Work Ability Index: Psychometric Testing in Aeronautical Industry Workers.

Background: The Work Ability Index (WAI) is an instrument that measures work ability. The wide dispersion of the WAI internationally has led to its adaptation for use in different countries. This study aimed to evaluate the psychometric properties of the Spanish version of the WAI. Methods: A methodological design was used over an opportunistic sample of 233 workers in the aeronautical industry in Spain. Reliability was evaluated through internal consistency. Factorial validity, known groups, and convergent validity were tested. Results: The Cronbach's alpha and item-total correlation indicated an adequate internal consistency. The confirmatory factor analysis, performed to evaluate the factorial validity, found adequate fit indices for a two-factor solution with a high correlation between the factors. Factor 1, "Subjectively estimated work ability and resources", was composed of 3 subscales and factor 2, "Ill-health-related", of 2 subscales. Subscales 4 and 6 had loading in both factors. Workers under 45 years of age obtained higher significant scores than older ones. Convergent validity was also evidenced since WAI was highly correlated with self-assessment of health status. Conclusions: The Spanish version of the WAI has shown evidence of reliability and validity in this study, supporting its use in individual and collective health surveillance by occupational health professionals. The factorial solution that was found has previously been reported in another international context. However, further research is needed to resolve the discrepancies detected in the role of some subscales between other national and international studies.

A cross-sectional study on stool- and gastrointestinal-related outcomes of Mexican infants consuming different formulae.

BACKGROUND: Immaturities present at birth, such as in the gut microbiome and digestive, nervous, and immune system, resolve with time. Nevertheless, this may result in mild digestive symptoms early in life, particularly in formula-fed infants. Formula composition and processing may impact this discomfort. This study therefore aimed to assess stool characteristics and gastrointestinal symptoms of healthy infants fed different formulae. METHODS: A multicenter, cross-sectional, observational trial was performed in Mexico between November 2019 and January 2022, where exclusively formula-fed infants (n = 342, aged 1-4 months) were studied in four groups based on their existing formula use. Feeding was continued per practice following label instructions. For 7 days, parents/caregivers were requested to record fecal characteristics, using the Amsterdam Infant Stool Scale, and rate gastrointestinal symptoms. Stool samples were collected to determine pH, dry matter content, and fecal calprotectin levels. RESULTS: Most infants had a soft/formed stool consistency, although odds for hard stools were different between groups. Gastrointestinal symptom scores revealed significant differences for burping and diarrhea, while other symptoms did not differ between groups. No significant differences between groups were found for stool frequency, dry matter content, and fecal pH. Although calprotectin was within the expected healthy ranges, significant differences among groups were seen. Furthermore, calprotectin significantly correlated with the severity of the gastrointestinal symptoms burping, flatulence, abdominal distension, and diarrhea. CONCLUSIONS: Differences in stool characteristics and specific differences in gastrointestinal symptoms were observed between different formula brand users. This may potentially be explained by the different composition and processing of the formulae, although there are multiple factors that influence the assessed outcomes. TRIAL REGISTRATION: The study was registered in the Netherlands Trial Registry (NL7805), linked to https://trialsearch.who.int/ , on 11/06/2019.

A dysregulated bile acids pool is associated with metabolic syndrome and gut microbial dysbiosis in early adolescence.

