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Introduction ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysis This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and dissemination The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration number NCT05868005.

Abstract Polylactic acid (PLA) is a bioresorbable and biodegradable polymer extensively used in various biomedical and engineering applications. In this study, we investigated the mass loss and thermal properties of PLA-multi-walled carbon nanotube (MWCNT) composites under simulated physiological conditions. The composites were prepared by melting PLA with 0.1, 0.5, 1.0, and 5.0 wt% MWCNTs using an ultrasonic agitator, and FTIR analysis confirmed composite formation. Subsequently, the composites were subjected to hydrolysis under simulated physiological conditions (pH 7.4 and 37 °C) for up to 60 days. The results revealed that the mass loss of the composites decreased with increasing MWCNT content, suggesting that the presence of MWCNTs decelerated the hydrolysis process. On day 58, the mass loss of pure PLA was 12.5%, decreasing to 8.34% with 0.1% MWCNT, 5.94% with 0.5% MWCNT, 4.59% with 1% MWCNT, and 3.54% with 5.0% MWCNT. This study offers valuable insights into the behavior of PLA-MWCNT composites under physiologically simulated conditions, facilitating the development of new polymer composites with enhanced thermal stability and degradation resistance for biomedical applications.

Objective Diagnostic testing is an important tool to combat the COVID-19 pandemic, yet access to and uptake of testing vary widely 3 years into the pandemic. The WHO recommends the use of COVID-19 self-testing as an option to help expand testing access. We aimed to calculate the cost of providing COVID-19 self-testing across countries and distribution modalities.Design We estimated economic costs from the provider perspective to calculate the total cost and the cost per self-test kit distributed for three scenarios that differed by costing period (pilot, annual), the number of tests distributed (actual, planned, scaled assuming an epidemic peak) and self-test kit costs (pilot purchase price, 50% reduction).Setting We used data collected between August and December 2022 in Brazil, Georgia, Malaysia, Ethiopia and the Philippines from pilot implementation studies designed to provide COVID-19 self-tests in a variety of settings—namely, workplace and healthcare facilities.Results Across all five countries, 173 000 kits were distributed during pilot implementation with the cost/test distributed ranging from $2.44 to $12.78. The cost/self-test kit distributed was lowest in the scenario that assumed implementation over a longer period (year), with higher test demand (peak) and a test kit price reduction of 50% ($1.04–3.07). Across all countries and scenarios, test procurement occupied the greatest proportion of costs: 58–87% for countries with off-site self-testing (outside the workplace, for example, home) and 15–50% for countries with on-site self-testing (at the workplace). Staffing was the next key cost driver, particularly for distribution modalities that had on-site self-testing (29–35%) versus off-site self-testing (7–27%).Conclusions Our results indicate that it is likely to cost between $2.44 and $12.78 per test to distribute COVID-19 self-tests across common settings in five heterogeneous countries. Cost-effectiveness analyses using these results will allow policymakers to make informed decisions on optimally scaling up COVID-19 self-test distribution programmes across diverse settings and evolving needs.

Background/Aims The study objective is to investigate the ultrasound features that allow suspecting the presence of submucosal fat deposition, called the fat halo sign (FHS), in the intestinal wall of patients with Crohn’s disease. Methods Computed tomography (CT) examinations over a period of 10 years were reviewed for the presence of the FHS in the bowel wall. A measurement of less than –10 Hounsfield units was regarded as indicative of fat. We included only patients who had undergone ultrasound examinations 3 months before or after CT. The study cohort group comprised 68 patients. Wall and submucosal thickness were measured on longitudinal ultrasound sections. A receiver operating characteristic curve was constructed to determine the best cutoff of ultrasound submucosal wall thickness value for predicting FHS in the bowel wall determined on CT. Results The FHS was present in 22 patients (31%) on CT. There were significant differences between submucosal thickness of patients with FHS and patients without FHS (4.19 mm vs. 2.41 mm). From the receiver operating characteristic curve, a threshold value of 3.1 mm of submucosal thickness had the best sensitivity and specificity to suspect FHS (95.5% and 89.1%, respectively; area under the curve, 0.962), with an odds ratio of 172. All of 16 patients with a submucosal thickness >3.9 mm had FHS. Conclusions FHS in patients with Crohn’s disease can be suspected on ultrasound in cases with marked thickening of the submucosa layer. In these cases, the activity of the disease should be measured by other parameters such as the color Doppler.

Background: knowledge of the factors that influence smoking initiation during adolescence is an issue that health decision makers pay special attention. Objective: to identify factors associated with tobacco consumption in students of the “Paco Cabrera”; Elementary School in Puerto Padre, Las Tunas, Cuba, in May 2023. Methods: a cross-sectional, analytical observational study was conducted in 257 secondary school students, intentionally divided into smokers (53) and non-smokers (204), in the institution and time previously declared. The information was collected from three instruments containing the variables of interest. A set of demographic, individual, family, academic, social and attitudinal factors related to smoking were analyzed. Descriptive and inferential statistics were used for data analysis. Results: male sex and average age were higher in smokers; low resilience (OR=6.38), alcohol consumption (OR=6.38) and money to spend (OR=2.40), were the demographic-individual factors with the highest association strength; in family members, parents with little concern about their child’s smoking (OR=41.52) and dysfunctional family (OR=10.2); in academics, belief that tobacco use causes weight loss (OR=14.5) and eliminates stress and anxiety (OR=20.9) and in social-attitudinal, present friends smokers (OR=12.9) and consider smoking a good option to spend free time (OR=40.61). Conclusions: factors associated with tobacco consumption were identified in the sample of adolescents studied.

Background: resilience is a social skill with great involvement in the prevention and reduction of smoking behavior. Objective: to determine the effect of resilience on tobacco consumption in students of the “Paco Cabrera” Secondary School from Puerto Padre, Las Tunas, in May 2023. Methods: a cross-sectional, analytical observational study was carried out on 257 students in secondary education, time and with the objective stated. The information was collected from a questionnaire and the 14 items Resilience Scale. Descriptive and inferential statistics were used in the statistical analysis. Results: smoking students were 14 years old (41.51 %), male (64.15 %) and ninth grade (45.28 %); 11.32 % of smokers had low or very low resilience (X2=30.309; p=0.0000). The overall resilience score for student smokers was 11.22 lower than for nonsmokers (w=2172.0; p=0.0000). The items of both subscales were statistically higher in the group of non-smokers (p

Aims Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices.Methods This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers.Results Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring.Conclusions Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.

