A content analysis on the perceptions of LGBTQ+ (centred) health care on Twitter.

BACKGROUND: LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person-centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic. AIM: This study aimed to explore tweets mentioning LGBTQ+ (centred) health care. METHODS: The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis. RESULTS: The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments. CONCLUSION: Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person-centred care is hardly noticeable. PUBLIC CONTRIBUTION: This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media.

Evaluación de la reperfusión tras angiogénesis terapéutica con fotopletismografía en un modelo murino de isquemia de miembros inferiores / Evaluation of the reperfusion after angiogenic therapy with photoplethysmography in a murine model of limb ischemia

INTRODUCCIÓN: a pesar del extendido uso de la fotopletismografía (PPG) en clínica como test diagnóstico no invasivo de la isquemia, su utilización en experimentación animal es escasa. OBJETIVO: evaluar el valor de la PPG en el seguimiento de la reperfusión angiogénica en un modelo murino de isquemia periférica. MATERIAL Y MÉTODOS: en ratas macho Sprague Dawley se excluyeron los sectores arteriales ilíaco y femoral de la pata trasera izquierda. Como control se utilizó la pata contralateral. Los animales se dividieron en tres grupos: GH (n = 8), placebo (n = 6) y sham (n = 2). La perfusión fue evaluada mediante escalas clínica y funcional y por PPG. Toda recuperación de la onda de PPG mayor del 5% fue considerada significativa. Se diseñaron controles basales, a los 10, 20 y 30 días. Se calculó el cociente de pulsatilidad pata/pata (rpp), así como los cambios morfológicos de la onda de pulso. La relación entre variables cualitativas fue evaluada por test Chi-cuadrado y la de las variables cuantitativas, mediante t de Student. RESULTADOS: los valores basales de rpp entre patas mostraron gran variabilidad, pero con una correlación significativa positiva: 0.9 (0,74-0,97, IC 95%, p < 0,001). La media de incremento de rpp a 30 días fue mayor en el grupo GH: 0,3 (0-1,1), p = 0,097 frente a 0,03 (0-0,2), p = 0,81. El 62,5% de animales GH presentó una recuperación significativa de la onda frente al 20% en el grupo placebo (recuperación media de la onda: 45% frente a 15,8% [p = 0,086], GH y placebo, respectivamente). CONCLUSIONES: la fotopletismografía ha mostrado una sensibilidad adecuada para detectar pequeños cambios de perfusión en el modelo de isquemia propuesto y tras la administración de GH. Dicha prueba podría ser de utilidad como complemento en el seguimiento de la reperfusión angiogénica tras isquemia en el modelo de tipo murino

INTRODUCTION: despite the widespread use of photoplethysmography (PPG) in clinical practice as a non-invasive diagnostic test for ischemia, it has been little used in animal experimentation. OBJECTIVE: to evaluate PPG for the follow-up of angiogenic reperfusion after growth hormone (GH) therapy in a murine model of limb ischemia. MATERIAL AND METHODS: in male Sprague Dawley rats, the iliac and femoral arterial sectors of the left hind limb were excluded. As a control, the contralateral limb was used. The rats were divided into three groups: GH (n = 8), placebo (n= 6) and sham (n = 2). Besides PPG, the perfusion was evaluated by clinical and functional scores. Any recovery of the PPG wave greater than 5% was considered as significant. Controls at baseline, 10, 20 and 30 days were planned. The paw/paw pulsatility ratio (rpp) was calculated, as well as the morphological changes of the pulse wave. The relationship between qualitative variables was evaluated by Chi-square test, and that of quantitative variables by Student's t-test. RESULTS: the baseline values of rpp between limbs showed great variability, but with a significant positive correlation: 0.9 (0.74-0.97, 95% CI, p < 0.001). The mean increase in rpp at 30 days was higher in the GH group: 0.3 (0-1.1), p = 0.097 vs. 0.03 (0-0.2), p = 0.81. Among GH animals, 62.5% presented a significant recovery of the wave as compared to 20% in placebo group (average recovery of the wave: 45% vs. 15.8% [p = 0.086], GH and placebo, respectively). CONCLUSIONS: photoplethysmography has shown a suitable sensitivity to detect small changes of perfusion in the proposed ischemic model and after GH administration. The aforementioned test could be useful as a supplementary tool during the identification of the angiogenic reperfusión process after ischemia in a murine model

