The use of digital escape rooms in nursing education.

Negative attitudes and prejudices towards people with a mental disorder are common across cultures and societies. The stigma associated with mental illness leads to a lower quality of life, given the discrimination and social exclusion suffered by people with this type of disorder. In the field of health, research has shown that doctors and nurses also manifest these types of stigmatizing behaviors and attitudes. The present study aims to create and apply an educational escape room for the purpose of training nursing students in mental health, promoting positive attitudes towards people who have a mental disorder. To do so, a pre-post study was conducted with an experimental group and a control group to determine whether the escape room was effective for the modification of stigmatizing behaviors compared to transmissive lecture class, and a third measurement was made at 6 months only to the experimental group to evaluate whether the changes produced by the escape room were maintained in the long term. The results indicate that the students participating in the study obtained better scores in sensitization and these remain better over time. It is concluded that the escape room used is suitable for the training and sensitization of future nursing professionals in the field of mental health, facilitating the learning of knowledge and positive attitudes towards severe mental disorder.

Endocarditis caused by anaerobic bacteria.

BACKGROUND: Infective endocarditis (IE) caused by anaerobic bacteria is a rare and poorly characterized disease. Most data reported in the literature are from case reports [1-3]. Therefore, we assessed the situation of anaerobic IE (AIE) in Spain using the database of the Spanish Collaboration on Endocarditis (GAMES). METHODS: We performed a prospective study from 2008 to 2016 in 26 Spanish centers. We included 2491 consecutive cases of definite IE (Duke criteria). RESULTS: Anaerobic bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years (IQR, 56-73), and 19 (86.4%) patients were men. Most patients (14 [63.6%]) had prosthetic valve IE and all episodes were left-sided: aortic valves, 12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic. Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality was 18.2% during admission and 5.5% after 1 year of follow-up. When patients with AIE were compared with the rest of the cohort, we found that although those with AIE had a similar age and Charlson comorbidity index, they were more likely to have community-acquired IE (86.4% vs. 60.9%, p = 0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have had lower mortality rates during admission (18.2% vs. 27.3%). CONCLUSION: IE due to anaerobic bacteria is an uncommon disease that affects mainly prosthetic valves and frequently requires surgery. Otherwise, there are no major differences between AIE and IE caused by other microorganisms.

The use of ertapenem for the treatment of community-acquired pneumonia in routine hospital practice: a matched cohort study.

OBJECTIVE: The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated. METHODS: We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014. RESULTS: Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years.). A significant higher proportion of bedridden patients (41% vs. 21%), residence in nursing homes (19% vs. 7%), previous use of antibiotics (39% vs. 29%) and necrotizing (13% vs. 1%) or complicated (36% vs. 19%) pneumonia, was observed in the ertapenem vs. non-ertapenem patients. Initial treatment with ertapenem was independently associated with an earlier resolution of signs of infection. In patients aged 65 or older the independent risks factors for mortality were: PSI score (7.0, 95%CI 1.8-27.7), bedridden status (4.6, 95%CI 1.1-20.9) and Health Care Associated Pneumonia (HCAP) (4.6, 95%CI 1.3-16.5). First-line treatment with ertapenem was an independent protector factor in this subgroup of patients (0.1, 95%CI 0.1-0.7). CONCLUSIONS: Ertapenem showed a superior clinical response in frail elderly patients with complicated community-acquired pneumonia, and it may be considered as a first-line therapeutic regimen in this setting.

Left-sided infective endocarditis in patients with liver cirrhosis.

OBJECTIVE: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.

Melatonin increases intracellular calcium in the liver, muscle, white adipose tissues and pancreas of diabetic obese rats.

Melatonin, a widespread substance with antioxidant and anti-inflammatory properties, has been found to act as an antidiabetic agent in animal models, regulating the release and action of insulin. However, the molecular bases of this antidiabetic action are unknown, limiting its application in humans. Several studies have recently shown that melatonin can modify calcium (Ca(2+)) in diabetic animals, and Ca(2+) has been reported to be involved in glucose homeostasis. The objective of the present study was to assess whether the antidiabetic effect of chronic melatonin at pharmacological doses is established via Ca(2+) regulation in different tissues in an animal model of obesity-related type 2 diabetes, using Zücker diabetic fatty (ZDF) rats and their lean littermates, Zücker lean (ZL) rats. After the treatments, flame atomic absorption spectrometry was used to determine Ca(2+) levels in the liver, muscle, main types of internal white adipose tissue, subcutaneous lumbar fat, pancreas, brain, and plasma. This study reports for the first time that chronic melatonin administration (10 mg per kg body weight per day for 6 weeks) increases Ca(2+) levels in muscle, liver, different adipose tissues, and pancreas in ZDF rats, although there were no significant changes in their brain or plasma Ca(2+) levels. We propose that this additional peripheral dual action mechanism underlies the improvement in insulin sensitivity and secretion previously documented in samples from the same animals. According to these results, indoleamine may be a potential candidate for the treatment of type 2 diabetes mellitus associated with obesity.