Objective: The objective of this study was to identify the implementation of triage in emergency wards, after the release of Resolution 5596 of 2015 of the Ministry of Health of Colombia, in the hospitals of the outhwest subregion of the department of Antioquia. Methodology: Descriptive, cross-sectional study. The 23 public hospitals in the municipalities of the southwestern subregion of Antioquia were in-cluded. A convenience non-probabilistic sampling was used. The data were obtained through a survey and structured interview technique. Findings: The survey was answered by hospital officials from the 23 municipalities of southwest Antioquia. Only 3 institutions (13%) have an adequate implementation of the triage service (adherence to the resolution greater than 80%), 74% reported adherence to the resolution > 20% and ≤ 80% and 3 institutions do not achieved a percentage of adherence greater than 20% to the resolution. Only 3 institutions (13%) use validated triage, in 3 other institutions (13%) they do not know what type of triage they use and in most institutions (74%) they use a non-validated triage. Conclusions: in spite of being a mandatory regulation for the hospitals of the national territory, only 13% of the hospitals included in the study com-ply with the technical criteria of triage policy of the Colombian Ministry of Health.

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Background: several studies show deterioration of theoretical and practical knowledge between three months and a year after taught; therefore, institutions recommend systematic reviews. Objective: to determine the relationship between study habits, learning styles and knowledge retention of physiological, taught in the subject Cardiovascular, respiratory, digestive and renal system, in third-year medical students, from Puerto Padre Medical Sciences College in April 2023. Methods: a cross-sectional, analytical observational study was conducted in 54 students of the third year of the medical science, with the objective, institution and period previously defined. Three instruments were applied, including the variables: age, sex, study habits, learning style and diagnostic test result. Descriptive and inferential statistics was used for its processing. Results: the average age of the sample was 21.28±1.07 years and 66.67 % of the female sex; 57.41 % passed the diagnostic examination; the respiratory and digestive systems had the best results. Reflective style was the most frequent (40.74 %), while in students with theoretical style the results were higher. 51.61 % of those approved had very adequate study habits (X2=6.538; p=0.0380) and in these the number of hours dedicated to the study was higher. Conclusions: the relationship between study habits, learning styles and knowledge retention of physiological contents in medical students was determined.

Abstract Objective To describe and compare the results obtained with a secondary healing protocol for fingertip amputations and their relationship to injury severity according to the Allen classification. Methods Medical records of 127 fingertip injuries were revised, and a retrospective, comparative, analytical study the amputations treated conservatively was performed. Injury characteristics, healing time, and complications were described and analyzed. Results Between April 2017 and May 2019, 127 fingertip injuries were treated conservatively. The average age of the sample was of 28.33 years. The average healing time was of 4.31 weeks. The complications during the follow-up were observed in 18.9% (n= 24) of the cases, but none require revision treatment. A statistically significant relationship between the development of complications and treatment revision according to the Allen classification was not found (p ≥ 0.05). Conclusion The proposed secondary healing protocol has shown to be safe and effective in types 1 to 3 fingertip amputations in the Allen classification, and it should be included as a therapeutic option even in injuries of greater extension than those that have traditionally been limited to.

Objectives To assess the values of and attitudes towards the use of rapid SARS-CoV-2 antigen-detection tests for self-testing in a rural and an urban area in Peru.Design Cross-sectional, street-based population survey.Setting A series of over 400 randomly selected street points in Valle del Mantaro and in Lima.Participants 438 respondents (203 female) participated. They were all older than 17 years and provided informed consent for participation.Intervention All respondents answered on the spot, a 35-item questionnaire developed in KoboToolbox.Primary and secondary outcome measures Primary outcomes of interest were: likelihood to use a SARS-CoV-2 self-test; willingness to pay for a SARS-CoV-2 self-test and likelihood to comply with recommended actions following a positive SARS-CoV-2 self-test result. Bivariate analyses and Poisson regression (PR) analyses were performed to identify significant associations between dependent variables and independent variables pertaining to respondents’ characteristics, risk perception and previous experiences with conventional COVID-19 testing.Results Of the 438 respondents, 51.49% had previous experience with conventional COVID-19 testing; 20.37% had COVID-19 disease; 86.96% accepted the idea of SARS-CoV-2 self-testing; and, 78.95% would be likely to use it if needed. Almost all (94.75%) would pay for a self-testing device (mean acceptable payment: US$10.4) if it was not provided free of charge by health authorities. Overall, 93.12%, 86.93% and 85.32% would self-isolate, report the results and warn their contacts, respectively. Being a female (adjusted PR 1.05, 95% CI 1.00 to 1.09, p

Background: undernutrition due to excess in the pediatric age is a pressing problem for health systems and society. Anthropometric indicators associated with adiposity are used in its diagnosis. Objective: to describe anthropometric parameters in children with overnourishment attending the "Camilo Cienfuegos" semi-boarding school in Puerto Padre, Las Tunas, from January to June 2022. Methods: an observational, descriptive, cross-sectional study was conducted in 67 children with excessive malnutrition, in the institution and time period defined in the objective. The information was obtained through a questionnaire and anthropometric parameters’ measurements. Descriptive statistics was used in the processing and the t-student and chi-square tests were used in the comparison of variables. Results: 56.72 % were overweight and 43.28 % obese, more frequent in males (64.18 %). Children with extremely high adiposity predominated (44.78 %), more pronounced in men (60 %). The percentage of body fat was higher in girls (33.52±5.02) showing significant differences (t=13.03; p=0.0000); by age there were more cases between 10 and 12 years. 58.21 % had a normal waist-to-hip index, although 57.14 % of the girls classified with an obese waist-to-hip index. In the fat area, the name predominated over the norm, with values above 90 % in both sexes, in the muscle prevailed the average fat. Conclusions: anthropometric characteristics were described in the children malnourished due to excess attending "Camilo Cienfuegos" semi-boarding school.

Background: academic stress is one of the problems that mostly affects the physical and mental health of university students, in particular of the medical career. Objective: to establish the descriptive profile of academic stress and determine its relationship with academic performance in the subject Cardiovascular, respiratory, digestive and renal system, in students of the second year of the medical degree of the Branch of Medical Sciences of Puerto Padre, in the University of Medical Sciences of Las Tunas. Methods: an observational, analytical and correlative study was carried out in 71 students declared in the objective. To collect the information, the SISCO SV 21 inventory was used for the study of academic stress, and the teaching records were reviewed to obtain academic results. We analyzed variables, age, sex, academic stress, stressors, symptoms, coping strategies and academic performance. Descriptive and inferential tests were used in the statistical processing. Results: an average level of stress prevailed in the male sex and the high level in the female sex; the stressor predominated, "limited time to do the work"; the most frequent symptom was, "reluctance to do the school work" and as the main copying strategy used, "concentrate on resolving the worrying situation". Students with very high stress levels had the lowest grades. Conclusions: the profile of academic stress was established and its relationship with academic performance was determined in students of the second year of the medical career of Puerto Padre.

