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Abstract Background Adaptation of evidence-based interventions (EBIs) often occurs when implemented in new local contexts and settings. It is unclear, however, during which phase of implementation adaptations are most frequently made and how these changes may impact the fidelity, effectiveness, and sustainability of the EBI. Pediatric Early Warning Systems (PEWS) are EBIs for early identification of deterioration in hospitalized children with cancer. This study evaluates adaptations of PEWS made among resource-variable pediatric oncology hospitals in Latin America implementing and sustaining PEWS. Methods We conducted a cross-sectional survey among pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), a collaborative to implement PEWS. Adaptations to PEWS were assessed via 3 multiple choice and 1 free text question administered as part of a larger study of PEWS sustainability. Descriptive statistics quantitatively described what, when, and why adaptations were made. Qualitative analysis of free text responses applied the Framework for Reporting Adaptations and Modifications Expanded (FRAME) to describe respondent perspectives on PEWS adaptations. Results We analyzed 2,094 responses from 58 pediatric oncology centers across 19 countries in Latin America. Participants were predominantly female (82.5%), consisting of nurses (57.4%) and physicians (38.2%) who were PEWS implementation leaders (22.1%) or clinical staff (69.1%). Respondents described multiple PEWS adaptations across all implementation phases, with most occurring during the planning and piloting of EBIs. Adaptations included changes to PEWS content (algorithm, scoring tool, terminology, and use frequency) and context (personnel delivering or population). Respondents felt adaptations streamlined monitoring, enhanced effectiveness, improved workflow, increased comprehension, and addressed local resource limitations. Qualitative analysis indicated that most adaptations were categorized as fidelity consistent and planned; fidelity inconsistent adaptations were unplanned responses to unanticipated challenges. Conclusion Adaptations made to PEWS across implementation phases demonstrate how EBIs are adapted to fit dynamic, real-world clinical settings. This research advances implementation science by highlighting EBI adaptation as a potential strategy to promote widespread implementation and sustainability in hospitals of all resource levels.

Abstract Background Senescent immune cells exhibit altered gene expression and resistance to apoptosis. The prevalence of these cells increases with age and emerging data implicate senescence-associated maladaptive signaling as a potential contributor to sepsis and septic shock. The senolytic drug fisetin promotes clearance of senescent cells and is hypothesized to mitigate septic responses to infection. Methods We are conducting a multi-center, randomized, double-blinded, adaptive allocation phase 2 clinical trial to assess the efficacy of the senolytic drug fisetin in preventing clinical deterioration of elderly patients diagnosed with sepsis. We intend to enroll and randomize 220 elderly patients (age > 65) with the clinical diagnosis of sepsis to receive either fisetin as a single oral dose of 20 mg/kg, fisetin in two oral doses of 20 mg/kg each spaced 1 day apart, or placebo. The primary outcome will be changed in the composite of cardiovascular, respiratory, and renal sequential organ failure assessment scores at 7 days from enrollment. Secondary outcomes include quantification of senescent CD3 + cells at 7 days, and 28-day assessments of organ failure-free days, days in an intensive care unit, and all-cause mortality. Discussion This multi-center, randomized, double-blinded trial will assess the efficacy of fisetin in preventing clinical deterioration in elderly patients with sepsis and measure the effects of this drug on the prevalence of senescent immune cells. We intend that the results of this phase 2 trial will inform the design of a larger phase 3 study. Trial registration This trial is registered to ClinicalTrials.gov under identifier NCT05758246, first posted on March 7, 2023.

Abstract Background Despite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI. Methods Eighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation. Results Important facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication. Conclusions Findings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

Los gases arteriales son herramientas fundamentales para evaluar objetivamente a pacientes con patologías agudas y crónicas, dado que proporcionan información sobre los índices de oxigenación, ventilación, equilibrio ácido-base y el suministro de oxígeno a nivel celular. Interpretarlos adecuadamente tiene gran importancia clínica, dado que influye en la toma de decisiones permite evaluar la respuesta a intervenciones terapéuticas. Este artículo tiene como objetivo presentar al lector los conceptos básicos de la fisiología del intercambio gaseoso, los trastornos ácido-base más comunes y una interpretación práctica de los gases arteriales. Se utiliza una combinación de ilustraciones gráficas, tablas y algoritmos para facilitar la comprensión y el abordaje clínico de pacientes con alteraciones respiratorias y metabólicas.

