Perception of Knowledge Transfer from Clinical Simulations to the Care Practice in Nursing Students / Percepción de la transferencia de conocimientos de las simulaciones clínicas a la práctica asistencial en estudiantes de enfermería / Percepção da transferência de conhecimentos das simulações clínicas para a prática assistencial em estudantes de enfermagem

Objetivo. Avaliar a percepção da transferência de conhecimentos das simulações clínicas para a prática assistencial em estudantes de enfermagem por meio de um debriefing eficaz. Métodos. Foi realizado um estudo observacional, descritivo e transversal com uma lista de 281 estudantes de enfermagem de uma universidade espanhola durante o curso 2020-2021, por meio de uma consulta ad hoc a partir do Debriefing Assessment for Simulation in Healthcare (DASH) em português, para valorizar as áreas competentes que um estudante de graduação deve alcançar ao finalizar seus estudos. Resultados. A consulta realizada após cada simulação mostrou que os estudantes valorizaram positivamente as sessões de debriefing realizadas por especialistas, com uma pontuação média de 6.61 sobre 7 [6.56-6.65%] com base em 675 consultas analisadas, e cada estudante realizou mais de uma simulação dentro do curso acadêmico. Foram observadas 221 respostas cumulativas que o aprendizado na simulação se traduziu na prática em 89.23% [86.39-92.06%], especificamente nas áreas de Comunicação, Segurança do paciente, Trabalho em equipe e Liderança. Conclusão. Na percepção dos estudantes participantes, o uso de um debriefing eficaz na simulação clínica permitiu a transferência de conhecimentos para a prática assistencial, mostrando ser uma ferramenta crucial que ajuda a melhorar a formação dos futuros enfermeiros.

Objetivo. Evaluar la percepción de la transferencia de conocimientos de las simulaciones clínicas a la práctica asistencial en estudiantes de enfermería mediante un debriefing eficaz.Métodos. Se realizó un estudio observacional, descriptivo y transversal con una muestra de 281 estudiantes durante el curso 2020-2021, mediante una encuesta ad hoc a partir de la Debriefing Assessment for Simulation in Healthcare (DASH) en español, para valorar las áreas competenciales que un estudiante de grado debe alcanzar al finalizar sus estudios. Resultados. La encuesta realizada después de cada simulación mostró que los estudiantes valoraban positivamente las sesiones de debriefing realizadas por expertos, con una puntuación media de 6.61 sobre 7 [6.56 % - 6.65 %] en base a 675 encuestas analizadas, ya que cada estudiante realizaba más de una simulación dentro del curso académico. Se observó en 221 respuestas cumplimentadas que lo aprendido en la simulación se transfirió a la práctica en el 89.23 % [86.39 % - 92.06 %], específicamente en áreas de Comunicación, Seguridad del paciente, Trabajo en equipo y Liderazgo. Conclusión. En la percepción de los estudiantes participantes, el uso de un debriefing eficaz en la simulación clínica permitió la transferencia de conocimientos a la práctica asistencial, mostrando ser una herramienta crucial que ayuda a mejorar la formación a de los futuros enfermeros.

Objective. This work sought to assess the perception of knowledge transfer from clinical simulations to the care practice in nursing students through effective debriefing.Methods. An observational, descriptive, and cross-sectional study was conducted with a sample of 281 students during the 2020-2021 course, through una ad hoc survey from the Debriefing Assessment for Simulation in Healthcare (DASH) in Spanish, to assess competence areas that undergraduate students must reach to complete their studies.Results. The survey conducted after each simulation showed that the students valued positively the debriefing sessions conducted by experts, with a mean score of 6.61 over 7 [6.56%-6.65%] based on 675 surveys analyzed, given that each student conducted more than one simulation within the academic course. It was observed in 221 completed answers that what was learned in the simulation was transferred to the practice in 89.23% [86.39%-92.06%], specifically in areas of Communication, Patient safety, Teamwork, and Leadership. Conclusion. In the perception by the participating students, the use of effective debriefing in clinical simulation enabled knowledge transfer to the care practice, proving to be a crucial tool that helps to improve the formation of the future nurses.

Exploring the Equilibrium State Diagram of Maltodextrins across Diverse Dextrose Equivalents.

This study investigates the equilibrium state diagram of maltodextrins with varying dextrose equivalents (DE 10 and 30) for quercetin microencapsulation. Using XRD, SEM, and optical microscopy, three transition regions were identified: amorphous (aw 0.07-0.437), semicrystalline (aw 0.437-0.739), and crystalline (aw > 0.739). In the amorphous region, microparticles exhibit a spherical morphology and a fluffy, pale-yellow appearance, with Tg values ranging from 44 to -7 °C. The semicrystalline region shows low-intensity diffraction peaks, merged spherical particles, and agglomerated, intense yellow appearance, with Tg values below 2 °C. The crystalline region is characterized by fully collapsed microstructures and a continuous, solid material with intense yellow color. Optimal storage conditions are within the amorphous region at 25 °C, aw 0.437, and a water content of 1.98 g H2O per g of dry powder. Strict moisture control is required at higher storage temperatures (up to 50 °C) to prevent microstructural changes. This research enhances understanding of maltodextrin behavior across diverse dextrose equivalents, aiding the development of stable microencapsulated products.

Perception of Knowledge Transfer from Clinical Simulations to the Care Practice in Nursing Students.