Self-testing for COVID-19 may be a preferable strategy for identifying SARS-CoV-2 infection among populations in low- and middle-income settings. To determine South Africans’ values related to COVID-19 self-testing should it become widely available, a cross-sectional survey was administered in Durban, KwaZulu-Natal Province and the King Sabata Dalindyebo sub-district of the Eastern Cape.A 35-question survey was administered to 531 participants (268 female) in one urban and one rural setting of South Africa. Survey participants were randomly selected by household in the rural setting, while in the urban setting participants were approached in randomly selected public places. The survey assessed participants’ likelihood of using and willingness to pay for a COVID-19 self-test and actions they would take following a COVID-19 self-test. The results were analysed using descriptive statistics and bivariate and multivariate regression.Overall, 93.03% of participants supported COVID-19 self-testing, 61.62% of participants were willing to pay for self-testing, and 90.15% indicated they would communicate their results if they tested positive. Rural participants were more positively associated with each of these outcomes compared with urban-based participants. Should they test positive, most participants said they would: go in-person to a health facility for counselling (76.45%), self-isolate (95.85%), notify close contacts (97.74%), and inform their employer (95.14%).COVID-19 self-testing was a preferable option for most participants, although this varied with setting and demographic characteristics. Self-testing may overcome barriers to care for South Africans, but to achieve this, policies for self-testing and delivery methods must not exacerbate individuals’ underlying economic vulnerabilities.

BackgroundThe COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. ObjectiveThis study aims to explore decision makers’ values and attitudes around SARS-CoV-2 self-testing. MethodsIn 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public’s attitudes around self-testing. ResultsIn total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. ConclusionsIn Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests’ features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru.

Introducción: La pesquisa activa como medida de prevención y control de la COVID-19, se realiza para detectar las manifestaciones clínicas de infecciones respiratorias agudas y garantizar la salud del pueblo. Objetivo: Describir los resultados de la pesquisa activa de infecciones respiratorias agudas realizada por estudiantes de Medicina del área de Salud ¨Románico Oro Peña¨. Métodos: Se realizó un estudio descriptivo, transversal, de la pesquisa activa de sintomáticos respiratorios, como estrategia de enfrentamiento a la COVID-19, en el Consultorio No. 5, de Puerto Padre, de marzo a julio del 2020. La población de estudio fueron 1638 habitantes. Se analizaron variables viviendas visitadas y pesquisadas, personas investigadas; con sintomatología respiratoria y consideradas vulnerables. La información se obtuvo de los partes diarios, emitidos al puesto de mando y analizada a través del cálculo porcentual. Resultados: Se destacaron los meses de mayo y junio con un 98 % de viviendas pesquisadas; el 69.2 % y el 66.7 % de viviendas recuperadas de forma respectiva; sobresalió el mes de marzo con un 27.3 % de pacientes pesquisados con sintomatología respiratoria. Las comorbilidades que predominaron fueron: la hipertensión arterial con 279 casos y el asma bronquial con 137 pacientes. Se pesquisó el 94.4 % de los adultos mayores de 60 años, el 72.2 %, vivían acompañados y el 22.2 % solos. Conclusiones: La pesquisa activa contribuye a la detección de casos, el diagnóstico precoz, así como a la atención diferenciada a los grupos de riesgo.

Abstract Human triosephosphate isomerase (HsTIM) is a central glycolytic enzyme and is overexpressed in cancer cells with accelerated glycolysis. Triple-negative breast cancer is highly dependent on glycolysis and is typically treated with a combination of surgery, radiation therapy, and chemotherapy. Deamidated HsTIM was recently proposed as a druggable target. Although thiol-reactive drugs affect cell growth in deamidated HsTIM-complemented cells, the role of this protein as a selective target has not been demonstrated. To delve into the usefulness of deamidated HsTIM as a selective target, we assessed its natural accumulation in breast cancer cells. We found that deamidated HsTIM accumulates in breast cancer cells but not in noncancerous cells. The cancer cells are selectively programmed to undergo cell death with thiol-reactive drugs that induced the production of methylglyoxal (MGO) and advanced glycation-end products (AGEs). In vivo, a thiol-reactive drug effectively inhibits the growth of xenograft tumors with an underlying mechanism involving deamidated HsTIM. Our findings demonstrate the usefulness of deamidated HsTIM as target to develop new therapeutic strategies for the treatment of cancers and other pathologies in which this post translationally modified protein accumulates.

Simple Summary: Pericardial disease is a common and severe complication in patients with cancer, often presenting as acute pericarditis, pericardial effusion, or constrictive pericarditis. Causes include direct tumor invasion, metastasis, and cancer treatments like chemotherapy and radiotherapy. Lung cancer is the most frequent etiology, followed by breast cancer and lymphomas. Early detection and multidisciplinary management are crucial. Acute pericarditis requires careful diagnosis and treatment with NSAIDs and colchicine. Pericardial effusion is commonly incidental but can lead to cardiac tamponade, necessitating pericardiocentesis or a pericardial window. Immunotherapy-related effusions typically respond to treatment cessation and steroids. Constrictive pericarditis, although rare, requires prompt diagnosis and may necessitate surgical intervention. Multidisciplinary care and early intervention are vital for improving patient outcomes and quality of life. Pericardial disease is increasingly recognized in cancer patients, including acute pericarditis, pericardial effusion, and constrictive pericarditis, often indicating a poor prognosis. Acute pericarditis arises from direct tumor involvement, cancer therapies, and radiotherapy. Immune checkpoint inhibitor (ICI)-related pericarditis, though rare, entails significant mortality risk. Treatment includes NSAIDs, colchicine, and corticosteroids or anti-IL1 drugs in refractory cases. Pericardial effusion is the most frequent manifestation, primarily caused by lung cancer, followed by breast cancer, lymphoma, leukemia, gastrointestinal tumors, and melanoma. Chemotherapy, immunotherapy, and radiotherapy may also cause fluid accumulation in the pericardial space. Symptomatic relief for pericardial effusion may require pericardiocentesis, prolonged catheter drainage, or a pericardial window. Instillation of intrapericardial cytostatic agents may reduce recurrence. Constrictive pericarditis, though less common, often develops from radiotherapy and requires multimodality imaging for diagnosis, with pericardiectomy as the definitive treatment. Primary pericardial tumors are rare, with metastases being more frequent. Patients with cancer and pericardial disease generally have poor survival, emphasizing the need for early detection. A multidisciplinary approach involving hematologists, oncologists, and cardiologists is crucial to tailoring pericardial disease treatment to a patient's clinical status, thereby improving the quality of life and prognosis. [ABSTRACT FROM AUTHOR]

Abstract Current theoretical accounts on the oscillatory nature of sustained attention predict that entrainment via transcranial alternating current stimulation (tACS) at alpha and theta frequencies on specific areas of the prefrontal cortex could prevent the drops in vigilance across time-on-task. Nonetheless, most previous studies have neglected both the fact that vigilance comprises two dissociable components (i.e., arousal and executive vigilance) and the potential role of differences in arousal levels. We examined the effects of theta- and alpha-tACS over the right dorsolateral prefrontal cortex in both components of vigilance and in participants who differed in arousal level according to their chronotype and time of testing. Intermediate-types performed the vigilance tasks when their arousal level was optimal, whereas evening-types performed the vigilance tasks when their arousal levels were non-optimal. Both theta- and alpha-tACS improved arousal vigilance in the psychomotor vigilance task (PVT), whereas alpha-tACS, but not theta-tACS, improved executive vigilance in the sustained attention to response task (SART), and counteracted the typical vigilance decrement usually observed in this task. Importantly, these stimulation effects were only found when arousal was low (i.e., with evening-types performing the tasks at their non-optimal time of day). The results support the multicomponent view of vigilance, the relevance of heeding individual differences in arousal, and the role of alpha oscillations as a long-range cortical scale synchronization mechanism that compensates the decrements in performance as a function of time-on-task by exerting and maintaining cognitive control attributed to activation of the right dorsolateral prefrontal cortex.

BackgroundCOVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria.MethodsIn-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied.ResultsThe 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive.ConclusionAlthough the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

BackgroundDespite being a new entity, there is a large amount of information on the characteristics of SARS-CoV-2 infection and the symptoms of the acute phase; however, there are still many unknowns about the clinical features and pathophysiology of post-COVID syndrome. Refractory chronic cough is one of the most prevalent symptoms and carries both a medical problem and a social stigma. Many recent studies have highlighted the role of SARS-CoV-2 neurotropism, but no studies have demonstrated vagus nerve neuropathy as a cause of persistent chronic cough or other COVID-19 long-term effects.ObjectiveThe main objective was to assess the involvement of the vagus nerve neuropathy as a cause of chronic cough and other post-COVID syndrome symptoms.Material and methodsThis was a single-center observational study with prospective clinical data collected from 38 patients with chronic cough and post-COVID-19 syndrome. Clinical characteristics and laryngeal electromyographic findings were analyzed.ResultsClinical data from 38 patients with chronic cough after 12 weeks of the acute phase of COVID-19 infection were analyzed. Of these patients, 81.6% suffered from other post-COVID conditions and, 73.6% reported fluctuating evolution of symptoms. Laryngeal electromyography (LEMG) of the thyroarytenoid (TA) muscles and cricothyroid (CT) muscles was pathological in 76.3% of the patients. Of the patients with abnormal LEMG, chronic denervation was the most frequent finding (82.8%), 10.3% presented acute denervation signs, and 6.9% presented myopathic pattern in LEMG.ConclusionsLEMG studies suggest the existence of postviral vagus nerve neuropathy after SARS-CoV-2 infection that could explain chronic cough in post-COVID syndrome.

Background: identifying the characteristics of congenital anomalies allows implementing risk studies and establishing individualized prevention strategies with the aim of reversing their impact. Objective: to describe the characteristics of mothers who had products of conception with major birth defects of the urinary system, diagnosed in Puerto Padre, during the period 2018-2020. Methods: an observational, descriptive, cross-sectional study was performed in a sample of 14 mothers as defined in the objective. The information was collected from the Cuban Registry of Congenital Malformations and the Cuban Prenatal Registry of Congenital Malformations. Descriptive statistics was used in data processing. Results: 14 major birth defects of the urinary system were identified, for a prevalence of 5.6 per 1000 live births. The most frequent abnormality was hydronephrosis (35.71 %), followed by the right polycystic kidney (28.57 %). Most mothers were between 19 and 34 years old (71.43 %). It prevailed the standard weight mothers (85.71 %), the increased genetic risk (78.57 %), pregnancies that came to term (71.43 %), health area of Puerto Padre (64.29 %), urban area (57.14 %). The main genetic and environmental factors included no ingestion of folic acid (78.57 %), drug consumption during pregnancy and toxic habits (57.14 %) and chronic diseases in the mother (50 %). 71,43 % had more than one factor. Conclusions: characteristics of mothers with conception products with major congenital malformations of the urinary system were described.

ObjectiveThe aim of the study was to gain a qualitative insight into scientific researchers' perceptions of gender inequality inside Nigerian research institutions through an investigation of how gender equality is enacted in medical and dental research institutions in Nigeria.MethodsThis descriptive and cross-sectional qualitative study probed decision-making around navigating gender inequity and explored opinions about how a supportive environment for female medical and dental researchers could be established. Data were collected through semi-structured telephone interviews with 54 scientific researchers across 17 medical and dental academic institutions in Nigeria between March and July 2022. Data were transcribed verbatim and analyzed using thematic analysis.ResultsThree core themes emerged: institutionalized male dominance in research institutions; changing narratives on gender equalities in research and academic enterprise; and women driving the conscience for change in research institutions. Female medical and dental researchers' perceived gender equality was challenging mainstream androcentric values in knowledge production within the medical and dental field; and queries the entrenchment of patriarchal values that promote a low number of female medical and dental trainees, fewer female research outputs, and few women in senior/managerial positions in the medical fields.ConclusionDespite the general view that change is occurring, a great deal remains to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria.

Objectives Nigeria has been badly affected by the COVID-19 pandemic, and the poor testing coverage in the country may make controlling the spread of COVID-19 challenging. The aim of this study was to assess the general public’s acceptability of SARS-CoV-2 self-testing as an approach which could help to address this gap.Setting A household-based survey was conducted in five urban and five rural local government areas in the states of Akwa Ibom, Anambra, Benue, Kaduna and Lagos, in mid-2021.Participants 2126 respondents (969 were female) participated. A five-pronged, probabilistic sampling approach was used to recruit individuals older than 17 years and available to participate when randomly approached in their households by the surveyors. A 35-item questionnaire was used to collect data on their values towards SARS-CoV-2 self-testing. Primary outcomes were: likelihood to use a self-test; willingness to pay for a self-test; and likely actions following a reactive self-test result.Results Of the total 2126 respondents, 14 (0.66%) were aware of COVID-19 self-testing, 1738 (81.80%) agreed with the idea of people being able to self-test for COVID-19, 1786 (84.05%) were likely/very likely to use self-tests if available, 1931 (90.87%) would report a positive result and 1875 (88.28%) would isolate if they self-tested positive. Factors significantly associated with the use of a self-test were having a college education or higher (adjusted Odds Ratio (AOR): 1.55; 95% CI: 1.03 to 2.33), full-time employment (AOR: 1.67; 95% CI: 1.06 to 2.63), feeling at moderate/high risk of COVID-19 (AOR: 2.43; 95% CI: 1.70 to 3.47) and presence of individuals at risk of COVID-19 within the household (AOR: 1.38; 95% CI: 1.06 to 1.78).Conclusion A majority of Nigerians agree with the concept of COVID-19 self-testing and would act to protect public health on self-testing positive. Self-test implementation research is necessary to frame how acceptability impacts uptake of preventive behaviours following a positive and a negative self-test result.

