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Clostridioides difficile (C. difficile) is widely distributed in the intestinal tract of humans, animals, and in the environment. It is the most common cause of diarrhea associated with the use of antimicrobials in humans and among the most common healthcare-associated infections worldwide. Its pathogenesis is mainly due to the production of toxin A (TcdA), toxin B (TcdB), and a binary toxin (CDT), whose genetic variants may be associated with disease severity. We studied genetic diversity in 39 C. difficile isolates from adults and children attended at two Mexican hospitals, using different gene and genome typing methods and investigated their association with in vitro expression of toxins. Whole-genome sequencing in 39 toxigenic C. difficile isolates were used for multilocus sequence typing, tcdA, and tcdB typing sequence type, and phylogenetic analysis. Strains were grown in broth media, and expression of toxin genes was measured by real-time PCR and cytotoxicity in cell-culture assays. Clustering of strains by genome-wide phylogeny matched clade classification, forming different subclusters within each clade. The toxin profile tcdA+/tcdB+/cdt+ and clade 2/ST1 were the most prevalent among isolates from children and adults. Isolates presented two TcdA and three TcdB subtypes, of which TcdA2 and TcdB2 were more prevalent. Prevalent clades and toxin subtypes in strains from children differed from those in adult strains. Toxin gene expression or cytotoxicity was not associated with genotyping or toxin subtypes. In conclusion, genomic and phenotypic analysis shows high diversity among C. difficile isolates from patients with healthcare-associated diarrhea. IMPORTANCE: Clostridioides difficile is a toxin-producing bacterial pathogen recognized as the most common cause of diarrhea acquired primarily in healthcare settings. This bacterial species is diverse; its global population has been divided into five different clades using multilocus sequence typing, and strains may express different toxin subtypes that may be related to the clades and, importantly, to the severity and progression of disease. Genotyping of children strains differed from adults suggesting toxins might present a reduced toxicity. We studied extensively cytotoxicity, expression of toxins, whole genome phylogeny, and toxin typing in clinical C. difficile isolates. Most isolates presented a tcdA+/ tcdB+/cdt+ pattern, with high diversity in cytotoxicity and clade 2/ST1 was the most prevalent. However, they all had the same TcdA2/TcdB2 toxin subtype. Advances in genomics and bioinformatics tools offer the opportunity to understand the virulence of C. difficile better and find markers for better clinical use.
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Toxinas Bacterianas , Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Diarrea , Variación Genética , Tipificación de Secuencias Multilocus , Filogenia , Humanos , Clostridioides difficile/genética , Clostridioides difficile/clasificación , Clostridioides difficile/aislamiento & purificación , Diarrea/microbiología , Diarrea/epidemiología , México/epidemiología , Niño , Toxinas Bacterianas/genética , Adulto , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Proteínas Bacterianas/genética , Enterotoxinas/genética , Masculino , Preescolar , Femenino , Prevalencia , Adolescente , Secuenciación Completa del Genoma , Fenotipo , Genoma Bacteriano/genética , Lactante , Persona de Mediana Edad , GenómicaRESUMEN
While Aß and Tau cellular distribution has been largely studied, the comparative internalization and subcellular accumulation of Tau and Aß isolated from human brain extracts in endothelial and neuronal cells has not yet been unveiled. We have previously demonstrated that controlled enrichment of Aß from human brain extracts constitutes a valuable tool to monitor cellular internalization in vitro and in vivo. Herein, we establish an alternative method to strongly enrich Aß and Tau aggregates from human AD brains, which has allowed us to study and compare the cellular internalization, distribution and toxicity of both proteins within brain barrier endothelial (bEnd.3) and neuronal (Neuro2A) cells. Our findings demonstrate the suitability of human enriched brain extracts to monitor the intracellular distribution of human Aß and Tau, which, once internalized, show dissimilar sorting to different organelles within the cell and differential toxicity, exhibiting higher toxic effects on neuronal cells than on endothelial cells. While tau is strongly concentrated preferentially in mitochondria, Aß is distributed predominantly within the endolysosomal system in endothelial cells, whereas the endoplasmic reticulum was its preferential location in neurons. Altogether, our findings display a picture of the interactions that human Aß and Tau might establish in these cells.