OBJECTIVE: The increased prevalence of childhood metabolic syndrome (MetS) is a public health issue. It has been shown that a dysregulated bile acid (BA) profile could be involved in the development of MetS, in which the gut microbiota could have a significant role in BA levels. This study aimed to evaluate differences in serum BA levels in children with and without MetS and whether these levels were associated with gut microbial composition. METHODS: A total of 100 children aged 10 to 12 years were enrolled in this study, 42 children with MetS (cases) and 58 control participants. Serum BAs were measured by liquid chromatography-tandem mass spectrometry and gut microbiota was determined by 16S ribosomal RNA gene sequencing. RESULTS: Children with MetS showed higher levels of total, secondary, and 12α-hydroxylated BAs, as well as deoxycholic acid, and these were associated with dyslipidemia and insulin resistance markers. Interestingly, total BAs were negatively correlated with gut bacterial diversity (Shannon index: rho = -0.218, p = 0.035), whereas total, 12α-hydroxylated, and secondary BAs, as well as deoxycholic acid, showed negative correlations with genera known for their potential health effects, including Bifidobacterium, Akkermansia, and Faecalibacterium. CONCLUSIONS: This study suggests that childhood MetS is associated with a dysregulated BA pool and that these alterations could influence the abundance of potentially beneficial bacteria, thus contributing to gut microbial dysbiosis.

Editing the Human Genome with CRISPR/Cas: A Review of its Molecular Basis, Current Clinical Applications, and Bioethical Implications.

Abstract: CRISPR/Cas genes evolved in prokaryotic organisms as a mechanism of defense designed to identify and destroy genetic material from threatening viruses. A breakthrough discovery is that CRISPR/Cas system can be used in eukaryotic cells to edit almost any desired gene. This comprehensive review addresses the most relevant work in the CRISPR/Cas field, including its history, molecular biology, gene editing capability, ongoing clinical trials, and bioethics. Although the science involved is complex, we intended to describe it in a concise manner that could be of interest to diverse readers, including anyone dedicated to the treatment of patients who could potentially benefit from gene editing, molecular biologists, and bioethicists. CRISPR/Cas has the potential to correct inherited diseases caused by single point mutations, to knock-in the promoter of a gene whose expression is highly desirable or knockout the gene coding for a deleterious protein. CRISPR/Cas technique can also be used to edit ex vivo immune cells and reinsert them in patients, improving their efficiency in attacking malignant cells, limiting the infectious potential of viruses or modulating xenotransplant rejection. Very important bioethical considerations on this topic include the need to internationally regulate its use by ad hoc expert committees and to limit its use until safety and bioethical issues are satisfactorily resolved.

Editing the Human Genome with CRISPR/Cas: A Review of its Molecular Basis, Current Clinical Applications, and Bioethical Implications

ABSTRACT CRISPR/Cas genes evolved in prokaryotic organisms as a mechanism of defense designed to identify and destroy genetic material from threatening viruses. A breakthrough discovery is that CRISPR/Cas system can be used in eukaryotic cells to edit almost any desired gene. This comprehensive review addresses the most relevant work in the CRISPR/Cas field, including its history, molecular biology, gene editing capability, ongoing clinical trials, and bioethics. Although the science involved is complex, we intended to describe it in a concise manner that could be of interest to diverse readers, including anyone dedicated to the treatment of patients who could potentially benefit from gene editing, molecular biologists, and bioethicists. CRISPR/Cas has the potential to correct inherited diseases caused by single point mutations, to knock-in the promoter of a gene whose expression is highly desirable or knockout the gene coding for a deleterious protein. CRISPR/Cas technique can also be used to edit ex vivo immune cells and reinsert them in patients, improving their efficiency in attacking malignant cells, limiting the infectious potential of viruses or modulating xenotransplant rejection. Very important bioethical considerations on this topic include the need to internationally regulate its use by ad hoc expert committees and to limit its use until safety and bioethical issues are satisfactorily resolved.

Acute Mitral Regurgitation Due to Chordae Tendineae Rupture: A Rare Presentation of Cardiac Amyloidosis.