Objective: This work sought to assess the perception of knowledge transfer from clinical simulations to the care practice in nursing students through effective debriefing. Methods: An observational, descriptive, and cross-sectional study was conducted with a sample of 281 students during the 2020-2021 course, through una ad hoc survey from the Debriefing Assessment for Simulation in Healthcare (DASH) in Spanish, to assess competence areas that undergraduate students must reach to complete their studies. Results: The survey conducted after each simulation showed that the students valued positively the debriefing sessions conducted by experts, with a mean score of 6.61 over 7 [6.56%-6.65%] based on 675 surveys analyzed, given that each student conducted more than one simulation within the academic course. It was observed in 221 completed answers that what was learned in the simulation was transferred to the practice in 89.23% [86.39%-92.06%], specifically in areas of Communication, Patient safety, Teamwork, and Leadership. Conclusion: In the perception by the participating students, the use of effective debriefing in clinical simulation enabled knowledge transfer to the care practice, proving to be a crucial tool that helps to improve the formation of the future nurses.

A multidisciplinary approach to analyze the antimicrobial resistance in natural ecosystems.

Antimicrobial Resistance (AMR) poses a global threat to both human health and environmental well-being. Our study delved into Costa Rican wildlife reserves, uncovering a substantial human impact on these ecosystems and underscoring the imperative to pinpoint AMR hotspots. Embracing a One Health perspective, we advocated for a comprehensive landscape analysis that intricately intertwined geographic, climatic, forest, and human factors. This study illuminated the link between laboratory results and observed patterns of antimicrobial use, thereby paving the way for sustainable solutions. Our innovative methodology involved deploying open-ended questions to explore antimicrobial usage across livestock activities, contributing to establishing a comprehensive methodology. Non-invasive sampling in wildlife emerged as a critical aspect, shedding light on areas contaminated by AMR. Feline species, positioned at the apex of the food chain, acted as sentinels for environmental health due to heightened exposure to improperly disposed waste. Regarding laboratory findings, each sample revealed the presence of at least one antimicrobial resistance gene (ARG). Notably, genes encoding resistance to tetracyclines dominated (94.9%), followed by beta-lactams (75.6%), sulfonamides (53.8%), aminoglycosides (51.3%), quinolones (44.9%), phenicols (25.6%), and macrolides (20.5%). Genes encoding polymyxins were not detected. Moreover, 66% of samples carried a multi-resistant microbiome, with 15% exhibiting resistance to three antimicrobial families and 51% to four. The absence of a correlation between forest coverage and ARG presence underscored the profound human impact on wildlife reserves, surpassing previous estimations. This environmental pressure could potentially modify microbiomes and resistomes in unknown ways. As not all antimicrobial families encoding ARGs were utilized by farmers, our next step involved evaluating other human activities to identify the primary sources of contamination. This comprehensive study contributed crucial insights into the intricate dynamics of AMR in natural ecosystems, paving the way for targeted interventions and sustainable coexistence.

Edema superoexterno de grasa de Hoffa: signo de rótula alta y su asociación clínica / Upper external edema of Hoffa's fat. Sign of patella alta and its clinical association

Introducción: Las almohadillas de grasa peripatelares en la cinemática normal de la rodilla son un elemento fundamental. La rótula alta es uno de los factores etiológicos más importantes de la inestabilidad femororrotuliana y se considera predisponente para el desarrollo del dolor femororrotuliano. El objetivo de este trabajo es demostrar los hallazgos en resonancia magnética del compromiso del sector superolateral externo de la grasa de Hoffa por edema como signo sugestivo de tendón rotuliano largo con rótula alta, y evaluar su sintomatología. Materiales y métodos: se evaluaron retrospectivamente una serie de pacientes y sus resonancias magnéticas de rodilla realizadas en nuestro centro entre 2019 y 2022. Se constató el edema en la región superoexterna de la grasa de Hoffa en los planos sagital, coronal y axial, se efectuaron las medidas de la altura rotuliana mediante el método de Insall-Salvati en la RM en un corte sagital en secuencia T2. Se evaluaron el motivo de consulta y la relación con la imagen observada. Resultados: se evaluaron un total de ciento diecinueve RM, que correspondían a ciento cuatro pacientes. En quince pacientes se analizaron ambas rodillas. Fueron sesenta y cinco de sexo femenino y treinta y nueve, masculino. La edad promedio fue 32.8 años (rango 14-75 años). Se evidenció edema superoexterno de grasa de Hoffa en todas las RM evaluadas, y se observó tendón patelar largo en ciento diecisiete rodillas, lo que representó el 98.3% de la muestra. La altura patelar promedio fue 1.49 según el índice IS (1.12-2.03). En dos RM (1.7%) se vio edema con altura patelar con valores normales de 1.12 y 1.18. Discusión: el edema superoexterno de la grasa de Hoffa tiene una fuerte relación con una altura patelar elevada. Se estudiaron en este trabajo estas variables y se trató de establecer una relación entre ellas. El método de evaluación de patela alta, el índice Insall-Salvati, es el más confiable. Varios estudios correlacionan el edema superoexterno y la patela alta, algunos de ellos asociadas a pacientes jóvenes, mientras que otros lo asocian a signos de artrosis y pacientes más añosos. En cuanto a los síntomas que ocasionan estos hallazgos, son poco claros. Conclusión: en el presente estudio se evidenció que existe una fuerte relación entre el edema superoexterno de la grasa de Hoffa y una patela alta, un signo muy útil a la hora de estudiar y entender la patología femororrotuliana. Observamos una mayor asociación con síntomas patelofemorales y traumatismos de rodilla. A pesar de que esto puede verse en otras patologías. Nivel de Evidencia: IV