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Péptidos beta-Amiloides , Células Endoteliales , Neuronas , Proteínas tau , Humanos , Proteínas tau/metabolismo , Péptidos beta-Amiloides/metabolismo , Neuronas/metabolismo , Células Endoteliales/metabolismo , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/patología , Encéfalo/metabolismo , Animales , Ratones , Mitocondrias/metabolismo , Línea CelularRESUMEN
The "orgasm gap" for women who have sex with men remains a pressing gender equity issue. Recent research found that women who pursued orgasm as a goal were more likely to have one. The current research replicated this relationship between orgasm goal pursuit and orgasm frequency for heterosexual women, and found that this relationship did not exist for heterosexual men (Study 1). Then, across two experimental studies, we examined how heterosexual women vary their orgasm goal pursuit across sexual encounters. In Study 2, women who read that a hypothetical sexual encounter would be "quick" reported less intent to pursue orgasm than women who were told they could "take their time" or received no time information. In Study 3, women who read that their hypothetical sexual partner seemed selfish reported less intent to pursue orgasm than women who were given a non-selfish partner or no partner information. Importantly, these effects were mediated by women's perceived orgasm likelihood in the scenario. These results suggest that women shift their pursuit of orgasm depending on cues which signal whether orgasm will be feasible. This research used self-regulation theory to understand women's motivations for pursuing orgasm during sexual encounters with men, with implications for reducing the orgasm gap.
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Heterosexualidad , Orgasmo , Masculino , Humanos , Femenino , Orgasmo/fisiología , Motivación , Señales (Psicología) , Estudios de Factibilidad , Objetivos , Conducta Sexual , Parejas SexualesRESUMEN
BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.
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Escabiosis , Humanos , Femenino , Escabiosis/tratamiento farmacológico , Escabiosis/epidemiología , España/epidemiología , Estudios Transversales , Insuficiencia del Tratamiento , Academias e InstitutosRESUMEN
BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.
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Escabiosis , Humanos , Femenino , Escabiosis/diagnóstico , Escabiosis/tratamiento farmacológico , Escabiosis/epidemiología , España/epidemiología , Estudios Transversales , Insuficiencia del Tratamiento , Academias e InstitutosRESUMEN
Background: Comorbidities may influence the levels of blood-based biomarkers for Alzheimer's disease (AD). We investigated whether differences in risk factors or comorbid conditions might explain the discordance between clinical diagnosis and biomarker classifications in a multi-ethnic cohort of elderly individuals. Aims: To evaluate the relationship of medical conditions and other characteristics, including body mass index (BMI), vascular risk factors, and head injury, with cognitive impairment and blood-based biomarkers of AD, phosphorylated tau (P-tau 181, P-tau 217), in a multi-ethnic cohort. Methods: Three-hundred individuals, aged 65 and older, were selected from a prospective community-based cohort for equal representation among three racial/ethnic groups: non-Hispanic White, Hispanic/Latino and African American/Black. Participants were classified into four groups based on absence (Asym) or presence (Sym) of cognitive impairment and low (NEG) or high (POS) P-tau 217 or P-tau 181 levels, determined previously in the same cohort: (Asym/NEG, Asym/POS, Sym/NEG, Sym/POS). We examined differences in individual characteristics across the four groups. We performed post-hoc analysis examining the differences across biomarker and cognitive status. Results: P-tau 217 or P-tau 181 positive individuals had lower BMI than P-tau negative participants, regardless of symptom status. Symptomatic and asymptomatic participants did not differ in terms of BMI. BMI was not a mediator of the effect of P-tau 217 or P-tau 181 on dementia. Frequencies of other risk factors did not differ between the four groups of individuals. Conclusions: Participants with higher levels of P-tau 217 or P-tau 181 consistent with AD had lower BMI regardless of whether the individual was symptomatic. These findings suggest that weight loss may change with AD biomarker levels before onset of cognitive decline. They do not support BMI as a confounding variable. Further longitudinal studies could explore the relationship of risk factors with clinical diagnoses and biomarkers.