BACKGROUND In cardiac amyloidosis (CA), misfolded proteins deposit in the extracellular space of cardiac tissue. These deposits classically cause restrictive cardiomyopathy with diastolic dysfunction. Although there are at least 30 proteins known to cause amyloid aggregates, 2 main types make up most diagnosed cases: light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Since CA is considered a rare condition, it is often underdiagnosed or recognized in the advanced stages. Once amyloid deposits involve the heart tissue, they are associated with a worse outcome and higher mortality rates, especially in patients presenting symptoms of heart failure. CASE REPORT We report a case of a 22-year-old man presenting with acute severe mitral regurgitation, secondary to posterior mitral leaflet chordae tendineae rupture (CTR). Surgical mitral valve replacement with a mechanical prosthesis was performed, and cardiac tissue biopsy samples were obtained. After surgery, the patient improved significantly but suddenly presented with hemodynamic deterioration, until he died due to severe hemodynamic compromise and multiorgan failure. Although the etiology of the CTR was not established before surgical intervention, the histopathological analysis suggested CA. CONCLUSIONS CA diagnosis can be complex, especially in a 22-year-old-man with atypical clinical and imaging manifestations. In this patient, other differential diagnoses were considered, since CA presenting in a young patient is a rare phenomenon and acute mitral regurgitation secondary to CTR presents more frequently in other heart conditions. Furthermore, rapid postoperative deterioration resulted in the patient's death before biopsy samples were available because suspicion of amyloidosis had not been raised until that point.

Effect of Gut Microbial Enterotypes on the Association between Habitual Dietary Fiber Intake and Insulin Resistance Markers in Mexican Children and Adults.

Dietary fiber (DF) is a major substrate for the gut microbiota that contributes to metabolic health. Recent studies have shown that diet-metabolic phenotype effect might be related to individual gut microbial profiles or enterotypes. Thus, the aim of this study was to examine whether microbial enterotypes modify the association between DF intake and metabolic traits. This cross-sectional study included 204 children (6-12 years old) and 75 adults (18-60 years old). Habitual DF intake was estimated with a Food Frequency Questionnaire and biochemical, clinical and anthropometric data were obtained. Gut microbiota was assessed through 16S sequencing and participants were stratified by enterotypes. Correlations adjusting for age and sex were performed to test the associations between dietary fiber components intake and metabolic traits. In children and adults from the Prevotella enterotype, a nominal negative correlation of hemicellulose intake with insulin and HOMA-IR levels was observed (p < 0.05), while in individuals of the other enterotypes, these associations were not observed. Interestingly, the latter effect was not related to the fecal short-chain-fatty acids profile. Our results contribute to understanding the enterotype influence on the diet-phenotype interaction, which ultimate could provide evidence for their use as potential biomarkers for future precision nutrition strategies.

[Case detection and follow-up of an outbreak of COVID-19 in repatriated workers: A case series study.] / Detección y segui-miento de casos de un brote de covid-19 en trabajadores repatriados: Un estudio de serie de casos.

OBJECTIVE: The mobility of workers to other countries in a globalized work world has posed an added risk in the current pandemy of COVID-19 and can carry with it an increased risk of spread and transmission of the disease. The collaboration of the Occupational Health Units of the companies and the Health Authorities has been fundamental in the investigation of COVID-19 outbreaks secondary to international travel of workers on mission. The objective of this study was to describe the process of detection and follow-up of cases in an outbreak of COVID-19 in repatriated workers after a six-month mission in a factory of aircraft components in Poland. METHODS: A case series study was conducted. Data on sociodemographic, epidemiological and clinical course variables of the cases were collected by telephone clinical interview. Descriptive statistics were used to summarize the data. RESULTS: The outbreak involved 20 workers who shared the workplace and made the repatriation trip together. The outbreak investigation was initiated after detecting that a worker presented symptoms compatible with COVID-19 during the 4 days prior to the return trip, which was later confirmed by PCR. During follow-up, 40% (n=8) of the workers were considered cases confirmed by PCR. Of these, only 62.5% (n=5) presented symptoms. Fifty percent (n=4) had fever, 25% (n=2) had cough, respiratory distress, general malaise, and diarrhea, and 12.5% (n=1) had anosmia, ageusia, and conjunctivitis. All of them underwent home isolation with outpatient telephone follow-up. At the end of the follow-up, all were asymptomatic and returned to work. The mean close contact was 1.85 per case within the group (SD=3.13), with a range of 0-11, occurring primarily during attendance at extra work social events that were limited to members of the workers' own group and/or during the return flight. The health authorities were informed through established channels so that they could proceed with the detection and tracking of close contacts with people outside the group of workers that occurred during the flight and after arrival to Spain. CONCLUSIONS: Early detection of potential cases of COVID-19 with transmission capacity by the Occupational Health and Safety Departments of the companies, in collaboration with the Health Authorities, is essential for more efficient case and contact management of imported cases of COVID-19.