CD27+ B cells from a subgroup of common variable immunodeficiency patients are less sensitive to apoptosis rescue regardless of interleukin-21 signalling.

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by hypogammaglobulinaemia and recurrent infections. Although the underlying cause is unknown, B cells from most CVID patients fail to differentiate to memory or plasma cells. We investigated if increased apoptosis could influence the fate of B cells. For this purpose we activated purified B lymphocytes of CVID patients with a surrogate T-dependent (anti-CD40) or T-independent [cytosine-phosphate-guanosine oligodeoxynucleotides (CpG-ODN) or anti-immunoglobulin (Ig)M)] stimulus with or without interleukin (IL)-21. We found that CD27(+) B cells were more sensitive than CD27(-) B cells to spontaneous apoptosis and less sensitive to rescue from apoptosis. The addition of IL-21 down-modulated the protective effect of all the stimuli on CD27(-) B cells and the protective effect of CpG-ODN and anti-IgM on CD27(+) B cells. In contrast, IL-21 rescued unstimulated CD27(-) B cells and improved the rescue of anti-CD40-stimulated CD27(+) B cells. When we compared patients and controls, mainly CD27(+) B cells from MB0 patients were less sensitive to rescue from apoptosis than those from MB1 patients and controls after activation, irrespective of the IL-21 effect. Increased apoptosis during an immune response could result in lower levels of immunoglobulin production in these patients.

IOFF generally extends fluorophore longevity in the presence of an optical trap.

The combination of optical tweezers force microscopy and single molecule fluorescence has previously been complicated by trap-induced photobleaching. Recent studies have suggested that this effect is caused by a sequential absorption of photons, leading to ionization of the fluorescent singlet state. In this work, we show the range of effects of optical trapping radiation on common fluorescent dyes. Using the interlaced optical force fluorescence (IOFF) laser modulation technique, we show that the removal of simultaneous near infrared radiation dramatically reduces photobleaching effects. However, these studies show that the sequential addition of near infrared radiation in some cases extends photobleaching longevity beyond the natural intrinsic decay. We suggest a refined photoelectronic mechanism that accounts for the possibility of reverse intersystem crossing from a reactive triplet state and explains the nature of trap-induced photobleaching.

[Effects of contrast, eccentricity and position in the detection of visual stimuli in humans]. / Efectos del contraste, excentricidad y posicion en la deteccion de estimulos visuales en humanos.

INTRODUCTION: Contrast, eccentricity and position of stimuli used on research of attention in human vision strongly vary among studies. AIM. To study how contrast, eccentricity and position affects detection of stimuli in humans. SUBJECTS AND METHODS: In adults with normal vision, we measured response times to stimuli (gray circles of 0.5 masculine of diameter) presented at random at eight polar coordinates, in three eccentricities with respect of fixation point (2.15, 3.83 and 5.53 masculine) and with three levels of contrast (6, 16 and 78%). RESULTS: Stimuli with eccentricity of 5.38 masculine and 6% of contrast showed the longest response times. In all eccentricities studied, longer response times were found with stimuli of 6% of contrast. Response times of stimuli of 16% and 78% of contrast showed similar response times in all eccentricities studied. Response times founded at eight polar coordinates were heterogeneous at eccentricities of 2.15 and 5.53 masculine, but not at 3.83 masculine. CONCLUSIONS: Contrast is the factor that most influence detection of visual stimuli used in this study, particularly at the biggest eccentricity employed. Response times among polar coordinates are also affected by eccentricities of 2.15 and 5.53 masculine, suggesting that distance of stimuli to fixation point is critical for visual detection of stimuli.