Introducción: En la población geriátrica, el deterioro del estado nutricional afecta de forma negativa, el mantenimiento de la funcionalidad física y cognitiva, la sensación de bienestar y en general la calidad de vida. Objetivo: Describir la situación nutricional del adulto mayor y su relación con las enfermedades crónicas no transmisibles. Métodos: Se realizó un estudio descriptivo transversal, en el Consultorio Médico de la Familia número 13 del policlínico ¨Luis Li Trigent¨, el universo estuvo constituido por 322 adultos mayores, se tomó una muestra no probabilística que quedó conformada por 97 adultos mayores, con enfermedades crónicas no transmisibles. Se estudiaron variables como: la edad, el sexo; el estado civil, los factores de riesgo; las enfermedades crónicas, el número de enfermedades y la valoración nutricional; se calculó el Índice de la masa corporal. Resultados: Predominaron los adultos mayores de 60 a 74 años, en un 52.57 %; el sexo femenino, el 32.98 %, el estado civil casados, un 42.26 %. El factor de riesgo de malnutrición más frecuente fue la polifarmacia, en 63.91 %, la enfermedad crónica más presente era la hipertensión arterial, 52.57 % y la valoración nutricional influyente el sobrepeso, en ancianos que presentaron de 2 a 3 enfermedades, 29.79 %. Conclusiones: El sobrepeso es el estado nutricional que prevalece en los adultos mayores, se asocia con las variables sociodemográficas y los factores de riesgo que describen la relación del proceso de envejecimiento y las enfermedades crónicas no transmisibles.

Abstract Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses ( 800 mg), either at the viral (1–7 days post-symptom onset), early inflammatory (8–15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37–4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4–15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400–800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses.

Abstract Objective To define the effectiveness of fluoroscopy-guided percutaneous vertebral biopsy. Methods Prospective study of patients with vertebral destruction syndrome at one institution. Percutaneous transpedicular vertebral biopsies guided by fluoroscopy were performed, and bony tissue and intervertebral disc tissue were extracted; histopathology and microbiology studies were also performed. Age, sex, vertebral segment, neurologic status, and biopsy and culture results were analyzed. Results The average age of the patients was 53.8 years (range: 2 to 83 years), and the main spine segment was the lumbar segment in 62% of the cases. According to the impairment scale of the American Spinal Injury Association (ASIA), preoperatively, 49% of the patients were classified as Asia E, and 100% had pain. Definitive etiology was identified in 83% of the sample. The etiology was grouped into three categories: infectious, neoplasia, and degenerative (osteoporotic). The infectious group was composed of 36% of the patients, in whom Staphylococcus aureus was the most common agent identified; in 34.9% the sample, the etiology was neoplastic, most commonly multiple myeloma and metastatic disease due to prostate cancer; 21.7% of the patients had osteoporosis. The average surgical time was of 47.5 minutes, the average blood loss was of 10 mL. No complications were reported. Conclusion Transpedicular percutaneous biopsy guided by fluoroscopy had an effectiveness of 83% for the etiological diagnosis of vertebral destruction syndrome in the present series. It should be considered a useful minimally-invasive procedure, which is easy, economical, and reproducible, with low risk of short- and long-term complications.

Fundamento: el bajo peso al nacer constituye la principal causa de morbilidad y mortalidad neonatal. Objetivo: caracterizar a las madres con hijos bajo peso al nacer pertenecientes al Policlínico Universitario “Romárico Oro Peña”, de Puerto Padre, Las Tunas, de enero 2020 a diciembre 2021. Métodos: se realizó un estudio descriptivo, de corte transversal, en relación a las madres con hijos bajo peso al nacer, del área de salud y período antes señalado. La población estuvo constituida por 36 madres. Los datos se obtuvieron a partir de las historias clínicas. Se estudiaron las variables: grupos de edades, enfermedades propias del embarazo, comorbilidades, evaluación nutricional, ganancia de peso materno, antecedentes obstétricos, otros factores de riesgo y clasificación del bajo peso. Para el análisis de los resultados se empleó la estadística descriptiva. Resultados: el grupo de edad materna con mayor incidencia de hijos con bajo peso fue el de menores de 20 años (52,8 %); la rotura prematura de membrana (25 %) fue la enfermedad propia del embarazo de mayor frecuencia y la infección vaginal (72,2 %) la comorbilidad. El 77,8 % de las madres presentaron una valoración nutricional inadecuada, predominando las de peso deficiente (44,4 %). Las nulíparas (47,2 %) y las que presentaron un periodo intergenésico corto (63,9 %) fueron las que más aportaron un bajo peso al nacer. Predominó el bajo peso por nacimiento pretérmino. Conclusiones: se caracterizaron las madres con niños bajo peso al nacer en el área de salud del policlínico “Romárico Oro Peña” durante el período 2020–2021.

Background: in patients with atopic dermatitis, sensitization to environmental allergens is a risk factor for asthma and/or allergic rhinitis and increases the severity of this disease. Objective: to determine the sensitization to environmental mites and fungi in patients with atopic dermatitis treated at the Allergy service of "Romárico Oro" polyclinic in Puerto Padre, from 2015 to 2020. Methods: an observational, descriptive cross-sectional study was carried out in 62 patients diagnosed with atopic dermatitis, at the institution and period aforementioned. Data were obtained from individual medical records and each patient underwent to a Prick skin test with allergenic extracts from three mites and three environmental fungi. Descriptive statistical tests were used and the t-student and Chi-square tests to compare variables. Results: it was more frequent in patients under 10 years (54.84 %) and females (53.23 %); 62.9 % of patients with positive skin tests had a family history of atopic dermatitis or allergic disease. Sensitization to one of the allergens occurred in 77.77 % of the patients at least, with a predominant positive response to mites (X2=11.82; p=0.0006); Blomia tropicalis was the most represented mite and Cladosporium herbarum was the predominant fungus; in 54.84 % of the patients, atopic dermatitis coexisted with respiratory allergies. Conclusions: sensitization to environmental mites and fungi was determined in the sample of patients with atopic dermatitis studied.

Objective To explore the lived experience of women diagnosed with breast cancer through the analysis of illness narratives, as an example of a narrative-based medicine approach.Setting Spain.Participants Nine narratives stemming from non-fiction books, and six from interviews through online platforms. All participants were cis women and their ages ranged between 34 and 60 years. The inclusion criteria were being a woman and having been diagnosed with and treated for breast cancer in Spain.Results The main topics that appeared on the analysis were: secondary effects of treatment, breast loss and scars, breast reconstruction, long-term effect of treatment, positive attitude, illness as learning and use of language. Although the results of this research are preliminary, it can be said that societal expectations quickly became a burden for the patients. Moreover, there was no common behavioural pattern among the participants and how they chose to manage their cancer journey. Choosing whether or not to hide their baldness, go through reconstructive surgery or fulfil the ‘patient role’ were options they wanted to review based on their own priorities, and not because of external impositions. Even though the women agreed with the benefits of having a positive attitude, they also asked for space to feel rage and sadness, not to be compared with others and to be heard with no haste, as well as to be accompanied beyond the treatment, and for their long-term effects of medications to be validated. The importance of the type of comments and language used is emphasised.Conclusion A narrative-based medicine approach enables us to incorporate the patient experience into the understanding of breast cancer. We encourage clinicians to be aware of the concepts of normality held by women, and to welcome different choices and different ways to experience illness.