Introduction: The importance of the peripatellar fat pads in the normal kinematics of the knee is a fundamental factor. Patella alta is one of the most important etiologic factors of patellofemoral instability and is considered a predisposing factor for the development of patellofemoral pain. The objective of this work was to demonstrate the magnetic resonance findings of the involvement of the external superolateral sector of Hoffa's fat due to edema, as a sign suggestive of a long patellar tendon with patella alta, and to evaluate its symptoms. Materials and methods: a series of patients and their MRIs of the knee performed in our center between 2019 and 2022 were retrospectively evaluated. Edema was found in the upper external region of Hoffa's fat in the sagittal, coronal, and axial planes, patellar height measurements were made using the Insall-Salvati method on MRI in a sagittal cut in T2 sequence. The reason for consultation and the relationship with the observed image were evaluated. Results: a total of 119 MRIs were evaluated, corresponding to 104 patients. In fifteen patients both knees were evaluated. They were sixty-five females and thirty-nine males. The average age was 32.8 years (14-75 years). Upper outer edema of Hoffa's fat was evidenced in all the evaluated MRIs, observing the long patellar tendon in 117 knees, which represented 98.3% of the sample. The average patellar height was 1.49 according to the IS index (1.12-2.03). Two MRIs (1.7%) showed edema with patellar height with normal values of 1.12 and 1.18. Discussion: upper external edema of Hoffa's fat has a strong relationship with elevated patellar height. These variables were studied in this work and an attempt was made to establish a relationship between them. The patella alta evaluation method, the Insall- Salvati index, is the most reliable. Several studies correlate upper outer edema and patella alta, some of them associated with young patients, while others associate it with signs of osteoarthritis and older patients. As for the symptoms that cause these findings, they are unclear. Conclusion: in the present study, it was evidenced that there is a strong relationship between the upper external edema of Hoffa's fat and a patella alta, making this a very useful sign when studying and understanding patellofemoral pathology. We observed a greater association with patellofemoral symptoms and knee trauma, despite this being seen in other pathologies. Level of Evidence: IV

Quiste meniscal posterior a la sutura meniscal con monofilamento de polipropileno / Meniscal cyst after polypropylene monofilament suture

Introducción: la función del tejido meniscal es fundamental en la transmisión y distribución de cargas de la rodilla. En casos de lesión meniscal, la sutura es el tratamiento quirúrgico de elección, y pueden utilizarse diferentes materiales para realizarla. El objetivo del trabajo es analizar la aparición de quistes meniscales sintomáticos con el uso de sutura no reabsorbible del tipo monofilamento de polipropileno en un grupo de pacientes con lesiones en asa de balde y evaluar el material de sutura como causal de quiste.Materiales y métodos: se realizó un estudio retrospectivo de un grupo de pacientes con lesiones en asa de balde suturadas con material no reabsorbible del tipo monofilamento de polipropileno (MP) y sutura de alta resistencia de polietileno de ultra alto peso molecular UHMWPE (SAR) y se analizó la presencia de quiste meniscal sintomático como complicación. Los criterios de inclusión para este estudio fueron pacientes con lesiones en asa de balde a los cuales se les realizó sutura meniscal con técnicas combinadas con material de tipo no reabsorbible. Se excluyeron pacientes con lesiones que no fueran con patrón en asa de balde o a los cuales se les hizo sutura meniscal todo-adentro únicamente.Resultados: un total de veinticinco pacientes, quince de sexo masculino y diez de sexo femenino. La edad media del grupo evaluado fue de 27.8 años. El 72% fue suturado con sutura de alta resistencia (SAR) mientras que a un 28% se les realizó sutura con monofilamento de polipropileno (MP). El 92% de las lesiones se presentaron en el menisco interno. Se observaron tres pacientes con quistes meniscales sintomáticos asociados a la sutura MP, los cuales fueron tratados quirúrgicamente con buena evolución. Conclusión: identificamos en nuestra serie que la aparición de quistes sintomáticos se relaciona estrechamente con el uso de monofilamento de polipropileno (MP). Consideramos la utilización de hilos no reabsorbibles de alta resistencia (polietileno de ultra alto peso molecular UHMWPE) como la primera opción para realizar las suturas meniscales por la baja tasa de complicación y los buenos resultados. Nivel de Evidencia: IV

Introduction: The function of the meniscal tissue is fundamental in the transmission and distribution of knee loads. In cases of meniscal injury, suturing is the surgical treatment of choice, and different materials can be used to perform it. The aim of the work is to analyze the appearance of symptomatic meniscal cysts with the use of non-absorbable polypropylene monofilament suture in a group of patients with bucket handle injuries and to evaluate the suture material as a cause of the cyst. Materials and methods: a retrospective study was carried out on a group of patients with bucket-handle injuries sutured with non-absorbable polypropylene monofilament (MP) material and high-strength ultra-high molecular weight UHMWPE polyethylene (SAR) suture and the presence of a symptomatic meniscal cyst as a complication was analyzed. The inclusion criteria for this study were patients with bucket-handle injuries in whom meniscal suture was performed with combined techniques with non-resorbable material. Patients with injuries other than a bucket-handle pattern or who underwent all-in meniscal suturing only were excluded.Results: a total of twenty-five patients, fifteen males and ten females. The average age of the evaluated group was 27.8 years. 72% were sutured with high resistance suture (SAR) while 28% were sutured with polypropylene monofilament (MP). 92% of the injuries occurred in the medial meniscus. Three patients were observed with symptomatic meniscal cysts associated with the MP suture, which were treated surgically with good outcomes. Conclusion: we identified in our series that the appearance of symptomatic cysts is closely related to the use of polypropylene monofilament (MP). We consider the use of high-strength non-absorbable threads (ultra-high molecular weight polyethylene UHMWPE) as the first option to perform meniscal sutures due to the low complication rate and good results. Level of Evidence: IV