Although perception of stigma (PS) has been dubbed as a key barrier to the optimal uptake of PrEP, research on PS is sparse. More specifically, no scholarly work has explored factors associated with the expression of PS toward PrEP use. This study addresses the literature gap by investigating factors associated with PS toward PrEP use. Data were drawn from the baseline survey (2017–2019) of the “Keeping It LITE Study”, involving a large cohort (n = 3330) of young sexual minority men, transgender men and women, and non-binary individuals in the US. Participants’ ages ranged from 13 to 34 years, with the majority (87%) assigned male at birth. The racial composition of the sample was diverse, with 53.9% identifying as white, 19.8% as Latinx, 10.7% as Black or African American, and smaller proportions as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and another race/ethnicity. Logistic regression models were utilized to examine two common measures of PS in PrEP use: (1) the perception that PrEP users are seen as promiscuous and (2) the perception that PrEP users are assumed to be HIV-positive. Two sets of models were developed to account for the correlation between gender identity and sex assigned at birth. The results suggest strong PS among current PrEP users, which can explain the weak PrEP adherence reported among this group. The findings underscore the need for targeted interventions to mitigate PS and enhance PrEP uptake and adherence in vulnerable populations. Social and practical implications of the results and directions for future research are discussed.

Abstract Background Venous thromboembolism (VTE) is a preventable medical condition which has substantial impact on patient morbidity, mortality, and disability. Unfortunately, adherence to the published best practices for VTE prevention, based on patient centered outcomes research (PCOR), is highly variable across U.S. hospitals, which represents a gap between current evidence and clinical practice leading to adverse patient outcomes. This gap is especially large in the case of traumatic brain injury (TBI), where reluctance to initiate VTE prevention due to concerns for potentially increasing the rates of intracranial bleeding drives poor rates of VTE prophylaxis. This is despite research which has shown early initiation of VTE prophylaxis to be safe in TBI without increased risk of delayed neurosurgical intervention or death. Clinical decision support (CDS) is an indispensable solution to close this practice gap; however, design and implementation barriers hinder CDS adoption and successful scaling across health systems. Clinical practice guidelines (CPGs) informed by PCOR evidence can be deployed using CDS systems to improve the evidence to practice gap. In the Scaling AcceptabLE cDs (SCALED) study, we will implement a VTE prevention CPG within an interoperable CDS system and evaluate both CPG effectiveness (improved clinical outcomes) and CDS implementation. Methods The SCALED trial is a hybrid type 2 randomized stepped wedge effectiveness-implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using the RE2-AIM planning and evaluation framework. Efforts will be made to ensure implementation consistency. Nonetheless, it is expected that CDS adoption will vary across each site. To assess these differences, we will evaluate implementation processes across trial sites using the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework (a determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date, an accepted process for evidence maintenance does not exist. We will pilot a “Living Guideline” process model for the VTE prevention CDS system. Discussion The stepped wedge hybrid type 2 trial will provide evidence regarding the effectiveness of CDS based on the Berne-Norwood criteria for VTE prevention in patients with TBI. Additionally, it will provide evidence regarding a successful strategy to scale interoperable CDS systems across U.S. healthcare systems, advancing both the fields of implementation science and health informatics. Trial registration Clinicaltrials.gov – NCT05628207. Prospectively registered 11/28/2022, https://classic.clinicaltrials.gov/ct2/show/NCT05628207 .

