a positive rating for hypothesis testing, and the Swedish version of the CDLQI achieved a negative rating for hypothesis testing. All other assessed measurement properties received indeterminate or unknown ratings due to flaws in study design. PROMs are paramount to the management of pediatric psoriasis. This synthesis emphasizes the critical need for additional studies to further describe the measurement properties of PROMs used in pediatric psoriasis and identify validated, standardized measures for use in clinical practice and research.

Winds measured by the Rover Environmental Monitoring Station (REMS) during the Mars Science Laboratory (MSL) rover's Bagnold Dunes Campaign and comparison with numerical modeling using MarsWRF.

A high density of REMS wind measurements were collected in three science investigations during MSL's Bagnold Dunes Campaign, which took place over ~80 sols around southern winter solstice (Ls~90°) and constituted the first in situ analysis of the environmental conditions, morphology, structure, and composition of an active dune field on Mars. The Wind Characterization Investigation was designed to Available online 14 December 2016 fully characterize the near-surface wind field just outside the dunes and confirmed the primarily upslope/downslope flow expected from theory and modeling of the circulation on the slopes of Aeolis Mons in this season. The basic pattern of winds is 'upslope' (from the northwest, heading up Aeolis Mons) during the daytime (~09:00-17:00 or 18:00) and 'downslope' (from the southeast, heading down Aeolis Mons) at night (~20:00 to some time before 08:00). Between these times the wind rotates largely clockwise, giving generally westerly winds mid-morning and easterly winds in the early evening. The timings of these direction changes are relatively consistent from sol to sol; however, the wind direction and speed at any given time shows considerable intersol variability. This pattern and timing is similar to predictions from the MarsWRF numerical model, run at a resolution of ~490 m in this region, although the model predicts the upslope winds to have a stronger component from the E than the W, misses a wind speed peak at ~09:00, and under-predicts the strength of daytime wind speeds by ~2-4 m/s. The Namib Dune Lee Investigation reveals 'blocking' of northerly winds by the dune, leaving primarily a westerly component to the daytime winds, and also shows a broadening of the 1 Hz wind speed distribution likely associated with lee turbulence. The Namib Dune Side Investigation measured primarily daytime winds at the side of the same dune, in support of aeolian change detection experiments designed to put limits on the saltation threshold, and also appears to show the influence of the dune body on the local flow, though less clearly than in the lee. Using a vertical grid with lower resolution near the surface reduces the relative strength of nighttime winds predicted by MarsWRF and produces a peak in wind speed at ~09:00, improving the match to the observed diurnal variation of wind speed, albeit with an offset in magnitude. The annual wind field predicted using this grid also provides a far better match to observations of aeolian dune morphology and motion in the Bagnold Dunes. However, the lower overall wind speeds than observed and disagreement with the observed wind direction at ~09:00 suggest that the problem has not been solved and that alternative boundary layer mixing schemes should be explored which may result in more mixing of momentum down to the near-surface from higher layers. These results demonstrate a strong need for in situ wind data to constrain the setup and assumptions used in numerical models, so that they may be used with more confidence to predict the circulation at other times and locations on Mars.

II Curso Internacional de Enfermeria Pediatrica. Cuidados intensivos en pediatria: Traumatismo craneoencefalico / s

Traumatismo caraneoencefalico. Tratamiento. Estudios radiologicos. Cuidados de enfermeria. Cuidados preoperatorios. Cuidados posoperatorios. Edema cerebral. Tratamiento. Atencion de enfermeria

II Curso Internacional de Enfermeria Pediatrica. Cuidados Intensivos en Pediatria: Planeacion, organizacion y funcionamiento de una Unidad de Cuidados Intensivos Pediatricos / s

Definicion. Objetivos. Tamaño y ubicacion de la Unidad. Material y equipo. Recursos humanos. Seleccion de las enfermeras para la unidad. Relaciones de la Unidad con otros servicios o departamentos

II Curso Internacional de Enfermeria Pediatrica. Cuidados Intensivos en Pediatria: Iatrogenias / s

Concepto. Causas. Factores condicionantes. Iatrogenias mas frecuentes. Estrategias de solucion. Conclusiones

II Curso Internacional de Enfermria Pediatrica. Cuidados Intensivos en Pediatria: Oxigenoterapia / s

Concepto. Objetivo. Indicaciones. Metodos de oxigenoterapia. Efectos toxicos de la oxigenoterapia. Riesgos y complicaciones. Humidificacion y nebulizacion. Nebulizadores. Indicaciones. Aspiracion de secreciones de las vias aereas. Complicaciones

II Curso Internacional de Enfermeria Pediatrica. Cuidados Intensivos en Pediatria / s

Cuidados intensivos en enfermedades respiratorias. Insuficiencia respiratoria aguda grave. Intubacion endotraqueal. Ventilacion asistida. Cuidados intensivos en padecimientos cardiovasculares. Choque. Intoxicacion digitalica. Cuidados intensivos en alteraciones neurologicas: Hemorragia intracraneana. Estado de coma. Muerte cerebral. Nutricion parenteral total. Aspectos psicosociales de la Unidad de Cuidados Intensivos Pediatricos

II Curso internacional de Terapia Intensiva en Enfermeria Pediatrica: Intoxicaciones / s

Definicion. Etiologia. Sintomatologia. Manejo y tratamiento. Atencion de enfermeria. Medidas especificas. Profilaxis