Reposicionamiento Labial. Caso Clínico

El reposicionamiento labial es un procedimiento quirúrgico mínimamente invasivo que se utiliza para tratar una sonrisa gingival, la cual, es una afección en la que una cantidad significativa de la encía queda expuesta cuando una persona sonríe y puede deberse a una variedad de factores, como un exceso de tejido gingival, un labio superior corto o músculos hiperactivos del labio superior, entre otros. El alargamiento clínico de la corona, por otro lado, consiste en eliminar el exceso de tejido gingival y, si es necesario, el tejido óseo para exponer una mayor parte de la corona natural del diente. Se reporta un caso clínico de paciente femenino de 31 años que presentó una sonrisa gingival provocada por hipermovilidad de labio superior y un exceso de tejido gingival localizado. El plan de tratamiento involucró una combinación de reposicionamiento labial y alargamiento de corona. Los resultados estéticos fueron significativos, con la sonrisa del paciente más equilibrada y proporcionada. Se redujo la cantidad de tejido gingival expuesto cuando la paciente sonreía y la longitud de los dientes fue más visible, lo que dio como resultado una sonrisa de aspecto más natural, además de aumentar su aceptación al sonreír.

SUMMARY: Lip repositioning is a minimally invasive surgical procedure used to treat a gummy smile, which is a condition in which a significant amount of the gum is exposed when a person smiles and may be due to a variety of factors, such as excess gum tissue, a short upper lip or overactive muscles of the upper lip, among others. Clinical crown lengthening, on the other hand, involves removing excess gingival tissue and, if necessary, bone tissue to expose more of the natural crown of the tooth. Clinical case: A clinical case of a 31-year-old female patient who presented a gummy smile caused by hypermobility of the upper lip and an excess of localized gingival tissue is reported. The treatment plan involved a combination of lip repositioning and crown lengthening. The aesthetic results were significant, with the patient's smile more balanced and displayed. The amount of the patient's exposed gum tissue when smiled was reduced and the length of the teeth was more visible, resulting in a more natural-looking smile, as well as increasing their acceptance of smiling.

Mechanical-acoustical analogy: From laboratory to home during the COVID-19 pandemic.

A clear comprehension of the oscillatory nature of sound for acoustics undergraduate students is of paramount importance. In this paper, two online experiments were implemented to aid teaching of the oscillatory nature of sound through the analogy between a mechanical mass-spring model and a Helmholtz resonator. The study was conducted among undergraduate students taking a science course in the Electronic and Electrical Engineering career curriculum. These in-class experiments were conducted during the COVID-19 pandemic via the Zoom platform. Students measured the Helmholtz resonant frequency of a plastic bottle with a smartphone application and compared its oscillatory behavior with that of a conventional harmonic oscillator under a professor-student collaborative environment. The results of this study suggest that, with careful experiment design, students can effectively benefit from the use of common technology tools, which, in turn, poses these methodologies as a rather satisfactory alternative to face-to-face laboratory sessions.

Invaginación Apendicular en preescolar: Reporte de un caso y revisión de la literatura / Appendicular invagination in a pre-school child; a case-report and literature review

La invaginación intestinal sucede cuando un segmento del intestino se introduce en otro. La presentación apendicular es menos común, afectando principalmente a lactantes. Frecuentemente, se comprueba durante el intraoperatorio. El tratamiento es la desinvaginación, seguido de la exéresis del apéndice. De no lograrse, se prefiere la resección amplia o una hemicolectomía derecha. Se presenta en caso de una niña de 4 años que acudió por dolor abdominal, hiporexia, vómitos y sensación de alza térmica; la ecografía mostró conglomeración de asas intestinales e imagen redondeada. En cirugía se encontró invaginación apendicular que compromete el ciego, se resecó la masa hasta el inicio del colon ascendente. Se realizó una ileostomía sin fístula mucosa; el estudio anatomo-patológico informó necrosis del apéndice cecal. Tres meses después se restituyó el tránsito intestinal. La Intususcepción apendicular tiene síntomas inespecíficos. En Perú, puede llegar a ser mortal. Una historia clínica detallada con evaluación minuciosa ofrece un acertado diagnóstico y un tratamiento oportuno.

SUMMARY Intestinal invagination occurs when an intestinal segment is introduced into another segment. The appendicular presentation is less common and affects predominantly infants. The diagnosis is corroborated during the surgical intervention which consists of de-invagination followed by surgical removal of the appendix, if the latter is not possible then a wide resection or right hemicolectomy is indicated. We present the case of a 4-year-old girl who attended with a history of abdominal pain, anorexia, vomiting and fever; an abdominal ultrasound showed intestinal agglomeration and a rounded mass. The surgical findings included appendicular invagination that affected the cecum, the lesion was resected until the ascending colon. An ileostomy was performed, the anatomopathological findings indicated necrosis of the appendix. Three months later the normal intestinal transit was restored. Appendicular intussusception has non-specific symptoms and could be mortal in Peru. A detailed clinical history may help in diagnosing and offering proper treatment.