Abstract Background Children with genetic conditions are at increased risk for mental health and neurodevelopmental problems, often accompanied by significant parental distress. Genetic and family factors can impact children and parents’ mental health. Early parenting interventions, like the Incredible Years® programs, have demonstrated to improve parental distress and children’s mental health. The recent version for young children with language delays or autism spectrum disorder (IY-ASLD®) has shown to be feasible and effective to support parents in their children’s developmental trajectories. The effectiveness of treatments for children with genetic conditions and neurodevelopmental problems is largely unexplored, leaving significant gaps in evidence-based options. Clinicians lack guidance, especially when patients exhibit language or social communication impairments but do not meet diagnostic criteria for a full-blown autism spectrum disorder (ASD). We aim to fill this gap, providing evidence on the feasibility and effectiveness of the IY-ASLD® intervention for such patients. Methods We designed a prospective multicenter pragmatic randomized controlled trial including approximately 68 children aged 3 to 7 years, recruited from three tertiary care reference hospitals. Inclusion criteria will necessitate genetic confirmation of a neurodevelopmental disorder along with language, communication, or socialization difficulties. Individuals with an ASD diagnosis will be excluded. All subjects are included in a territorial register for rare conditions (ReMin, Registre de Malalties Minoritàries de Catalunya). Families will randomly be assigned to the intervention or the control group. The intervention will be held online by clinical psychologists and child and adolescent psychiatrists. Discussion Our group has recently piloted the online implementation of the IY-ASLD® intervention for the first time in Spain, for parents of children with language delays, socialization difficulties, or ASD, but not genetically determined. Our multicenter research consortium is well-positioned to recruit patients with rare conditions and implement efficient treatment pathways within the National Health System. Given the geographical dispersion of families affected by rare conditions, the online format offers logistical advantages and improved therapy access, enhancing homogeneity across all patients. The results of this study will inform clinicians and policymakers about evidence-based treatment options for this vulnerable and overlooked group of young children. Trial registration ClinicalTrials.gov NCT06125093 . Date of registration: first submitted 2023–10-23; first posted 2023–11-09. URL of trial registry record.

Se describe el caso clínico de una mujer que tuvo un papiloma invertido en el seno esfenoidal. El esfenoides fue muy neumatizado y el papiloma invertido se extendió a un receso lateral del seno, más allá de la arteria carótida interna paraclival, que fue procidente. Se hizo un abordaje endonasal unilateral, combinando una esfenoidotomía bilateral con septectomía posterior con un abordaje transpterigoideo, para exponer el receso lateral neumatizado del esfenoides localizado detrás de la pared posterior del maxilar. El papiloma invertido fue resecado en forma completa, sin evidencia de recurrencias.

Introduction A proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise long-term COVID-19 sequelae in populations globally and compare the prevalence of reported symptoms in HICs and low-income and middle-income countries (LMICs).Methods A prospective, observational study in 17 countries in Africa, Asia, Europe and South America, including adults with confirmed COVID-19 assessed at 2 to

Objetivo. El objetivo de esta investigación fue determinar las propiedades métricas del Test de Rendimiento Motor Infantil (TIMP) adaptado al español de Colombia. Métodos. Este estudio evaluó una prueba diagnóstica mediante análisis de propiedades métricas, es decir, consistencia interna, confiabilidad interevaluadores y validez concurrente. La unidad de análisis fue el Test de Rendimiento Motor Infantil. Se evaluó una muestra de 112 niños de entre 36 semanas de edad postmenstrual y 4 meses de edad. Participaron dos evaluadores expertos en el área de la neurorrehabilitación infantil, con experiencia y formación en la aplicación del instrumento. El análisis de consistencia interna se realizó mediante el coeficiente alfa de Cronbach. La evaluación de la fiabilidad entre evaluadores se realizó mediante el cálculo de los coeficientes de correlación intraclase. Para determinar la validez concurrente se utilizó el coeficiente de correlación de Pearson. Los análisis de los datos obtenidos se realizaron con el programa SPSS versión 27.0. Resultados. El α de Cronbach se situó entre 0,61 y 0,84. En cuanto a la fiabilidad, el instrumento arrojó un coeficiente de correlación intraclase entre 0,54 y 0,93. La validez concurrente arrojó un coeficiente de correlación de Pearson de 0,82. Conclusiones. El TIMP adaptado al español colombiano es un instrumento válido y confiable que puede ser utilizado para la evaluación del desempeño motor en niños.