OBJETIVO: La movilidad de los trabajadores a otros países en un mundo laboral globalizado, ha supuesto un riesgo añadido en el contexto actual de la pandemia de COVID-19 y puede llevar consigo un riesgo mayor de propagación y transmisión de la enfermedad. La colaboración de las Unidades de Salud Laboral de las empresas y las Autoridades Sanitarias ha sido fundamental en la investigación de brotes de COVID-19 secundarios a viajes internacionales de trabajadores en misión. El objetivo de este estudio fue describir el proceso de detección y seguimiento de casos en un brote de COVID-19 en trabajadores repatriados tras una misión de seis meses en una fábrica de elementos aeronáuticos en Polonia. METODOS: Se realizó un estudio de serie de casos. Se recogieron datos relativos a variables sociodemográficas, epidemiológicas y relativas al curso clínico de los casos mediante entrevista clínica telefónica. Se utilizó la estadística descriptiva para resumir los datos. RESULTADOS: El brote implicó a 20 trabajadores que compartían lugar de trabajo y realizaron el viaje de retorno juntos. La investigación del brote se inició tras detectar que un trabajador presentó sintomatología compatible con COVID-19 durante los 4 días previos al viaje de regreso, que posteriormente fue confirmado con PCR. Durante el seguimiento, el 40% (n=8) de los trabajadores fueron considerados casos confirmados con PCR. De ellos, únicamente el 62,5% (n=5) presentó sintomatología. El 50% (n=4) presentó fiebre, mientras que el 25% (n=2) presentó tos, dificultad respiratoria, malestar general y diarrea, y el 12,5% (n=1) presentó anosmia, ageusia y conjuntivitis. Todos realizaron aislamiento domiciliario con seguimiento ambulatorio telefónico y estaban asintomáticos al final del seguimiento causando alta laboral. Los casos presentaron una media de 1,85 (DE=3,13) contactos estrechos dentro del grupo con un rango de 0-11, principalmente ocurridos durante la asistencia a eventos sociales extralaborales que se limitaban a los miembros del propio grupo y/o durante el viaje de avión de regreso. Las autoridades sanitarias fueron informadas a través de los cauces establecidos para que procedieran a la detección y seguimiento de los contactos estrechos con personas externas al grupo de trabajadores sucedidos durante el vuelo y tras la llegada a España. CONCLUSIONES: La detección precoz de los casos de COVID-19 con capacidad de transmisión a través de los servicios de prevención de las empresas, en colaboración con las Autoridades Sanitarias, es fundamental para el manejo de casos y contactos más eficiente ante la eventual aparición de casos importados de COVID-19.

Pneumoperitoneum and COVID-19. A causal association?

We read with great interest the letter from Pérez Naranjo et al. regarding the case we recently published in this journal. We believe that the case presented by the authors is undoubtedly useful as it contributes to the scarce existing casuistry on the relationship between COVID-19 and the development of pneumatosis/pneumoperitoneum. We would like to emphasize the difficulty of determining the causality of this association due to the frequent co-occurrence of other causes that could justify the presence of pneumatosis/pneumoperitoneum.

Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine.