En la búsqueda de predictores que nos ayuden a obtener un mejor resultado en la cirugía de revisión de ligamento cruzado anterior / In the search for predictors that help us obtain a better result in anterior cruciate ligament revision surgery

Introducción: Los factores de riesgo de re-ruptura de LCA son errores técnicos, características del injerto, lesiones meniscales, condrales o lesiones no tratadas. El objetivo de nuestro trabajo fue reconocer predictores modificables que nos ayuden a obtener un mejor resultado en la cirugía de revisión de LCA. Materiales y métodos: estudio descriptivo transversal. Serie de pacientes tratados en nuestro centro entre 2011 y 2021 a los cuales se les realizó cirugía de revisión de LCA. Se registraron edad, sexo, falla de cirugía primaria traumática, o no, fijación utilizada, ubicación de ambos túneles, injerto utilizado en la cirugía primaria, lesiones articulares condrales y meniscales antiguas y nuevas y tipo de injerto utilizado en cirugía de revisión. Resultados: se analizaron un total de ciento nueve pacientes. Con mayor frecuencia, los pacientes masculinos se sometieron a revisión entre los veinte y los cuarenta años. La principal causa traumática fue la práctica deportiva (40.37%), seguida de accidente de tránsito o en domicilio (7.33%) y en ambiente laboral (24.8%), y sin causa demostrable (27.5%). La mala posición del túnel femoral aislada fue la falla técnica más común en un 41.29%, sin error técnico en 38.53%, y falla de colocación de túnel tibial aislada en 2.75%. En el total de los pacientes evaluados, el 28.44% (treinta y un pacientes) no presentó lesión meniscal previa ni actual; mientras que el 71.56% (setenta y ocho pacientes) evidenció algún tipo de lesión. La elección del injerto fue autoinjerto de H-T-H (30.28%), aloinjerto de tibial posterior (30.28%), aloinjerto de tibial anterior (19.27%), autoinjerto de ST-RI (11.01%), y otros aloinjertos Aquiles, Peroneos y ST (9.17%).Discusión: serán necesarios más estudios para determinar si esta tasa de falla persiste a pesar de nuestro mayor conocimiento de la técnica y diversos aspectos de la cirugía de revisión. Nivel de Evidencia: IV

Introduction: Risk factors for ACL rupture are technical errors, graft characteristics, meniscal and chondral injuries, or untreated injuries. The objective of our work was to recognize modifiable predictors that help us obtain a better result in ACL revision surgery. Materials and methods: cross-sectional descriptive study. Series of patients treated at our center between 2011 and 2021 who underwent ACL revision surgery. Age, sex, traumatic or non-traumatic primary surgery failure, fixation used, location of both tunnels, graft used in primary surgery, old and new chondral and meniscal joint injuries and type of graft used in revision surgery were recorded. Results: a total of one hundred and nine patients were analyzed. Most often, male patients underwent revision between the ages of twenty and forty. The main traumatic cause was sports practice (40.37%), followed by traffic accident or at home (7.33%) and in the work environment (24.8%), and without demonstrable cause (27.5%). Isolated femoral tunnel malposition was the most common technical failure at 41.29%, no technical error at 38.53%, and isolated tibial tunnel placement failure at 2.75%. In all the patients evaluated, 28.44% (thirty-one patients) did not present a previous or current meniscal lesion; while 71.56% (seventy-eight patients) showed some type of injury. Graft choice was H-T-H autograft (30.28%), posterior tibial allograft (30.28%), anterior tibial allograft (19.27%), ST-RI autograft (11.01%), and other Achilles, fibular, and ST allografts (9.17%) Discussion: more studies will be necessary to determine if this failure rate persists despite our greater knowledge of the technique and various aspects of revision surgery. Level of Evidence: IV

Después de una cirugía de ligamento cruzado anterior, ¿cuándo puedo manejar? Evaluación postoperatoria de habilidades de conducción y de reacción de frenado / After anterior cruciate ligament surgery, when can I drive? Postoperative assessment of driving skills and braking reaction

Introducción: La mayoría de las personas que se someten a una reconstrucción del LCA están en edad de conducir, por lo tanto, es importante saber cuándo es seguro para el paciente reanudar la conducción. El objetivo de este trabajo es evaluar de manera prospectiva cuándo los pacientes recuperan las habilidades de manejo y de reacción de frenado después de la reconstrucción primaria de LCA, y compararlos con un grupo control de voluntarios sanos. Materiales y métodos: estudio prospectivo de una serie de pacientes que se sometieron a reconstrucción primaria del LCA utilizando injerto semitendinoso y recto interno. Se excluyeron pacientes en los que se empleó otro tipo de injerto o se les realizó otro gesto quirúrgico y laborales. Se evaluó la capacidad de volver a manejar de manera segura a las 2-3 semanas y a las 4-5 semanas postoperatorias mediante test de reacción simple y de resistencia a la monotonía, y se compararon los resultados con un grupo control de voluntarios sanos. Resultados: en total fueron ciento sesenta y seis pacientes, treinta fueron casos y ciento treinta y seis, controles. Se hallaron diferencias significativas (p = 0.03) entre los casos y controles en las pruebas realizadas tempranamente en cuanto a la aprobación, y no, de los test. Según el promedio en segundos obtenido en cada test realizado, se observan diferencias significativas en el primera prueba de resistencia a la monotonía (p = 0.0001) a favor del grupo control. Discusión: de acuerdo a la prueba de reacción simple y al test a la monotonía evaluados en nuestro trabajo, los pacientes que se someten a reconstrucción del LCA con autoinjertos de ST-RI están en condiciones de manejar un automóvil luego de las 4-5 semanas de la cirugía