Summary: Background: Clinical trials and registry studies are essential for advancing research and developing novel treatments. However, these studies rely on manual entry of thousands of variables for each patient. Repurposing real-world data can significantly simplify the data collection, reduce transcription errors, and make the data entry process more efficient, consistent, and cost-effective. Methods: We developed an open-source computational pipeline to collect laboratory and medication information from the electronic health record (EHR) data and populate case report forms. The pipeline was developed and validated with data from two independent pediatric hospitals in the US as part of the Long-terM OUtcomes after Multisystem Inflammatory Syndrome In Children (MUSIC) study. Our pipeline allowed the completion of two of the most time-consuming forms. We compared automatically extracted results with manually entered values in one hospital and applied the pipeline to a second hospital, where the output served as the primary data source for case report forms. Findings: We extracted and populated 51,845 laboratory and 4913 medication values for 159 patients in two hospitals participating in a prospective pediatric study. We evaluated pipeline performance against data for 104 patients manually entered by clinicians in one of the hospitals. The highest concordance was found during patient hospitalization, with 91.59% of the automatically extracted laboratory and medication values corresponding with the manually entered values. In addition to the successfully populated values, we identified an additional 13,396 laboratory and 567 medication values of interest for the study. Interpretation: The automatic data entry of laboratory and medication values during admission is feasible and has a high concordance with the manually entered data. By implementing this proof of concept, we demonstrate the quality of automatic data extraction and highlight the potential of secondary use of EHR data to advance medical science by improving data entry efficiency and expediting clinical research. Funding: NIH Grant 1OT3HL147154-01, U24HL135691, UG1HL135685.

The dysfunction of TAR DNA-binding protein 43 (TDP-43) is implicated in various neurodegenerative diseases, though the specific contributions of its toxic gain-of-function versus loss-of-function effects remain unclear. This study investigates the impact of TARDBP loss on cellular metabolism and viability using human-induced pluripotent stem cell-derived motor neurons and HeLa cells. TARDBP silencing led to reduced metabolic activity and cell growth, accompanied by neurite degeneration and decreased oxygen consumption rates in both cell types. Notably, TARDBP depletion induced a metabolic shift, impairing ATP production, increasing metabolic inflexibility, and elevating free radical production, indicating a critical role for TDP-43 in maintaining cellular bioenergetics. Furthermore, TARDBP loss triggered non-apoptotic cell death, increased ACSL4 expression, and reprogrammed lipid metabolism towards lipid droplet accumulation, while paradoxically enhancing resilience to ferroptosis inducers. Overall, our findings highlight those essential cellular traits such as ATP production, metabolic activity, oxygen consumption, and cell survival are highly dependent on TARDBP function.

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p

En el presente estudio se estimó el rendimiento diagnóstico de la prueba Xpert®Xpress SARS-CoV-2 en comparación con la RT PCR en tiempo real–protocolo Charité, para la detección de SARS-CoV-2 en pacientes peruanos. Se trató de un diseño de prueba diagnóstica que incluyó 100 muestras de hisopado nasal y faríngeo. Se obtuvo una concordancia global de 98,70% (IC95%: 92,98–99,97), con un coeficiente kappa de 0,97 (IC95%: 0,86–1.00); se estimó una sensibilidad y especificad relativa de 100% y 96,15%, respectivamente. Adicionalmente, el porcentaje del área bajo la curva ROC fue 98,08% en ambos casos y se obtuvo una especificidad analítica del 100% para los diferentes virus respiratorios evaluados. En conclusión, la prueba Xpert®Xpress SARS-CoV-2 a partir de muestras de hisopado nasal y faríngeo fue altamente sensible y específica, así mismo el coeficiente kappa mostró una excelente correlación, al compararla con la prueba de referencia.