Background: the modifications of the skin prick test results can be used to determine the effectiveness of immunotherapy. Objective: to assess the modifications of the skin prick test results after treatment with immunotherapy, in patients treated at the “Dr. Gustavo Aldereguía Lima” University Polyclinic of Las Tunas, from September 2019 through September 2021. Methods: a cuasi-experimental, longitudinal and prospective study was carried out with 100 allergic patients treated with immunotherapy at the allergology department of the aforementioned polyclinic and during the period herein stated. Each patient underwent the skin prick test with mite extract, before the beginning and at two years of treatment. The following variables were assessed: age, sex, allergic diseases, mites, values of the prick test and frequency of symptoms. Results: there was prevalence in the sample of the 5 to 19 age group (69 %) and females were more frequent (57 %). The Dermatophagoides pteronyssinus was the mite with the highest sensibility (80 %) and the most frequent disease was allergic rhinitis (65 %), followed by bronchial asthma (59 %). Before the intervention, 63 % of the patients presented symptoms with a weekly frequency and at two years 93 % had reduced the frequency to more than three months. The response intensity of the skin test decreased significantly. Conclusions: the modifications of the skin prick test results, after treatment with immunotherapy, were significant.

Background: congenital anomalies are the second leading cause of infant mortality in the country. To quickly identify the risk factors associated with them must contribute to reduce its prevalence and the resulting mortality. Objectives: to determine the maternal risk factors associated with major congenital anomalies identified in the municipality of Puerto Padre, Las Tunas, during the period 2018-2020. Methods: an observational, analytical, case-control study was carried out with a sample of 55 registered congenital anomalies (cases) and 110 without defects (controls), at the aforementioned health district and period of time. The following variables were analyzed: prevalence of congenital anomalies, types and affected systems, extreme maternal age, maternal and family history of congenital anomalies, spontaneous abortion and previous fetal death, consanguinity, non-intake of preconception folic acid, maternal obesity, chronic and infectious maternal diseases, medication intake, toxic habits, hyperthermia and exposure to environmental toxins during pregnancy. The information was gathered from the Cuban registers of congenital malformations. Results: a high prevalence of congenital anomalies was found; the factors that showed an association with the defects were: previous spontaneous abortions (X2=7,0047 p=0,0081 OR=10,9), non-intake of preconception folic acid (X2=11,1375 p=0,0008 OR=4,49), family history of genetic disease (X2=4,7596 p=0,0291 OR=4,37), toxic habits (X2=10,5061 p=0,0011 OR=3,63), medication intake (X2=8,3192 p=0,0039 OR=2,83) and maternal chronic diseases (X2=5,8581 p=0,0155 OR=2,42). Conclusions: the risk factors associated with congenital anomalies in pregnant women from Puerto Padre during the period 2018-2020 were determined.

Introducción:En los exámenes finales de las asignaturas es necesario conocer la calidad de los instrumentos evaluativos que se emplean porque los defectos en su elaboración provocan efectos negativos en el currículo, el proceso docente y los estudiantes.Objetivo:Analizar la validez del examen final de la asignatura Metabolismo y Nutrición de la carrera de Medicina.Métodos:Se realizó un estudio observacional, analítico transversal, en la Facultad de Ciencias Médicas de Mayabeque, el universo fue estudiado en su totalidad, se constituyó por los resultados del examen final ordinario de la asignatura Metabolismo y Nutrición de la carrera de Medicina del curso 2018-2019. Para argumentar la validez se utilizaron el contenido y la estructura interna.Resultados:Fueron aplicados dos temarios A y B a 47 y 45 estudiantes. Hubo una adecuada correspondencia entre el fondo de tiempo asignado en la planificación docente de los contenidos y la cantidad de incisos que los exploraron, más de un tercio de los distractoresde ambos temarios resultaron no funcionales. El 63.2 % en el temario A y 70.5 % del temario B resultaron fáciles, elevada proporción de incisos con pobre o pésimo poder discriminativo.Conclusiones:Los dos temarios aplicados presentan resultados similares. Las principales deficiencias que afectan la validez del examen se detectan en el predominio del carácter reproductivo y el nivel de asimilación del conocimiento, alto porcentaje de distractores no funcionales; inadecuada distribución de ítems según el nivel de dificultad y un tercio no discrimina de forma adecuada.

Abstract Chronotype refers to the time of day preferred by individuals to perform daily activities according to their circadian rhythm. We asked whether synchrony effects, that is, the difference in performance between the optimal and non-optimal time of day as a function of chronotype, are observed in two tasks that differently involve the endogenous component of the alerting network, the psychomotor visual task (PVT) and the flanker task. From an initial sample of 132 students that filled in the Morningness–Eveningness Questionnaire (MEQ), 18 were classified as Morning-types and 16 as Evening-types. Evening-types showed synchrony effects in both tasks, whereas Morning-types failed to show synchrony effects in the flanker task and when the PVT was first performed at the non-optimal time of day. Thus, Morning-types might have seen increased their vigilant attention at their non-optimal time of day due to the cognitive demands of the flanker task and to the novelty with the PVT. Phasic alerting generated by alerting tones increased conflict score in the flanker task, but time of day did not modulate the congruence effect. Chronotype determines vigilant attention more decisively in Evening-types than in Morning-types individuals. Also, exogenous but not endogenous alerting exerts a deleterious effect on conflict resolution.

Constantemente se emiten juicios y decisiones sobre los estudiantes basados en varios tipos de evaluación. Para hacer juicios imparciales, se debe entender cuidadosamente las fortalezas y limitaciones de las herramientas y procesos de evaluación sobre el cual se basan estas decisiones. En realidad, se requiere de evidencia para respaldar la validez de nuestras decisiones. Es necesario conocer los indicadores técnicos que definen la calidad del instrumento evaluativo que se emplea por su dimensión y por el poderoso impacto social que tiene, pues los defectos en la elaboración de los mismos tienen efectos negativos en los estudiantes. Con el objetivo de presentar algunos criterios que en la actualidad predominan en relación con la calidad de los instrumentos evaluativos escritos, se realizó una búsqueda bibliográfica a través de Infomed, Medline, SciELO y Redalyc.y Google Scholar. Se concluye que el actual modelo de Validez, por su carácter holístico, procesal, dinámico y abierto, resulta esencial como criterio de calidad en la evaluación. Cuando se emplean instrumentos escritos, el contenido de la prueba y su estructura interna constituyen las más importantes fuentes de evidencia para argumentar su validez.