Introduction: Most people who undergo ACL reconstruction are of driving age, it is important to know when it is safe for the patient to resume driving. The objective of this work was to prospectively evaluate when patients recover driving skills and brake reaction skills after ACL reconstruction and compare them with a control group of healthy volunteers. Materials and methods: prospective study of a series of patients who underwent primary ACL reconstruction using semitendinosus and medial rectus graft. Patients in whom another type of graft was used, or another surgical and labor gesture was performed, were excluded. The ability to return to driving safely at 2-3 weeks and 4-5 weeks postoperatively was evaluated using the simple reaction and resistance to monotony tests, and the results were compared with a control group of healthy volunteers.Results: a total of 166 patients, 30 are cases and 136 controls. Significant differences (p = 0.03) were found between cases and controls in the tests carried out early in terms of passing and not passing the tests. The relationship according to the average in seconds obtained in each test carried out, significant differences are observed in the first test of resistance to monotony (p = 0.0001) in favor of the control group. Discussion: according to the simple reaction test and the monotony test evaluated in our study, patients who undergo ACL reconstruction with ST-RI autografts are able to drive a car 4-5 weeks after surgery

Alternative CUG Codon Usage in the Halotolerant Yeast Debaryomyces hansenii: Gene Expression Profiles Provide New Insights into Ambiguous Translation.

The halotolerant yeast Debaryomyces hansenii belongs to the CTG-Ser1 clade of fungal species that use the CUG codon to translate as leucine or serine. The ambiguous decoding of the CUG codon is relevant for expanding protein diversity, but little is known about the role of leucine-serine ambiguity in cellular adaptations to extreme environments. Here, we examine sequences and structures of tRNACAG from the CTG-Ser1 clade yeasts, finding that D. hansenii conserves the elements to translate ambiguously. Then, we show that D. hansenii has tolerance to conditions of salinity, acidity, alkalinity, and oxidative stress associated with phenotypic and ultrastructural changes. In these conditions, we found differential expression in both the logarithmic and stationary growth phases of tRNASer, tRNALeu, tRNACAG, LeuRS, and SerRS genes that could be involved in the adaptive process of this yeast. Finally, we compare the proteomic isoelectric points and hydropathy profiles, detecting that the most important variations among the physicochemical characteristics of D. hansenii proteins are in their hydrophobic and hydrophilic interactions with the medium. We propose that the ambiguous translation, i.e., leucylation or serynation, on translation of the CUG-encoded residues, could be linked to adaptation processes in extreme environments.

Turbostratic Carbon/Graphene Prepared via the Dry Ice in Flames Method and Its Purification Using Different Routes: A Comparative Study.

Although the dry ice method used to synthesize turbostratic carbon/graphene is little known and used, it has significant advantages over others, such as the following: it is low cost, simple, and a large quantity of material can be obtained using some inorganic and highly available acids (which can be reused). Despite the above advantages, the main reason for its incipient development is the resulting presence of magnesium oxide in the final product. In the present work, three different treatments were tested to remove this remnant using some acid chemical leaching processes, including hydrochloric acid, aqua regia, and piranha solution. Based on the experimental evidence, it was determined that using aqua regia and combining the leaching process with mechanical milling was the most efficient way of removing such a remnant, the residue being only 0.9 wt.%. This value is low compared to that obtained with the other acid leaching solutions and purification processes (2.8-29.6 wt.%). A mandatory high-energy mechanical milling stage was necessary during this treatment to expose and dissolve the highly insoluble oxide without secondary chemical reactions on the turbostratic carbon. High-energy mechanical milling is an effective route to exfoliate graphite, which allows the magnesium oxide to be more susceptible to acid treatment. A yield of turbostratic carbon/graphene of 1 wt.% was obtained from the metallic Mg. The obtained surface area was 504.8 m2g-1; this high value resulting from the intense exfoliation can potentiate the use of this material for a wide variety of applications.

Anthocyanins and Functional Compounds Change in a Third-Generation Snacks Prepared Using Extruded Blue Maize, Black Bean, and Chard: An Optimization.

The effect of extrusion cooking on bioactive compounds in third-generation snacks (TGSE) and microwave-expanded snacks (MWSE) prepared using black bean, blue maize, and chard (FBCS) was evaluated. FBCS was extruded at different moisture contents (MC; 22.2-35.7%), extrusion temperatures (ET; 102-142 °C), and screw speeds (SP; 96-171 rpm). Total anthocyanin content (TAC), contents of individual anthocyanins, viz., cyanidin-3-glucoside, malvidin-3-glucoside, pelargonidin-3-glucoside, pelargonidin-3-5-diglucoside, and delphinidin-3-glucoside chloride, total phenolic content (TPC), antioxidant activity (AA), and color parameters were determined. TAC and individual anthocyanin levels increased with the reduction in ET. ET and MC affected the chemical and color properties; increase in ET caused a significant reduction in TPC and AA. Microwave expansion reduced anthocyanin content and AA, and increased TPC. Extrusion under optimal conditions (29% MC, 111 rpm, and 120 °C) generated products with a high retention of functional compounds, with high TAC (41.81%) and TPC (28.23%). Experimental validation of optimized process parameters yielded an average error of 13.73% from the predicted contents of individual anthocyanins. Results suggest that the TGSE of FBCS obtained by combining extrusion and microwave expansion achieved significant retention of bioactive compounds having potential physiological benefits for humans.