Ramiro Cabello,1 Gonzalo Bueno-Serrano,1 Alberto Hernando Arteche,1 José Miguel Villacampa,2 Carlos Castilla,3 Carlos Carnero,3 María Garranzo Garcia-Ibarrola,1 Carmen Gonzalez Enguita1 1Department Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 2Department Otorhinolaryngology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; 3Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, SpainCorrespondence: Ramiro Cabello, Email rcabello@quironsalud.esIntroduction: Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our “LAP training program for residents”.Material: Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents’ practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey.Results: All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS.Conclusion: Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.Keywords: training, laparoscopy, resident, urology

Abstract Background Pseudomyxoma peritonei (PMP) is a rare peritoneal mucinous carcinomatosis with largely unknown underlying molecular mechanisms. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the only therapeutic option; however, despite its use, recurrence with a fatal outcome is common. The lack of molecular characterisation of PMP and other mucinous tumours is mainly due to the physicochemical properties of mucin. Results This manuscript describes the first protocol capable of breaking the mucin barrier and isolating proteins from mucinous tumours. Briefly, mucinous tumour samples were homogenised and subjected to liquid chromatography using two specific columns to reduce mainly glycoproteins, albumins and immunoglobulin G. The protein fractions were then subjected to mass spectrometry analysis and the proteomic profile obtained was analysed using various bioinformatic tools. Thus, we present here the first proteome analysed in PMP and identified a distinct mucin isoform profile in soft compared to hard mucin tumour tissues as well as key biological processes/pathways altered in mucinous tumours. Importantly, this protocol also allowed us to identify MUC13 as a potential tumour cell marker in PMP. Conclusions In sum, our results demonstrate that this protein isolation protocol from mucin will have a high impact, allowing the oncology research community to more rapidly advance in the knowledge of PMP and other mucinous neoplasms, as well as develop new and effective therapeutic strategies.

La intoxicación por 3,4-metilendioximetanfetamina (MDMA), ha tenido un dramático resurgimiento desde 1980, se ha extendido por gran parte de los Estados Unidos, Europa y América, ha sido ampliamente utilizada como drogas con fines recreativos, actualmente Las catinonas sintéticas se venden como "euforizantes legales" para eludir las leyes existentes, lo que resulta en toxicidad grave y muertes. Presentamos un caso clínico de un adulto joven, quien debuto con intoxicación aguda severa MDMA, con falla multiorgánica, el cual se realizó atención y manejo agudo de la intoxicación en el servicio de urgencias, con posterior manejo de complicaciones en la unidad de cuidados intensivo y finalmente con sobrevida a pesar del mal pronóstico.

Abstract Alternative Splicing (AS) programs serve as instructive signals of cell type specificity, particularly within the brain, which comprises dozens of molecularly and functionally distinct cell types. Among them, retinal photoreceptors stand out due to their unique transcriptome, making them a particularly well-suited system for studying how AS shapes cell type-specific molecular functions. Here, we use the Splicing Regulatory State (SRS) as a novel framework to discuss the splicing factors governing the unique AS pattern of photoreceptors, and how this pattern may aid in the specification of their highly specialized sensory cilia. In addition, we discuss how other sensory cells with ciliated structures, for which data is much scarcer, also rely on specific SRSs to implement a proteome specialized in the detection of sensory stimuli. By reviewing the general rules of cell type- and tissue-specific AS programs, firstly in the brain and subsequently in specialized sensory neurons, we propose a novel paradigm on how SRSs are established and how they can diversify. Finally, we illustrate how SRSs shape the outcome of mutations in splicing factors to produce cell type-specific phenotypes that can lead to various human diseases.

AbstractBackground Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.Objectives To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.Methods Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.Results 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for ‘Practice activation.’ A sample between 60–90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for ‘Practice activation’ and ‘Harm burden’ but showed excellent fit after reducing the response categories.Conclusion The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .

Introducción: el raquitismo se caracteriza por una alteración en la mineralización normal del tejido óseo, clasificándose según la causa en formas adquiridas o hereditarias. De los raquitismos hereditarios, el raquitismo hipofosfatémico ligado al cromosoma X es el más común. Se caracteriza por anomalías en el metabolismo del fósforo, secundario a una alteración en el gen PHEX (phosphate regulating endopeptidase analog, X-linked) ubicado en el cromosoma X. Como resultado de esta alteración se afecta la codificación de una metaloproteasa que tiene como función disminuir los niveles séricos del factor de crecimiento fibroblástico - 23 (FGF-23), que resulta en la perdida anormal de fósforo por orina. Clínicamente se presenta con deformidades óseas en miembros inferiores, dolor óseo, talla baja y alteraciones dentales. El diagnóstico es clínico, asociado a hipofosfatemia, fosfaturia y hallazgos radiológicos de raquitismo, confirmándose con la prueba molecular de la mutación del gen PHEX. Presentación del caso: Se describe el caso de una paciente de 5 años de edad a quien se le hace diagnóstico de esta enfermedad, lo que permitió el inicio de un tratamiento oportuno y un abordaje integral. Conclusión: por tratarse de una enfermedad hereditaria poco común, con debut en la infancia y gran impacto en el crecimiento longitudinal y salud ósea que afecta la calidad de vida de los niños, el conocimiento de este caso tiene como objetivo brindar herramientas básicas para un abordaje que lleve a un diagnóstico temprano, dado que esto es clave para el pronóstico, seguimiento y tratamiento multidisciplinario de esta patología.

Introduction: Sphenoidal sinus surgery and transsphenoidal approaches are commonly used by ENT surgeons and neurosurgeons to treat various pathologies. Radiological evaluation of this area is essential to identify neurovascular structures and their anatomical relationships. Objective: To propose a pre-surgical classification system for the sphenoid sinus, where risk groups are established in relation to neurovascular structures, with an alphanumeric code. Methods: Retrospective study, with simple computed tomography scans of the nose and paranasal sinuses of patients from the otolaryngology and head and neck surgery service of the General Hospital of Mexico. Classified according to the transverse diameter of the sphenoid sinus: I, < 29 mm; II, 29-39.9 mm; and III, > 40 mm. The lateralization of included elements is their light: L, left; R, right; and B, bilateral. Anatomical element involved: N, optic nerve; V, internal carotid artery; and O, another type of element. Results: 200 imaging studies were analyzed. The average age of the population studied was 36.2 years. 49.5% were men (n = 99) and 50.5% (n = 101) women. Grade III presents a higher risk by compromising neurovascular structures in 90.6%. The general lateralization presented was 13.5% to the right side and 13% to the contralateral side. Isolated optic nerve protrusion occurred in 13.5% (n = 11), protruding internal carotid was found in 40% (n = 80), and in 7.5% (n = 15) both elements were found protruding towards the lumen of the sphenoid sinus. Conclusions: The proposed classification facilitates the transmission of information to the surgical team, prior to surgery, with a simple alphanumeric code, increasing the safety of the surgical procedure.

Introduction and objectives: Increasing evidence shows that newborn weight loss is significantly influenced by the type of labour among other factors, implying a wider understanding of weight loss and its context to intervene accordingly. Given the importance of breastfeeding and the impact of infant formula use on its success, we aimed to understand the impact of the application of nomogram weight loss tools in initiating infant formula. Methods: This study included 206 newborns in a nonrandomised clinical trial, who were divided into two groups. In the intervention group, weight loss was managed through the use of the “Early Weight Loss Nomogram”, rather than with clinical experience associated with weight loss percentage, the standard type of care. We analysed the characteristics of mothers, newborns, and labours and their influence on each group. Results: We found that the introduction of formula milk due to weight loss tended to diminish (61.3% vs. 38.7%, p = 0.082) and nurses’ suggestions dropped to zero in the intervention group. The intervention group reported a longer period of exclusive breastfeeding, up to nearly six months of age. The babies who were not breastfed during the first hour of life were more often supplemented (78.6% vs. 21.4%, p < 0.001) and those with skin-on-skin contact were given a lower proportion of formula milk (69.8% vs. 30.2%, p < 0.001). Discussion: Application of the nomogram allowed the introduction of formula milk in more selected cases. This tool should be applied in healthcare units because it increases health professionals’ awareness of the criteria for formula supplementation.