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The use of osteometry for human identification is a key element in the field of forensic sciences. Currently, the osteometry focuses on the use of digital techniques such as photography or 3D scans, to study and measure bones, offering advantages like easy access, preservation of bones, and worldwide collaboration possibilities. The study aims to analyze whether digital tools such as Anatomage can be used to collect reliable data. The study compares measurements of the sacral bone from 41 individuals from Orgiva Collection using both traditional and digital methods. The variables analyzed were described previously, including landmarks and positions, and were coded by differentiating the measurements between dry bone (caliper) and digital measurement (Anatomage). Results indicate minimal differences between digital and dry bone measurements, with only one variable showing a significant differences in the effect size analysis (d > 0.80). The TEM analysis showed four variables as non-acceptable (rTEM > 1.5), possibly due to the landmark location or the experience using the tool to locate landmarks. Digital resources are valuable for morphometric evaluations and human identification within forensic sciences. However, caution is necessary to ensure accurate landmark localization and validate these tools across various bone types and larger sample sizes.
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Huesos , Antropología Forense , Humanos , Huesos/diagnóstico por imagen , Sacro/diagnóstico por imagen , Pesos y Medidas Corporales , Ciencias ForensesRESUMEN
El presente estudio tuvo como objetivo evaluar el impacto de una unidad didáctica de Educación Física (EF) sobre la satisfacción en las clases de EF, la satisfacción de las necesidades psicológicas básicas, la motivación, el clima social escolar y el rendimiento cognitivo. Se utilizó un diseño cuasi-experimental con grupo control para una muestra total de 120 estudiantes de Educación Secundaria (M = 13,48; DT = 1,36) a los que se les administró un cuestionario para analizar las variables de estudio. Se aplicó la unidad didáctica basada en la hibridación de la gamificación y el aprendizaje cooperativo (GF + CL) durante 8 sesiones. El programa mostró mejoras en el índice de mediadores psicológicos, la función ejecutiva de la planificación, la satisfacción de los alumnos de educación física y el clima social escolar, lo que podría ser adecuado para mejorar el rendimiento de los profesores de educación física en los centros educativos. (AU)
The present study aimed to assess the impact of a Physical Education (PE) teaching unit on PE satisfaction classes, basic psychological needs satisfaction, motivation, school social climate and cognitive performance. A quasi-experimental design with a control group was used for a total sample of 120 students of Secondary Education (M = 13,48; SD = 1,36) to whom a questionnaire was administered to analyse the study variables. The teaching unit based on the hybridization of gamification and Cooperative Learning (GF + CL) was applied for 8 sessions. The programme showed improvements in the psychological mediators index, executive function of planning, the PE students satisfaction and the school social climate, which would make it suitable for the improvement in the performance of PE teachers in educational centres. (AU)
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Humanos , Masculino , Femenino , Adolescente , Educación y Entrenamiento Físico/tendencias , Satisfacción Personal , Encuestas y Cuestionarios , Educación Primaria y Secundaria , EspañaRESUMEN
Electrocyclic reactions are characterized by the concerted formation and cleavage of both σ and π bonds through a cyclic structure. This structure is known as a pericyclic transition state for thermal reactions and a pericyclic minimum in the excited state for photochemical reactions. However, the structure of the pericyclic geometry has yet to be observed experimentally. We use a combination of ultrafast electron diffraction and excited state wavepacket simulations to image structural dynamics through the pericyclic minimum of a photochemical electrocyclic ring-opening reaction in the molecule α-terpinene. The structural motion into the pericyclic minimum is dominated by rehybridization of two carbon atoms, which is required for the transformation from two to three conjugated π bonds. The σ bond dissociation largely happens after internal conversion from the pericyclic minimum to the electronic ground state. These findings may be transferrable to electrocyclic reactions in general.