Emergency Endovascular Management of a Symptomatic Pseudoaneurysm of the Left Subclavian Artery Ostium Using a Combination of an Abdominal Aortic Stent-Graft Extension Cuff and a Periscope Stent Graft.

A pseudoaneurysm located at the subclavian artery ostium is an infrequent but life-threatening pathology that usually requires major thoracic surgery with a high risk of mortality and morbidity. Endovascular therapy applied to the aortic arch branches is a recent alternative technique, which is still in its early stages because dedicated endovascular devices for the aortic arch are lacking. In this article, we present the emergency endovascular management of a symptomatic pseudoaneurysm of the left subclavian artery ostium which was presumably secondary to an atherosclerotic plaque rupture. Endovascular exclusion required a combination of an abdominal aortic stent-graft extension cuff, which was placed via a retroperitoneal iliac access, and a subclavian artery periscope stent graft.

Mobile Decision Support Tool for Emergency Departments and Mass Casualty Incidents (EDIT): Initial Study.

BACKGROUND: Chemical exposures pose a significant threat to life. A rapid assessment by first responders and emergency nurses is required to reduce death and disability. Currently, no informatics tools exist to process victims of chemical exposures efficiently. The surge of patients into a hospital emergency department during a mass casualty incident creates additional stress on an already overburdened system, potentially placing patients at risk and challenging staff to process patients for appropriate care and treatment efficacy. Traditional emergency department triage models are oversimplified during highly stressed mass casualty incident scenarios in which there is little margin for error. Emerging mobile technology could alleviate the burden placed on nurses by allowing the freedom to move about the emergency department and stay connected to a decision support system. OBJECTIVE: This study aims to present and evaluate a new mobile tool for assisting emergency department personnel in patient management and triage during a chemical mass casualty incident. METHODS: Over 500 volunteer nurses, students, and first responders were recruited for a study involving a simulated chemical mass casualty incident. During the exercise, a mobile application was used to collect patient data through a kiosk system. Nurses also received tablets where they could review patient information and choose recommendations from a decision support system. Data collected was analyzed on the efficiency of the app to obtain patient data and on nurse agreement with the decision support system. RESULTS: Of the 296 participants, 96.3% (288/296) of the patients completed the kiosk system with an average time of 3 minutes, 22 seconds. Average time to complete the entire triage process was 5 minutes, 34 seconds. Analysis of the data also showed strong agreement among nurses regarding the app's decision support system. Overall, nurses agreed with the system 91.6% (262/286) of the time when it came to choose an exposure level and 84.3% (241/286) of the time when selecting an action. CONCLUSIONS: The app reliably demonstrated the ability to collect patient data through a self-service kiosk system thus reducing the burden on hospital resources. Also, the mobile technology allowed nurses the freedom to triage patients on the go while staying connected to a decision support system in which they felt would give reliable recommendations.