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

Resumen: Introducción: la salud mental de los profesionales sanitarios es una preocupación constante. Estudios muestran altas tasas de ansiedad, relacionadas con factores como la carga laboral y el ambiente psicosocial. Material y métodos: estudio transversal entre los residentes del Hospital Universitario Fundación Alcorcón (HUFA). Se envió por el correo institucional un formulario anónimo y voluntario con datos epidemiológicos, la escala State-Trait Anxiety Inventory (STAI), el cuestionario de Evaluación de Riesgos Psicosociales en el Trabajo y el Inventario de Estrategias de Afrontamiento (CSI). El objetivo fue evaluar el estado de ansiedad de los residentes y las estrategias de afrontamiento para comprarlas en función del sexo, tipo de especialidad, año de residencia y riesgo psicosocial percibido. Resultados: cumplimentaron el formulario 60 residentes (65,93%). La puntuación STAI fue mayor en las mujeres, en los que dedican más tiempo libre al trabajo (p=0,02) y en aquellos con una puntuación desfavorable en la escala de riesgo psicosocial (p=0,007). Existe mayor autocrítica entre las mujeres (p=0,013), mayor apoyo social en los residentes pequeños (p=0,045), mayor autocrítica a mayor riesgo psicosocial (p=0,017) y a más tiempo libre dedicado al trabajo (p=0,025). Conclusión: las tasas de ansiedad son altas entre los residentes con factores de riesgo identificables para el empleo de estrategias de afrontamiento desadaptativas. Proponemos intervenciones psicológicas y programas de apoyo para el personal en formación. Abstract: Introduction: The mental health of healthcare professionals is a constant concern. Studies show high rates of anxiety, linked to factors such as workload and psychosocial environment. Materials and methods: A cross-sectional study was conducted among residents of the Alcorcón Foundation University Hospital (HUFA). An anonymous and voluntary form containing epidemiological data, the State-Trait Anxiety Inventory (STAI), the Psychosocial Risks Assessment Questionnaire at Work, and the Coping Strategies Inventory (CSI) was sent through institutional email. The objective was to assess the anxiety levels among residents and their coping strategies, comparing them based on gender, specialty, year of residency and perceived psychosocial risk. Results: Sixty residents (65.93%) completed the form. STAI scores were higher in women, those who dedicated more free time to work (p=0.02), and those with an unfavorable score on the psychosocial risk scale (p=0.007). There was more selfcriticism among women (p=0.013), more social support in younger residents (p=0.045), more self-criticism in those with higher psychosocial risk (p=0.017), and among residents who dedicate more free time to work (p=0.025). Conclusion: Anxiety rates are high among residents with identifiable risk factors for employing maladaptive coping strategies. We propose psychological interventions and support programs for trainees.