Clinical characteristics and evolution of hematological patients and COVID-19 in Argentina: a report from the Argentine Society of Hematology.

Individuals with malignancies and COVID-19 have a lower survival compared with the general population. However, the information about the impact of COVID-19 on the whole hematological population is scarce. We aimed to describe the 30th day overall survival (OS) after COVID-19 infection in patients with a hematological disease in Argentina. A completely anonymous survey from the Argentine Society of Hematology was delivered to all the hematologists in Argentina; it started in April 2020. A cut-off to analyze the data was performed in December 2020 and, finally, 419 patients were reported and suitable for the analysis (average age: 58 years, 90% with malignant diseases). After the COVID-19 diagnosis, the 30-day OS for the whole population was 80.2%. From the entire group (419), 101 (24.1%) individuals required intensive care unit admission, where the 30-day OS was 46.6%. Among allogeneic stem cell transplant recipients, the 30-day OS was 70.3%. Factors associated with a low OS were two or more comorbidities, an active hematological disease and history of chemotherapy. In individuals with the three factors, the 30-day OS was 49.6% while the 30-day OS in those without those factors was 100%. Patients with hematological diseases have a higher mortality than the general population. This group represents a challenge and requires careful decision-making of the treatment in order not to compromise the chances of cure.

El presente estudio tuvo por objetivo primario conocer la mortalidad de pacientes con enfermedad hematológica que presentaron infección por COVID-19 en Argentina. Para ello se difundió una encuesta desde la Sociedad Argentina de Hematología (SAH) entre los hematológos para informar sobre los pacientes con enfermedades hematológicas y diagnóstico de infección por SARS- CoV-2, entre el 19/4/2020, y el 7/12/2020. Se incluyeron individuos de todas las edades con diagnóstico de enfermedad hematológica benigna o maligna e infección por SARS-CoV-2 confirmada por técnica de RTPCR. Se analizaron 419 pacientes (mediana 58 años; 90% enfermedades malignas). La supervivencia al día 30 fue de 80.2%. La supervivencia fue menor en aquellos que requirieron internación (74.2%), cuidados intensivos (46.6%) y asistencia respiratoria mecánica (36.8%). Entre los trasplantados alogénicos la supervivencia fue 70.3%. Los factores vinculados a la supervivencia global fueron las comorbilidades, el estado de la enfermedad al momento de la infección y el antecedente de quimioterapia. Se pudo establecer un score en el que aquellos que tuvieron un puntaje de 4 alcanzaron una supervivencia del 49.6% al día 30, mientras que la de los pacientes con score 0 fue del 100% a 30 días. En comparación con la población general, los pacientes con enfermedades hematológicas presentan una mayor mortalidad vinculada al COVID-19, motivo por el cual es primordial definir pautas destinadas a disminuir la exposición de los mismos sin comprometer las posibilidades de beneficiarse del tratamiento de la enfermedad de base.

Clinical characteristics and evolution of hematological patients and COVID-19 in Argentina: a report from the Argentine Society of Hematology / Características clínicas y evolución de pacientes hematológicos y COVID-19 en Argentina: datos de la Sociedad Argentina de Hematología

Abstract Individuals with malignancies and COVID-19 have a lower survival compared with the general population. However, the information about the impact of COVID-19 on the whole hematological population is scarce. We aimed to describe the 30th day overall survival (OS) after COVID-19 infection in pa tients with a hematological disease in Argentina. A completely anonymous survey from the Argentine Society of Hematology was delivered to all the hematologists in Argentina; it started in April 2020. A cut-off to analyze the data was performed in December 2020 and, finally, 419 patients were reported and suitable for the analysis (average age: 58 years, 90% with malignant diseases). After the COVID-19 diagnosis, the 30-day OS for the whole population was 80.2%. From the entire group (419), 101 (24.1%) individuals required intensive care unit admission, where the 30-day OS was 46.6%. Among allogeneic stem cell transplant recipients, the 30-day OS was 70.3%. Factors associated with a low OS were two or more comorbidities, an active hematological disease and history of chemotherapy. In individuals with the three factors, the 30-day OS was 49.6% while the 30-day OS in those without those factors was 100%. Patients with hematological diseases have a higher mortality than the general population. This group represents a challenge and requires careful decision-making of the treatment in order not to compromise the chances of cure.

Resumen El presente estudio tuvo por objetivo primario conocer la mortalidad de pacientes con enfermedad hematológica que presentaron infección por COVID-19 en Argentina. Para ello se difundió una encuesta desde la Sociedad Argentina de Hematología (SAH) entre los hematológos para informar sobre los pacientes con enfermedades hematológicas y diagnóstico de infección por SARS- CoV-2, entre el 19/4/2020, y el 7/12/2020. Se incluyeron individuos de todas las edades con diagnóstico de enfermedad hematológica benigna o maligna e infección por SARS-CoV-2 confirmada por técnica de RT-PCR. Se analizaron 419 pacientes (mediana 58 años; 90% enfermedades malignas). La supervivencia al día 30 fue de 80.2%. La supervivencia fue menor en aquellos que requirieron internación (74.2%), cuidados intensivos (46.6%) y asistencia respiratoria mecánica (36.8%). Entre los trasplantados alogénicos la supervivencia fue 70.3%. Los factores vinculados a la supervivencia global fueron las comorbilidades, el estado de la enfermedad al momento de la infección y el antecedente de quimioterapia. Se pudo establecer un score en el que aquellos que tuvieron un puntaje de 4 alcanzaron una supervivencia del 49.6% al día 30, mientras que la de los pacientes con score 0 fue del 100% a 30 días. En comparación con la población general, los pacientes con enfermedades hematológicas presentan una mayor mortalidad vinculada al COVID-19, motivo por el cual es primordial definir pautas destinadas a disminuir la exposición de los mismos sin comprometer las posibilidades de beneficiarse del tratamiento de la enfermedad de base.