Giant Symptomatic Aneurysm Secondary to Hereditary Hemorrhagic Telangiectasia of a Main Hepatic Artery with Aberrant Origin in Superior Mesenteric Artery.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a rare disease consistent in vascular dysplasias affecting different organs. Liver involvement includes telangiectases, arteriovenous shunting, and ischemic cholangitis, and its prevalence ranges from 8% to 31%. Spontaneous pseudoaneurysms have never been reported associated to HHT. Several variations in the origin of the main hepatic artery (MHA) have been described in large radiological series and can be found in around 4% of general population. METHODS: A 64-year-old woman with history of HHT was diagnosed of acute symptomatic saccular aneurysm involving the MHA. The associated portovenous fistulae suggested that liver perfusion could be impaired if embolization of the MHA without revascularization was performed. Because of an aberrant origin on the superior mesenteric artery, a hybrid procedure was designed, consistent on endovascular exclusion of the MHA associated with a surgical aortic-hepatic bypass graft. RESULTS: Angio computed tomography (Angio CT) was performed at discharge, 1 month, and 6 months after intervention, revealed complete exclusion of the aneurysm, which reduced 50% in diameter after 6 months. Aneurysms of the MHA can be associated with HHT when intrahepatic arteriovenous fistulae are present. This complication is rare, and the reported cases have been treated by surgical and totally endovascular procedures. The confluence of this very rare condition with an uncommon vascular anatomy makes this a unique case that required the design of a customized intervention. CONCLUSIONS: Hybrid procedures are useful to treat conditions that cannot be solved with standard interventions. Longer series of cases with long-term surveillance are needed to asses the results of these techniques in these complex pathology.

Frecuencia de alveolitis dentaria y factores que la caracterizan / Dental alveolitis frequency and factors characterizing it

Introducción: la alveolitis dentaria es la complicación postextracción dental más frecuente, caracterizada por un dolor postoperatorio en el alveolo, el cual se incrementa en severidad entre el primer y tercer día; síntoma que obliga al paciente a acudir al servicio estomatológico de inmediato. Objetivo: describir la frecuencia de alveolitis dentaria y los factores que la caracterizan en el área de salud del Policlínico Docente Enrique de los Ángeles Betancourt Nenínger. Materiales y métodos: se realizó un estudio descriptivo, observacional y transversal, en el mencionado policlínico, de septiembre 2012 a septiembre 2013, con 140 pacientes, que después de realizada la exodoncia presentaron esta afección. Se recogió información y procesaron variables sociodemográficas, de caracterización y riesgo de alveolitis. Resultados: el grupo de edad de 35 a 59 años representó el 5,72 %. El sexo femenino, 60 %; la localización mandibular, 51,4 %. El grupo dentario molares, 38,6 %; sin trauma del alveolo, 71,42 %, pero 82,85 % tienen hábito de fumar, y el 60 % no tuvo tratamiento con antibióticos. Conclusiones: se concluyó que el grupo más afectado fue desde la mediana edad hasta el comienzo de la tercera, afectando más a las féminas, la localización mandibular y al grupo dentario molares. El trauma en el alveolo tiene una menor frecuencia, pero el hábito de fumar está relacionado con la mayoría de los afectados, y el tratamiento con antibióticos no influye en la aparición o no de alveolitis.

Background: Dental alveolitis is the most frequent dental post-removal complication, characterized by post-surgery pain in the alveolus, seriously increasing in the first and third day: this symptom makes the patient immediately visit the stomatologic service. Aim: describing dental alveolitis frequency and factors characterizing it in the teaching Policlinic Enrique de los Angeles Betancourt Nenínger. Materials and Methods: a cross-sectional, observational, descriptive study was carried out in the before mentioned policlinic, from September 2012 to September 2013, with 140 patients showing this affection after removal. Information was collected and sociodemographic variables of alveolitis risk and characterization were processed. Outcomes: the 35-59 years age group represented 5.72 %, and the 14-19 years one, 0 % from the total of the removals carried out; the female gender, 60 %; mandibular location, 51.4 %. The dental group molars represented 38.6 %; without alveolar trauma, 71.42 %, but 82.85 of the patients were smokers, and 60 % had not treatment with antibiotics. Conclusions: it was concluded that the most affected age group was the one enclosing people from medium age to elder years, affecting more women, mandibular location and molars. The alveolar trauma is less frequent, but smoking habit is related with most of the affected people, and the treatment with antibiotics does not have influence in the alveolitis appearance or not.