Efectos del contraste, excentricidad y posición en la detección de estímulos visuales en humanos / Effects of contrast, eccentricity and position in the detection of visual stimuli in humans

Introducción. Los estudios en humanos sobre percepción visual espacial tienen en común proyectar estímulos en laretina central, pero difieren notablemente en cuanto a su contraste, excentricidad y posición en el campo visual. Objetivo. Estudiar los efectos del contraste, excentricidad y posición en la detección de estímulos visuales presentados en la retina central humana. Sujetos y métodos. Se estudiaron los tiempos de respuesta, en personas con visión normal, a la presentación de estímulos (círculos grises de 0,5º de diámetro) presentados al azar en ocho coordenadas polares, con tres excentricidades (2,15,3,83 y 5,53º) y tres niveles de contraste (6, 16 y 78%). Resultados. Los estímulos presentados a 5,53º de excentricidad y contraste del 6% mostraron los tiempos de respuesta más elevados. Con este contraste, los tiempos de respuesta fueron mayores en todaslas excentricidades estudiadas. Por el contrario, con contrastes del 16 y 78%, los tiempos de respuesta fueron similares en las tres excentricidades. Para las ocho coordenadas polares, los tiempos de respuesta fueron homogéneos en la excentricidad de 3,83º y mostraron mayor variabilidad en las excentricidades de 2,15 y 5,53º. Conclusiones. De los tres factores analizados,el contraste es determinante en la detección de estímulos, especialmente en la excentricidad mayor. La posición también influye cuando los estímulos se presentan con excentricidades pequeñas o grandes, lo que sugiere que la distancia de los estímulos respecto al punto de fijación es crítica en la detección visual en este tipo de estudios

Introduction. Contrast, eccentricity and position of stimuli used on research of attention in human vision strongly vary among studies. Aim. To study how contrast, eccentricity and position affects detection of stimuli in humans. Subjects and methods. In adults with normal vision, we measured response times to stimuli (gray circles of 0.5º of diameter) presented at random at eight polar coordinates, in three eccentricities with respect of fixation point (2.15, 3.83 and 5.53º) and with three levels of contrast (6, 16 and 78%). Results. Stimuli with eccentricity of 5.38º and 6% of contrast showed the longest response times. In all eccentricities studied, longer response times were found with stimuli of 6% of contrast. Response times of stimuliof 16% and 78% of contrast showed similar response times in all eccentricities studied. Response times founded at eight polar coordinates were heterogeneous at eccentricities of 2.15 and 5.53º, but not at 3.83º. Conclusions. Contrast is the factor thatmost influence detection of visual stimuli used in this study, particularly at the biggest eccentricity employed. Response times among polar coordinates are also affected by eccentricities of 2.15 and 5.53º, suggesting that distance of stimuli to fixationpoint is critical for visual detection of stimuli

Phenotypic characterisation of T-lymphocytes in COPD: abnormal CD4+CD25+ regulatory T-lymphocyte response to tobacco smoking.

Tobacco smoking induces an inflammatory response in the lungs of all smokers but, for reasons that are still poorly understood, only a proportion of them develop chronic obstructive pulmonary disease (COPD). Recent evidence indicates that this inflammatory response persists after smoking cessation, suggesting some type of auto-perpetuation mechanism similar to that described in autoimmune disorders. T-lymphocytes (CD4+ and CD8+) have been implicated in the pathogenesis of both COPD and several autoimmune processes. A subtype of regulatory CD4+ T-cells expressing CD25 (Tregs) plays a critical role in the maintenance of peripheral tolerance and the prevention of autoimmunity, but their potential role in COPD has not been explored. The present study sought to evaluate maturation (CD45RA/CD45R0) and activation markers (CD28) of T-lymphocytes and to explore potential Treg abnormalities in COPD. Flow cytometry was used to characterise T-lymphocytes obtained from blood and bronchoalveolar lavage fluid (BALF) in 23 patients with moderate COPD, 29 smokers with normal lung function and seven never-smokers. The main findings were that in BALF: patients with COPD showed higher CD8+CD45RA+ and lower CD8+CD45R0+ than smokers with normal lung function; and compared with never-smokers, smokers with preserved lung function showed a prominent upregulation of Tregs that was absent in patients with COPD. These observations indicate a final maturation-activation state of CD8+ T-lymphocytes in chronic obstructive pulmonary disease and, for the first time, identify a blunted regulatory T-cell response to tobacco smoking in these patients, further supporting a potential involvement of the acquired immune response in the pathogenesis of the disease.