Synthesis and experimental/computational characterization of sorghum procyanidins-gelatin nanoparticles.

In this research, sorghum procyanidins (PCs) and procyanidin B1 (PB1) were encapsulated in gelatin (Gel) to form nanoparticles as a strategy to maintain their stability and bioactivity and for possible applications as inhibitors of metalloproteinases (MMPs) of the gelatinase type. Encapsulation was carried out by adding either PCs or PB1 to an aqueous solution of A- or B-type Gel (GelA or GelB) at different concentrations and pH. Under this procedure, the nanoparticles PCs-GelA, PCs-GelB, PB1-GelA, and PB1-GelB were synthesized and subsequently characterized by experimental and computational methods. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed that all types of nanoparticles had sizes in the range of 22-138 nm and tended to adopt an approximately spherical morphology with a smooth surface, and they were immersed in a Gel matrix. Spectral analysis indicated that the nanoparticles were synthesized by establishing hydrogen bonds and hydrophobic interactions betweenGel and the PCs or PB1. Study of simulated gastrointestinal digestion suggested that PCs were not released from the Gel nanoparticles, and they maintained their morphology (SEM analysis) and antioxidant activity determined by Trolox-equivalent antioxidant capacity (TEAC) assay. Computational characterization carried out through molecular docking studies of PB1 with Gel or (pro-)metalloproteinase-2 [(pro-)MMP-2], as a model representative of the PCs, showed very favorable binding energies (around -5.0 kcal/mol) provided by hydrogen bonds, van der Waals interactions, and desolvation. Additionally, it was found that PB1 could act as a selective inhibitor of (pro-)MMP-2.

Chitosan hydrogel synthesis to remove arsenic and fluoride ions from groundwater.

Groundwater samples from eight deep drinking water wells that cover three aquifers in Chihuahua City, northern Mexico, were fully characterized. Water is naturally contaminated with arsenic, fluoride, and uranium, according to the Environmental Protection Agency (EPA) and local standards. The results from the Geochemist's Workbench (GWB) program revealed that the minerals in equilibrium with the groundwater were calcite and dolomite, while others, such as fluoride, schoepite, rutherfordite and K(UO2)(AsO4), were also dissolved. The hydrogeochemical characterization of water samples indicates that they were sodium bicarbonate-type water samples at neutral to slightly alkaline pH (7.6-8.3). A batch equilibrium sorption procedure was implemented using natural groundwater, a synthesized chitosan network (net-CS) and a chitosan binary network grafted with N-vinylcaprolactam/N-N-dimethylacrylamide (net-CS)-g-NVCL/DMAAm hydrogels. Isotherms and kinetics sorption tests were evaluated. The adsorption capacity of net-CS hydrogels for As ions was 0.0022 mg/g and F ions 0.15 mg/g after 50 h. Scanning electron microscopy coupled with energy-dispersive spectroscopy (SEM-EDS) was used to investigate the hydrogel surface before and after the sorption process, and TGA was used to evaluate the stability of the adsorbents. Freundlich adsorption isotherm constants for As and F ions indicate heterogeneous sorption and the mechanism of retention by physisorption.

Forest cover mediates large and medium-sized mammal occurrence in a critical link of the Mesoamerican Biological Corridor.

Connectivity of natural areas through biological corridors is essential for ecosystem resilience and biodiversity conservation. However, robust assessments of biodiversity in corridor areas are often hindered by logistical constraints and the statistical challenges of modeling data from multiple species. Herein, we used a hierarchical community occupancy model in a Bayesian framework to evaluate the status of medium and large-sized mammals in a critical link of the Mesoamerican Biological Corridor (MBC) in Costa Rica. We used camera traps deployed from 2013-2017 to detect 18 medium (1-15 kg) and 6 large (>15 kg) mammal species in a portion of two Jaguar Conservation Units (JCUs) and the Corridor linking them. Camera traps operated for 16,904 trap nights across 209 stations, covering an area of 880 km2. Forest cover was the most important driver of medium and large-sized mammal habitat use, with forest specialists such as jaguars (Panthera onca) and pumas (Puma concolor) strongly associated with high forest cover, while habitat generalists such as coyotes (Canis latrans) and raccoons (Procyon lotor) were associated with low forest cover. Medium and large-sized mammal species richness was lower in the Corridor area ([Formula: see text] = 9.78±1.84) than in the portions evaluated of the two JCUs ([Formula: see text] = 11.50±1.52). Puma and jaguar habitat use probabilities were strongly correlated with large prey species richness (jaguar, r = 0.59, p<0.001; puma, r = 0.72, p<0.001), and correlated to a lesser extent with medium prey species richness (jaguar, r = 0.36, p = 0.003; puma, r = 0.23, p = 0.064). Low estimated jaguar habitat use probability in one JCU (Central Volcanic Cordillera: [Formula: see text] = 0.15±0.11) suggests that this is not the jaguar stronghold previously assumed. In addition, the western half of the Corridor has low richness of large mammals, making it necessary to take urgent actions to secure habitat connectivity for mammal populations.