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Reliable neutron star mass measurements are key to determining the equation of state of cold nuclear matter, but such measurements are rare. Black widows and redbacks are compact binaries consisting of millisecond pulsars and semi-degenerate companion stars. Spectroscopy of the optically bright companions can determine their radial velocities, providing inclination-dependent pulsar mass estimates. Although inclinations can be inferred from subtle features in optical light curves, such estimates may be systematically biased due to incomplete heating models and poorly understood variability. Using data from the Fermi Large Area Telescope, we have searched for gamma-ray eclipses from 49 spider systems, discovering significant eclipses in 7 systems, including the prototypical black widow PSR B1957+20. Gamma-ray eclipses require direct occultation of the pulsar by the companion, and so the detection, or significant exclusion, of a gamma-ray eclipse strictly limits the binary inclination angle, providing new robust, model-independent pulsar mass constraints. For PSR B1957+20, the eclipse implies a much lighter pulsar (1.81 ± 0.07 solar masses) than inferred from optical light curve modelling.
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Objetivo Describir las principales alteraciones retinianas detectadas por screening con cámara retinal no midriática y evaluar los factores relacionados con la derivación a oftalmología en una población de alto riesgo cardiovascular en Palmira, Colombia. Materiales y métodos Estudio observacional de tipo transversal, con 11.983 registros fotográficos de pacientes con hipertensión y diabetes mellitus del programa de enfermedades crónicas de Gesencro S.A.S. entre 2018 y 2020. Se evaluaron con regresión logística los factores de riesgo relacionados con la derivación a oftalmología y se obtuvieron los odds ratios (OR) crudos y ajustados. Resultados Se analizaron 11.880 registros; la edad media fue de 67,7±12años, y el 69,5% fueron mujeres. Entre las alteraciones retinianas se encontraron pacientes con retinopatía diabética clasificada como más que leve (10%) y gradoI de retinopatía hipertensiva (54,9% ojo derecho, 51,9% ojo izquierdo). También se identificó edema macular (15%). Solo 2.069 (17,4%) pacientes requirieron derivación a oftalmología; el 81,3% requirieron control a 1año y el 1,3% a los 6meses. En el análisis multivariado los factores de riesgo que se relacionaron con la probabilidad para ser derivados fueron: el género masculino, la edad mayor o igual a 60años, la hemoglobina glucosilada (HbA1c) fuera de metas, la enfermedad renal crónica avanzada y la razón microalbúmina-creatinina moderada a severamente elevada. Conclusión Este estudio permitió determinar la importancia que tiene el screening con cámara retinal no midriática en pacientes de alto riesgo cardiovascular para detectar alteraciones retinianas y evaluar factores de riesgo asociados con derivación a oftalmología. El documentar tempranamente el compromiso ocular en estos pacientes podría prevenir y evitar la discapacidad visual y la ceguera (AU)
Objective To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. Materials and methods Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. Results A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. Conclusion This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness (AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/diagnóstico , Retinopatía Diabética/diagnóstico , Retinopatía Hipertensiva/diagnóstico , Estudios Transversales , Factores de Riesgo , Tamizaje Masivo , Derivación y ConsultaRESUMEN
OBJECTIVE: To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. MATERIALS AND METHODS: Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. RESULTS: A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. CONCLUSION: This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness.