ObjectiveThis study aims to identify barriers to the professional advancement of women researchers in West Africa.MethodsThis was a descriptive, observational, cross-sectional qualitative study conducted between June and September 2020 in five West African countries (Ghana, Senegal, Burkina Faso, Niger and Mali). Interviews were conducted with 21 female and 9 male health researchers by video call. After transcription, the data was thematically analysed using an inductive process.ResultsFour themes associated with barriers to women's careers development were identified. First. was family- and environmental-related barriers. Gender norms that assign domestic tasks and responsibilities to women reduced the time they were able to dedicate to research. Second was gender insensitive organisational culture and institutional policies that deepened gender disparities and made it more difficult for women to attain leadership positions. Third was the need for women in research to undergo emancipation programs to strengthen their resilience and ability to make critical decisions as strategic approaches to address the challenges faced by women in the academia were a lot more focused on addressing their relationship with their spouse. Forth, was the individual intermediate perception of professional and personal success which for many women, they perceive themselves as competent as their male counterparts and should not be subject to the gender discrimination they experience.ConclusionThe web created between work-life and home-life for West African women researchers mainly as a result of the gender inequalities in the social structure will require more medium- and long-term strategic planning by institutional authorities to reduce gender disparities in research and academia. This work has highlighted the influence of family and social life on the professional lives of West African women researchers. The study could help contribute to the development of gender equality interventions for the career development of women researchers in West Africa.

Introducción: por su dimensión y por el poderoso impacto social que tienen, la elaboración de exámenes debe ajustarse a rigurosos estándares de calidad, pues los defectos en la elaboración de los mismos tienen efectos negativos en el currículo, el proceso docente y los estudiantes.Objetivo: analizar evidencias que argumentan la validez del examen final de la asignatura Biología molecular de la carrera de Medicina, aplicado en la convocatoria ordinaria del curso 2018/2019, en la Facultad de Ciencias Médicas de Mayabeque.Métodos: estudio observacional analítico transversal. Universo estudiado en su totalidad, constituido por los resultados del examen final ordinario de 98 estudiantes. Como fuentes de evidencia para argumentar la validez se utilizarán las relacionadas con el contenido y con la estructura interna de los exámenes.Resultados: coeficiente de correlación positivo débil entre el fondo de tiempo asignado en la planificación docente de los contenidos y la cantidad de incisos que los exploran, el 36 % de distractores No funcionales. Ausencia de incisos medianamente difíciles y 16.7% de incisos fáciles. Poder de discriminación de los incisos, excelente, buena en el 56.7% y 33 % pobre o pésimo.Conclusiones: la muestra que explora el examen no es representativa de los contenidos del programa; predominio de preguntas de carácter reproductivo; elevada proporción de incisos fáciles; pr

Esta investigación es de carácter cuantitativo, con un nivel descriptivo y correlacional cuyo objetivo fue analizar la relación entre el componente intelectual y nutricional en un grupo de 76 menores escolarizados de una institución educativa de carácter oficial seleccionada por conveniencia, 38 sujetos hicieron parte del grupo control (sin desnutrición) y 38 conformaron el grupo caso (con desnutrición crónica). La evaluación clínica de la capacidad intelectual se realizó a través de la prueba RIAS; además de la valoración nutricional; de acuerdo con los resultados se encontró un menor desempeño en los sujetos tanto del grupo caso como del control a nivel de las escalas de inteligencia verbal, no verbal e índice de memoria; sin embargo, no se presentaron diferencias significativas en los grupos en funcion del componente intelectual. Por lo anterior se concluye que al investigar el factor de implicación nutricional en los menores se debe tener en cuenta el análisis de otro tipo de variables como es el psicosocial la cual podría estar explicando el desempeño análogo obtenido por los grupos evaluados.

BackgroundAccessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members’ views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. ObjectiveWe aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. MethodsThis multisite, mixed methods, observational study will be conducted in 9 countries—Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa—and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. ResultsAs of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. ConclusionsThe views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID)DERR1-10.2196/33088

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Introducción: conforme envejecen las poblaciones, aumenta la carga de enfermedades no trasmisibles. Objetivo: determinar la mortalidad anatomopatológica por causas cardiorespiratorias en adultos mayores de 60 años. Método: se realizó una investigación de desarrollo analítico y transversal con el objetivo de determinar las causas directas de muerte en los adultos mayores de 60 años. La población de estudio estuvo constituida por los pacientes a los que se les realizó necropsia que cumplían con los criterios que se establecieron para el estudio. Resultados: predominaron los pacientes del sexo masculino, con edades entre 70 y 79 años, antecedentes cardiovasculares de hipertensión arterial, insuficiencia cardíaca, cardiopatía isquémica, consumo de tabaco e hipertensión arterial; como factores de riesgo de infecciones respiratorias predominaron el género, el consumo de tabaco, la humedad y el hacinamiento. El tiraje, la taquipnea y la expectoración fueron los resultados del examen físico de mayor incidencia. Conclusiones: la incidencia y la letalidad por enfermedades cardiorespiratorias incrementó con la edad del paciente y con la presencia de factores de riesgo como la hipertensión arterial, el género, el hacinamiento y el consumo de tabaco. Las principales causas directas de muerte fueron las infecciones respiratorias agudas asociadas a las neumonías y las bronquitis.

Epigenetic modifications could drive some of the molecular events implicated in proliferation, drug resistance and metastasis of pancreatic ductal adenocarcinoma (PDAC). Thus, epigenetic enzyme inhibitors could be the key to revert those events and transform PDAC into a drug-sensitive tumor. We performed a systematic study with five different epigenetic enzyme inhibitors (1, UVI5008, MS275, psammaplin A, and BIX01294) targeting either Histone Deacetylase (HDAC) 1 or 1/4, DNA methyltransferase 3a (DNMT3a), Euchromatic histone lysine methyltransferase 2 (EHMT2), or Sirtuin 1 (SIRT1), as well as one drug that restores the p53 function (P53R3), in three different human PDAC cell lines (SKPC-1, MIA PaCa-2, and BxPC-3) using 2D and 3D cell cultures. The synergistic effect of these antitumoral drugs with gemcitabine was tested and the most efficient combinations were characterized by RNA-seq. The inhibition of HDAC1/4 (MS275), HDAC1/4/SIRT1/DNMT3a (UVI5008) or EHMT2 (BIX01294) induced a significant reduction on the cell viability, even in gemcitabine-resistance cells. The combination of UVI5008 or MS275 with gemcitabine induced a synergistic effect at low concentration and the RNA-Seq analysis revealed some synergy candidate genes as potential biomarkers. Reverting aberrant epigenetic modifications in combination with gemcitabine offers an alternative treatment for PDAC patients, with an important reduction of the therapeutic dose.