Frecuencia de alveolitis dentaria y factores que la caracterizan / Dental alveolitis frequency and factors characterizing it

Introducción: la alveolitis dentaria es la complicación postextracción dental más frecuente, caracterizada por un dolor postoperatorio en el alveolo, el cual se incrementa en severidad entre el primer y tercer día; síntoma que obliga al paciente a acudir al servicio estomatológico de inmediato. Objetivo: describir la frecuencia de alveolitis dentaria y los factores que la caracterizan en el área de salud del Policlínico Docente Enrique de los Ángeles Betancourt Nenínger.Materiales y métodos: se realizó un estudio descriptivo, observacional y transversal, en el mencionado policlínico, de septiembre 2012 a septiembre 2013, con 140 pacientes, que después de realizada la exodoncia presentaron esta afección. Se recogió información y procesaron variables sociodemográficas, de caracterización y riesgo de alveolitis. Resultados: el grupo de edad de 35 a 59 años representó el 5,72 por ciento. El sexo femenino, 60 por ciento; la localización mandibular, 51,4 por ciento. El grupo dentario molares, 38,6 por ciento; sin trauma del alveolo, 71,42 por ciento, pero 82,85 por ciento tienen hábito de fumar, y el 60 por ciento no tuvo tratamiento con antibióticos. Conclusiones: se concluyó que el grupo más afectado fue desde la mediana edad hasta el comienzo de la tercera, afectando más a las féminas, la localización mandibular y al grupo dentario molares. El trauma en el alveolo tiene una menor frecuencia, pero el hábito de fumar está relacionado con la mayoría de los afectados, y el tratamiento con antibióticos no influye en la aparición o no de alveolitis(AU)

Background: Dental alveolitis is the most frequent dental post-removal complication, characterized by post-surgery pain in the alveolus, seriously increasing in the first and third day: this symptom makes the patient immediately visit the stomatologic service. Aim: describing dental alveolitis frequency and factors characterizing it in the teaching Policlinic Enrique de los Angeles Betancourt Nenínger. Materials and Methods: a cross-sectional, observational, descriptive study was carried out in the before mentioned policlinic, from September 2012 to September 2013, with 140 patients showing this affection after removal. Information was collected and sociodemographic variables of alveolitis risk and characterization were processed. Outcomes: the 35-59 years age group represented 5,72 percent, and the 14-19 years one, 0 % from the total of the removals carried out; the female gender, 60 percent; mandibular location, 51,4 percent. The dental group molars represented 38,6 percent; without alveolar trauma, 71,42 percent, but 82,85 of the patients were smokers, and 60 percent had not treatment with antibiotics. Conclusions: it was concluded that the most affected age group was the one enclosing people from medium age to elder years, affecting more women, mandibular location and molars. The alveolar trauma is less frequent, but smoking habit is related with most of the affected people, and the treatment with antibiotics does not have influence in the alveolitis appearance or not(AU)

The cofactor preference of glucose-6-phosphate dehydrogenase from Escherichia coli--modeling the physiological production of reduced cofactors.

In Escherichia coli, the pentose phosphate pathway is one of the main sources of NADPH. The first enzyme of the pathway, glucose-6-phosphate dehydrogenase (G6PDH), is generally considered an exclusive NADPH producer, but a rigorous assessment of cofactor preference has yet to be reported. In this work, the specificity constants for NADP and NAD for G6PDH were determined using a pure enzyme preparation. Absence of the phosphate group on the cofactor leads to a 410-fold reduction in the performance of the enzyme. Furthermore, the contribution of the phosphate group to binding of the transition state to the active site was calculated to be 3.6 kcal·mol(-1). In order to estimate the main kinetic parameters for NAD(P) and NAD(P)H, we used the classical initial-rates approach, together with an analysis of reaction time courses. To achieve this, we developed a new analytical solution to the integrated Michaelis-Menten equation by including the effect of competitive product inhibition using the ω-function. With reference to relevant kinetic parameters and intracellular metabolite concentrations reported by others, we modeled the sensitivity of reduced cofactor production by G6PDH as a function of the redox ratios of NAD/NADH (rR(NAD)) and NADP/NADPH (rR(NADP)). Our analysis shows that NADPH production sharply increases within the range of thermodynamically feasible values of rR(NADP), but NADH production remains low within the range feasible for rR(NAD). Nevertheless, we show that certain combinations of rR(NADP) and rR(NAD) sustain greater levels of NADH production over NADPH.