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Enfermedades Cardiovasculares , Retinopatía Diabética , Oftalmología , Humanos , Masculino , Femenino , Persona de Mediana Edad , Oftalmología/métodos , Estudios Transversales , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Factores de Riesgo , Tamizaje Masivo/métodos , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Derivación y ConsultaRESUMEN
Objetivo: el trastorno de déficit de atención e hiperactividad (TDAH) ha sido descrito como el trastorno del neurodesarrollo más común en la infancia. Esta condición se asocia a un significativo deterioro en calidad de vida, múltiples comorbilidades y, a largo plazo, a menores logros académicos y laborales. A pesar de que se ha evidenciado que en los pacientes de ascendencia latina se presenta un posible subdiagnóstico, que en Colombia se han estimado prevalencias mayores a las descritas en el planeta, y que los efectos de la pandemia por Covid-19 han podido exacerbar esta problemática, el volumen de estudios con estimaciones reproducibles sobre las características, tratamientos recibidos y control de síntomas de estos pacientes aún requiere ampliarse. Este estudio busca establecer los factores sociodemográficos, clínicos y del tratamiento asociados al control de los síntomas nucleares de este trastorno, que consisten en patrones persistentes y generalizados de inatención, impulsividad e hiperactividad. Metodología: estudio descriptivo con intención analítica en una cohorte retrospectiva de pacientes pediátricos con trastorno de déficit de atención e hiperactividad seguidos durante seis meses en un centro especializado de Medellín, Colombia, entre 2018 y 2019. Resultados: se identificó una incidencia de control de síntomas de 46,7% que se asoció de manera significativa con la adherencia al tratamiento y con historia familiar de TDAH. Conclusiones: puede afirmarse que, en pacientes pediátricos con TDAH, estos factores podrían aumentar la probabilidad de lograr el control de los síntomas nucleares.
Objective: Attention Deficit Hyperactivity Disorder (ADHD) has been described as the most common neurodevelopmental disorder in childhood. This condition is associated with significant deterioration in the quality of life, multiple comorbidities and, in the long term, lower academic and work achievements. Despite the fact that it has been shown that patients of Latin descent present a possible underdiagnosis, that in Colombia higher prevalence has been estimated than those described worldwide, and that the effects of the Covid-19 pandemic have been able to exacerbate this problem, the volume of studies with reproducible estimates on the characteristics, treatments received, and symptom control of these patients still needs to be expanded. This study seeks to establish the sociodemographic, clinical and treatment factors associated with the control of the core symptoms of this disorder, which consist of persistent and generalized patterns of inattention, impulsivity and hyperactivity. Methodology: Descriptive study with analytical intent in a retrospective cohort of pediatric patients with attention deficit hyperactivity disorder followed up for 6 months in a specialized center in Medellín, Colombia, between 2018 and 2019. Results: An incidence of symptom control of 46.7% was identified, which was significantly associated with adherence to treatment and with a family history of ADHD. Conclusions: It can be affirmed that, in pediatric patients with ADHD, these factors could increase the probability of achieving control of nuclear symptoms.
Objetivo: o transtorno dedéficit de atenção e hiperatividade (TDAH) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. Apesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade. Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, signifi-cativamente associada à adesão ao tratamento e ao histórico familiar de TDAH.Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.
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Humanos , Preescolar , Niño , Adolescente , Trastorno por Déficit de Atención con Hiperactividad , Trastornos del Neurodesarrollo , Cumplimiento y Adherencia al TratamientoRESUMEN
BACKGROUND: There are currently no drug therapies modifying the natural history of patients suffering Alzheimer's disease (AD). Most recent clinical trials in the field include only subjects in early stage of the disease, while patients with advanced AD are usually not represented. OBJECTIVES: To evaluate the feasibility, safety and efficacy of systemic infusions of adenosine triphosphate (ATP) in patients with moderate to severe AD, and to select the minimum effective dose of infusion. DESIGN: A phase IIb, randomized, double-blind, placebo-controlled clinical trial investigates. PARTICIPANTS: A total of 20 subjects with moderate or severe AD were included, 16 in the treatment group and 4 in the placebo group (4:1 randomization) at two dosage regimens, 6-hour or 24-hour infusions. RESULTS: The proof-of-concept study was successfully conducted, with no significant deviations from the study protocol and no serious adverse events reported. Regarding efficacy, only marginal differences were observed between ATP and placebo arms for H-MRS and MMSE variables. CONCLUSIONS: Our study demonstrates that the use of ATP infusion as therapy is feasible and safe. Larger studies are however needed to assess the efficacy of ATP in moderate to severe AD.