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Disección de arteria vertebral secundaria a fractura tipo hangman / Vertebral artery dissection secondary to hangman's fracture

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Perfil emocional y cognitivo de la hipertensión arterial esencial mantenida frente a la normotensión / Emotional and cognitive profile of sustained essential hypertension in comparison with normotension

El objetivo de este estudio ha siso analizar el perfil psicológico de la hipertensión arterial esencial (HTA-E) respecto a los siguientes constructos emocionales: ira rasgo, expresión y control de la ira, ansiedad, depresión y estrés, incluyéndose como novedad el análisis de los pensamientos automáticos y actitudes disfuncionales relacionadas con la ira-hostilidad. Para ello se comparó un grupo de 57 adultos con HTA-E mantenida con un grupo de 37 adultos con normotensión en diferentes medidas psicométricas de dichos constructos emocionales y cognitivos. Los resultados sugieren que las personas con HTA-E, en comparación a las normotensas, muestran niveles significativamente más elevados de ansiedad y de pensamientos de afrontamiento de la ira-hostilidad así como una tendencia casi significativa a una mayor frecuencia de pensamientos hostiles y físicamente agresivos. Se discuten las implicaciones de estos hallazgos para los modelos psicológicos de la HTA-E y para el diseño o mejora de las intervenciones psicológicas en HTA-E (AU)

This study was aimed at analyzing the psychological profile of essential hypertension (EHT) concerning the following emotional constructs: trait anger, anger expression and control, anxiety, depression, stress, and, as a novelty in comparison with previous scientific literature, automatic thoughts and dysfunctional attitudes related to anger-hostility. To do that, a group of 57 adults with sustained EHT was compared with a group of 37 adults with normotension on a variety of psychometric measures of those emotional and cognitive constructs. Results suggest that people with EHT, in comparison with normotensive, show significantly higher levels of anxiety and anger-hostility coping thoughts as well as an almost significant trend toward a higher frequency of hostile and physically aggressive thoughts. Implications of these findings for psychological models of EHT and for the design and improvement of psychological interventions in EHT are discussed (AU)

Establishing a method for tracking persistence rates of nursing students: one school's experience.

The national nursing shortage is challenging schools and policymakers to develop strategies to increase the number of registered nurses. A tracking system that reports retention rates can provide a critical measure of a school's effectiveness and can assist decision makers in prioritizing where it is best to spend private and public dollars. It can also support a school's efforts to engage in continuous quality-improvement activities. This article explains how one school of nursing developed a method to track its students, how it perfected the method, and how it now uses the findings as part of its ongoing program-improvement activities. The principle players in the creation of the tracking system are identified along with the steps that have been taken to accurately track students in different nursing-program options at the baccalaureate level as well as the masters program and doctoral program levels. Suggestions for sustaining the tracking system and the use of the data are given.

Experiencia clínica en pacientes VIH positivos con diagnóstico de toxoplasmosis cerebral / Clinic experience in patients positive VIH with cerebral toxoplasmosis diagnostic

El virus de la inmunodeficiencia humana (VIH) tipo 1 CD4 es un retrovirus humano que infecta a linfocitomas, y provoca alteraciones de la respuesta inmunitaria celular. Esta alteración inmune causada por el VIH es el origen del síndrome de inmunodependencia adquirida (SIDA) que se caracteriza por infecciones oportunista como toxoplasmosis cerebral. El toxoplasma gondil es un protozoo intracelular obligatorio, que infecta con mayor frecuencia al sistema nervioso central (SNC) de pacientes con VIH, produciendo encefalitis o lesión intracerebral ocupante de espacio. Entre las manifestaciones se incluyen signos neurológicos focales o síntomas difusos, como alteraciones del estado mental y convulsiones. Entre los años 1995 y 1996 se revisaron 138 historias de la UDIS* del Hospital Dr. Carlos Arvelo. Se encontraron 17 casos con diagnóstico de infección en SNC, de los cuales ocho tenían diagnóstico presuntivo de toxoplasmosis cerebral