Background: the correct diagnosis on what the allergens that sensitize the patient are makes it possible to establish an adequate management of the disease, avoiding the contact of patients with these allergens and establishing a more precise desensitizing therapy.Objective: to determine the sensitization to environmental mites and fungi in pediatric patients with asthma and allergic rhinitis treated at the allergy department of the "Romárico Oro" University Polyclinic of Puerto Padre, Las Tunas, during the period 2016 to 2020.Methods: an observational, descriptive, cross-sectional study was carried out with 165 patients between the ages of 5 and 18 years, and with a diagnosis of bronchial asthma and/or allergic rhinitis, at the aforementioned institution and during the period herein declared. Each patient underwent the prick skin test, using allergenic extracts from three mites and three environmental fungi. Simple descriptive statistical tests were used and the t-Student and chi-square tests were used for the comparison of variables.Results: in 73,3 % of the patients the skin test was positive for at least one of the allergens used; male patients and those with a family history of allergic disease predominated; mites showed higher prevalence of sensitization than that found among environmental fungi; Blomia tropicalis mite presented the highest prevalence of sensitization with 53,72 % and was responsible for a skin response of greater intensity.Conclusions: sensitization to environmental mites and fungi was determined in the studied sample of pediatric patients with asthma and allergic rhinitis.

Background: the adaptation of the learning style to the requirements of the degree course being studied favors the acquisition of knowledge in the students.Objective: to determine the variation of the learning styles and its relationship with the academic performance during the first five years of the degree in medicine with students from the Affiliated School of Medical Sciences of Puerto Padre, University of Medical Sciences of Las Tunas.Methods: an analytical, prospective and correlational study was carried out with 69 students who entered the degree in medicine in the 2015-2016 academic year, at the aforementioned teaching site. The CHAEA questionnaire on learning strategies was given at the beginning and at the fifth year of the studies. The variables, learning style, sex and academic performance were analyzed. Descriptive tests were used for statistical processing and Student's t-test, ANOVA, Chi-square test and Pearson's correlation coefficient were used for the comparison of variables.Results: at the beginning of the degree, the reflective style predominated and at the end of the fifth year, this, together with the theoretical, were the most represented ones; at the end of the fifth year, 72,47 % of the students modified their learning style and obtained the better grades; the greatest association at the end of the fifth year was found between the theoretical and the reflective styles, as well as between the pragmatic and the active ones. A correlation was also observed between the variation of the style and the accumulated academic grade.Conclusions: the variation of the learning styles and its relationship with the academic performance in medical students from Puerto Padre was determined.

We typically observe a decrement in vigilance with time-on-task, which favors the propensity for mind-wandering, i.e., the shifting of attention from the task at hand to task-unrelated thoughts. Here, we examined participants' mind-wandering, either intentional or unintentional, while performing vigilance tasks that tap different components of vigilance. Intentional mind-wandering is expected mainly when the arousal component is involved, whereas unintentional mind-wandering is expected mainly in tasks involving the executive component. The Psychomotor Vigilance Task (PVT) assessed the arousal component, whereas the Sustained Attention to Response task (SART) assessed the executive component of vigilance. The two types of mind-wandering were probed throughout task execution. The results showed that the overall rate of mind-wandering was higher in the PVT than in the SART. Intentional mind-wandering was higher with the PVT than with the SART, whereas unintentional mind-wandering was higher with the SART than with the PVT. Regarding mind-wandering as a function of vigilance decrement with time-on-task, unintentional mind-wandering in the PVT increased between blocks 1 and 2 and then stabilized, whereas a progressive increase was observed in the SART. Regarding intentional mind-wandering, a progressive increase was only observed in the SART. The differential patterns of intentional and unintentional mind-wandering in both tasks suggest that, intentional mind wandering occurs mainly in arousal tasks in which propensity to mind-wander has little impact on task performance. However, unintentional mind-wandering occurs mainly in executive tasks as a result of a failure of cognitive control, which promotes attentional resources to be diverted toward mind-wandering. These results are discussed in the context of the resource-control model of mind-wandering.

Background: adverse outcomes for mental health in confinement and epidemic situations are not usually evident; therefore, a systematic approach is required for the identification of cases and the selection of appropriate interventions.Objective: to characterize aspects of affective emotional states and determine their relationship with some sociodemographic factors, in the adult population of Puerto Padre, as a consequence of the context generated by COVID-19.Methods: an observational, descriptive, cross-sectional and correlational study was carried out with 206 subjects over 18 years of age, selected at random, from six family doctor’s offices of the health district of Puerto Padre, during the month of May 2020. For the psychological study of the emotional affective states (stress, anxiety and depression) the DASS-21 scale was applied. Simple descriptive statistical tests were used, and the t-Student and Chi-square tests, as well as and Pearson's correlation coefficient were used to compare variables.Results: 32,52 % of the studied subjects presented at least one of the three studied emotional states. The three affective conditions showed a significant relationship with a history of mental illness. The correlation analysis showed that there was a significant and positive association among the three emotional affective states, finding the greatest association between anxiety and stress.Conclusions: the relationship between emotional affective states and socio-demographic factors was determined during the COVID-19 pandemic in the studied population.

The digestive system and metabolism of the cannonball jellyfish Stomolophus sp. 2 are not well-known. The digestion study was critical to explain its ecology and bloom success. Different enzymes are involved in food digestion, which hydrolyze carbohydrates, proteins, and lipids. This study detected lipolytic activity in enzymatic extracts from gastric pouches of Stomolophus sp. 2 collected in the summer of 2013 at Bahía de Kino, Sonora, México (28°47′47″N 111°57′25″W). Lipase/esterase activity showed optimal pH at 11.0 and 50–60 °C with a half-life (t1/2) of 33 min at 55 °C, whereas halotolerance of this activity was recorded from 0-4 M NaCl. Metal ions Ca2+ and Mn2+ did not affect the activity, but Mg2+ decreased it 14.2% ± 3.15, while chelating agents as ethylenediaminetetraacetic acid reduced the activity 8.55% ± 2.13. Inhibition of lipase/esterase activity with tetrahydrolipstatin and paraoxon-ethyl decreased the activity 18.2% ± 2.3, and 62.80% ± 0.74, respectively, whereas phenylmethanesulfonyl fluoride (a protease inhibitor) did not affect it. The enzyme displayed a higher specificity for short-chain triglycerides, but triolein, coconut oil, olive oil, and fish oil were hydrolyzed. For the first time, phospholipase activity from the gastric pouch of Stomolophus sp. 2 was detected using L-α-phosphatidylethanolamine from chicken egg yolk as a substrate. These results suggest that Stomolophus sp. 2 hydrolyze several kinds of lipids, and lipolytic enzymes are active at alkaline pH under different saline conditions, which may be essential to digest different preys.