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Enfermedad de Alzheimer , Adenosina Trifosfato/uso terapéutico , Enfermedad de Alzheimer/tratamiento farmacológico , Método Doble Ciego , Estudios de Factibilidad , Humanos , Infusiones IntravenosasRESUMEN
Several plants of the Fabaceae family have been assessed regarding their high nutritional value and anthelmintic properties. The ovicidal effect of the hydroalcoholic extract (Bm-HAE) and subfractions from the aerial parts of Brongniartia montalvoana (Fabaceae) against a mixed strain of gastrointestinal nematodes (GIN) (Haemonchus spp., Trichostrongylus spp. and Oesophagostomum spp.) resistant to albendazole sulfoxide, ivermectin and levamisole was evaluated by the egg hatch test (EHT). The Bm-HAE was subjected to liquid-liquid chemical separation with ethyl acetate giving two fractions, an aqueous (Bm-Aq) and an organic (Bm-EtOAct). The purification of the bioactive fraction (Bm-EtOAct) through chromatographic separation resulted in four bioactive subfractions (BmR6, BmR7, BmR8 and BmR10). The treatments were designed as follows: Bm-HAE at 800, 1,500, 3,000 and 6,000 µg/mL, and Bm-Aq, Bm-EtOAct and subfractions (BmR6, BmR7, BmR8 and BmR10) at 100, 200, 400 and 800 µg/mL. Two properly negative controls (distilled water and 2% methanol) and thiabendazole (100 µg/mL) as a positive control were used for each bioassay. The chemical identification of the extract, fractions and subfractions was performed through chromatographic processes like open column chromatography, thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC-PDA). Additionally, the GIN eggs exposed to the bioactive compounds were observed through confocal laser scanning microscopy (CLSM). The Bm-HAE showed 99.5% egg hatching inhibition (EHI) at 6,000 µg/mL with a lethal concentration (LC50) of 1110 µg/mL. The Bm-EtOAc fraction displayed 99.1% EHI at 800 µg/mL with LC50 = 180 µg/mL. The ovicidal activity of the four subfractions was similar at 800 µg/mL: BmR6 (92% EHI); BmR7 (100% EHI); BmR8 (97.8%); and BmR10 (99.1%). The HPLC-PDA analysis of the bioactive subfractions allowed identification of p-coumaric acid, ferulic acid and coumarin derivatives as major compounds. The CLSM analysis allowed observation of morphological alterations in unhatched larvae caused by bioactive compounds present in the Bm-EtOAc and BmR10. In addition, the flavonoids eriodyctiol, luteolin and cynaroside were described for the first time for B. montalvoana.
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Antihelmínticos , Fabaceae , Haemonchus , Nematodos , Animales , Antihelmínticos/uso terapéutico , Larva , Extractos Vegetales/química , RumiantesRESUMEN
JUSTIFICACIÓN: los medicamentos veterinarios de animales de compañía son una parte cada vez más importante de la farmacia comunitaria. Por ello, el uso correcto de estos medicamentos es de vital importancia tanto para la salud animal como para la humana y el medio ambiente. Actualmente existen pocos estudios que evalúen el proceso de prescripción veterinaria.OBJETIVO: conocer cómo se está realizando el proceso de prescripción veterinaria a partir de la información obtenida de recetas veterinarias, a fin de contribuir a su mejora.MATERIAL Y MÉTODOS: se realizó un estudio descriptivo a partir de una muestra de recetas veterinarias procedentes de tres farmacias de distintas zonas de la Región de Murcia (urbana, periurbana y rural), con fecha de prescripción desde 2017 hasta febrero de 2022. Las recetas veterinarias destinadas a animales de producción fueron excluidas. Se elaboró una tabla donde se recogieron los siguientes datos: localización de la farmacia, fecha de prescripción, datos del prescriptor anonimizados por codificación, descripción del medicamento (denominación, dosis y forma farmacéutica) y datos del propietario. En caso de prescripción excepcional, también se recogieron: dosis a administrar, vía de administración, duración del tratamiento, número de animales, identificación individual del animal y diagnóstico. A partir de estos datos se determinaron los principios activos prescritos y se evaluó el correcto cumplimiento de la prescripción excepcional, utilizando para ello los buscadores de la Agencia Española del Medicamentos y Productos Sanitarios (CIMA y CIMAVet).RESULTADOS: hasta el momento se han recogido 324 recetas veterinarias prescritas por 72 veterinarios diferentes. Se emplearon 63 principios activos, siendo los antibióticos los más frecuentes (46,20 %), destacando tobramicina (15,12 %) y amoxicilina (13,27 %). (AU)