Endoprótesis aortouniilíaca como alternativa a la cirugía abierta en el remodelado de las endoprótesis de aorta abdominal / Aortouniiliac stent-grafts as an alternative to open surgery in remodelling abdominal aorta stents

Introducción. La incidencia de conversiones tardías quirúrgicas tras endoprótesis de aorta abdominal es del 2.1% anual, y la mortalidad asociada, del 24.4%. Es por tanto deseable ofrecer soluciones endovasculares para disminuir dicha mortalidad. Objetivo. Realizar un estudio retrospectivo de la utilización de la endoprótesis aortouniilíaca para rescatar endoinjertos con gran remodelado, evitando así la conversión a cirugía abierta. Pacientes y métodos. Se revisó una serie de 56 endoprótesis aórticas bifurcadas implantadas por aneurisma de aorta abdominal (AAA) entre los años 1996 y 2000. Resultados. Se hallaron cinco casos de gran remodelado protésico que conllevó conversión a endoprótesis aortouniilíaca y bypass extranatómico. La edad media fue de 73,4 años, y los factores de riesgo más frecuentes, la hipertensión arterial y la cardiopatía isquémica. En todos los casos de conversión, la prótesis previa fue la Vanguard, y los tipos de AAA tratados, B y C. Entre las complicaciones menores hubo un caso de linforrea inguinal, y entre las mayores, una trombosis de endoprótesis y bypass cruzado, rescatados con fibrinólisis. La tomografía computarizada abdominal realizada a los dos años mostró ausencia de fugas y disminución del diámetro del saco aneurismático. No hubo ninguna conversión a cirugía abierta. Conclusiones. La endoprótesis aortouniilíaca asociada a bypass femorofemoral cruzado representa una vía de tratamiento del remodelado protésico grave de menor morbimortalidad que la cirugía abierta. Además, parece disminuir la posibilidad de nuevos remodelados

Introduction. The incidence of late surgical conversions following stent-grafting in the abdominal aorta is 2.1% per year, and the associated mortality rate is 24.4%. Endovascular solutions are therefore needed to reduce this mortality. Aim. To conduct a retrospective study of the use of aortouniiliac stent-grafts to salvage highly remodelled endografts, thus avoiding the need for conversion to open surgery. Patients and methods. We reviewed a series of 56 bifurcated aortic stents implanted due to abdominal aortic aneurysm (AAA) between 1996 and 2000. Results. Results of the review produced five cases of important prosthetic remodelling that entailed conversion to aortouniiliac stent-grafts and extra-anatomical bypasses. Mean age was 73.4 years and the most frequent risk factors were arterial hypertension and ischaemic heart disease. In all the cases of conversion, the previous stent-graft was the Vanguard and the types of AAA that were treated were B and C. Less important complications included one case of inguinal lymphorrhagia and the more complicated cases included a thrombosis of the crossed bypass and stent-graft, which were salvaged using fibrinolysis. Computed tomography scanning of the abdomen performed at two years revealed the absence of leaks and a reduction in the diameter of the aneurysmal sac. There were no conversions to open surgery. Conclusions. Aortouniiliac stent-grafts in association with a femorofemoral crossover bypass represent a way of treating severe stent-graft remodelling with a lower morbidity and mortality rate than open surgery. This technique also seems to reduce the chances of further remodelling being required

Role of d electrons in Auger neutralization at metal surfaces.

A generalized theory of Auger electron transfer processes in the interaction of ions with metal surfaces, including the previously ignored role of d electrons is presented. It is shown that a correct and accurate description of Auger neutralization has to account for the contribution of d electrons, as this is illustrated on the case of He+ ion neutralization on Ag, where the neglect of these leads to a strong overestimation of ion survival probabilities. Crystal lattice site specific rates are calculated and allow for a correct description of crystal azimuthal effects in neutralization.