Asunto(s)
Humanos , Medicina Veterinaria , Farmacias , Drogas Veterinarias , TerapéuticaRESUMEN
JUSTIFICACIÓN: desde hace más de 20 años las enfermedades cardiovasculares se mantienen como la primera causa de muerte en todo el mundo. Por lo general, son poco frecuentes en la mujer premenopáusica debido a la protección cardiovascular que les confieren los estrógenos endógenos, por lo que tradicionalmente se ha subestimado el riesgo cardiovascular en las mujeres.OBJETIVO: establecer un protocolo de cribado de riesgo vascular en mujeres durante la perimenopausia desde la farmacia comunitaria.MATERIAL Y MÉTODOS: muestra oportunista de pacientes por reclutamiento a través de una intervención educativa previa en el Centro de la Mujer y por comunicación por redes sociales. Los criterios de inclusión en el estudio son ser mujer y tener entre 45 y 55 años, según los criterios de la Organización Mundial de la Salud. Materiales: documento de consentimiento informado, formulario de recogida de datos. Métodos: Se citó a las participantes en la farmacia y se les midieron los niveles de colesterol y presión arterial, el peso y la altura. Además, se recopiló información sobre factores de riesgo vascular generales y específicos de la mujer, medicación que tomaban y hábito tabáquico. Todos estos datos se recopilaron en un formulario de recogida de datos y con ellos se estimó el riesgo cardiovascular de las participantes mediante tablas SCORE. Una vez calculado, se les proporcionaba información sobre los factores de riesgo hallados de manera oral y escrita.RESULTADOS: se recogieron un total de 16 formularios, con una edad media de las demandantes de 49±3 años. El 43,75% presentaba niveles altos de presión arterial, tomando solo una de las participantes medicación para ello, y el 68,75% presentaban sobrepeso. El 43,75% presentaba niveles de colesterol iguales o superiores a 190 mg/ml. El 31,25% declararon que hacía dos años o más que se habían realizado la última analítica. (AU)
Asunto(s)
Humanos , Femenino , Farmacia , Servicios Farmacéuticos , Pacientes , Menopausia , Presión Arterial , Mujeres , Encuestas y CuestionariosRESUMEN
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
Asunto(s)
Anestesia , Cirugía Torácica , Humanos , Pulmón , Dolor , Estudios Retrospectivos , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: Overall, more than 50% of international travelers develop symptoms while traveling and 55% of them seek medical assistance during the trip. We conducted a study to evaluate the usefulness of a Smartphone app called TRIP Doctor® to provide telemedicine to international travelers. METHODS: Participants over 18 years old attending our travel clinic at Hospital Clinic in Barcelona were invited to participate during 2017-2019. After downloading the app, the health status of the traveler was monitored on a daily basis, providing specific medical advice and offering remote contact with specialized physicians through an integrated chat, if needed. RESULTS: From 449 users, 59 (13%) contacted for medical assistance through the app during the trip. Main reasons for telemedicine were diarrhea (25.7%), skin conditions (19.7%) and fever (12.1%). Among patients who contacted, 90% of the travelers did not require to be referred to a local doctor. Symptomatic treatment was the main treatment prescribed (38%). In a 14.7% of the cases a follow-up was not required, a 63.2% recovered and 22.1% were loss of follow-up. After a multivariate analysis, duration of trip >14 days was found to be the only factor associated with the use of telemedicine (OR 2.2, CI 95% 1.1-4.5, p = 0.03). CONCLUSION: In conclusion, travelers using telemedicine travelled for longer periods of time and mostly contacted for mild symptoms which could be solved successfully by remote assistance with our specialized doctors.