Objective: This study aimed to use the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) to assess the experience of person-centered coordinated care among people with long-term conditions in the Balearic Islands, Spain. Methods: Over 1300 participants receiving treatment for chronic conditions or HIV pre-exposure prophylaxis were invited to complete the P3CEQ and a socio-demographic questionnaire, both administered electronically via the Naveta app. The P3CEQ assesses the key domains of the P3C through an 11-item questionnaire. Items 1, 2, 3, 4, 5, 8, 9 and 10 assess specifically person-centredness (PC subscale), while items 5, 6, 7, 8 and 9 measure care coordination (CC subscale; question 7 includes 4 sub-questions to specifically assess care plans). Descriptive statistics were used to summarize patient characteristics and P3CEQ items scores. Data analysis included chi-squared test of independence, Student’s t -test and analysis of variance test. Pairwise comparisons were adjusted by Bonferroni correction. Results: The P3CEQ and a socio-demographic questionnaire were sent to 1313 individuals (651 men, 657 women, 5 ‘other gender’). A response rate of 35.34% was achieved, with 464 P3CEQ responders (223 men and 241 women). Significant differences in response rates were observed by age, smoking status, alcohol consumption, membership of patient organizations, and use of alternative medicine. Care planning was rated significantly lower than other measured domains. Women experienced less person-centered care than men (16.64 vs 17.91) and rated care coordination worse than their male counterparts (9.18 vs 10.23). There were also differences in scores between medical condition types, with cancer and inflammatory bowel disease patients rating highest for both person-centered care (21.20 and 19.13, respectively) and care coordination (10.70 vs 10.88, respectively). Patients with skin and rheumatic diseases rated lowest their experience of person-centered care. People with higher education and those employed or studying experienced better person-centeredness. Conclusion: Using the P3CEQ, we detected significant differences in the care experiences of people with chronic conditions, suggesting the need to address potential gender biases, social inequalities, and the poorer ratings observed for certain conditions in the study population.

The dissemination of multidrug-resistant (MDR) bacterial isolates in low- and middle-income countries, including several African countries, is a major concern. The poor sanitary conditions of rural and urban families observed in certain regions may favor the transmission of bacterial infections between animals and humans, including those promoted by strains resistant to practically all available antibiotics. In Angola, in particular, the presence of these strains in human hospitals has already been described. Nevertheless, the information on antimicrobial resistance (AMR) prevalence in Angola is still scarce, especially regarding veterinary isolates.This review aimed to synthesize data on antimicrobial resistance in African countries, with a special focus on Angola, from a One Health perspective. The main goals were to identify research gaps that may require further analysis, and to draw attention to the importance of the conscious use of antimicrobials and the establishment of preventive strategies, aiming to guarantee the safeguarding of public health. To understand these issues, the available literature on AMR in Africa was reviewed. We searched PubMed for articles pertinent to AMR in relevant pathogens in Angola and other African countries. In this review, we focused on AMR rates and surveillance capacity.The principal findings were that, in Africa, especially in sub-Saharan countries, AMR incidence is high due to the lack of legislation on antibiotics, to the close interaction of humans with animals and the environment, and to poverty. The information about current resistance patterns of common pathogenic bacteria is sparse, and the number of quality studies is limited in Angola and in some other Sub-Saharan African countries. Also, studies on the “One Health Approach” focusing on the environment, animals, and humans, are scarce in Africa. The surveillance capacity is minimal, and only a low number of AMR surveillance programs and national health programs are implemented. Most international and cooperative surveillance programs, when implemented, are not properly followed, concluded, nor reported. In Angola, the national health plan does not include AMR control, and there is a consistent omission of data submitted to international surveillance programs. By identifying One Health strengths of each country, AMR can be controlled with a multisectoral approach and governmental commitment.

Abstract Background Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26–37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. Method The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). Discussion This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. Trial registration EudraCT Number: 2021–003376-14. Registered on November 26, 2021.

Fundamento: en un contexto de creciente preocupación por la salud cardiovascular de la población adulta mayor, resulta relevante, explorar la posible asociación entre el consumo de tabaco y las enfermedades cardiovasculares. Objetivo: determinar la relación entre el consumo de tabaco y la presencia de enfermedades cardiovasculares en adultos mayores de un hospital de la provincia de Tungurahua en Ecuador. Método: se realizó un estudio descriptivo, transversal en adultos mayores atendidos en un hospital de la provincia de Tungurahua, Ecuador, entre julio y diciembre de 2022. Se tomó el criterio de selección basado en que los sujetos fueran adultos mayores de ambos géneros, con edades iguales o superiores a 65 años, con residencia en la provincia de Tungurahua durante al menos los últimos cinco años. La población de estudio estuvo compuesta por 352 adultos mayores y la muestra se obtuvo mediante muestreo probabilístico aleatorio simple y quedó constituida por 184 individuos. Las variables de estudio fueron: presencia de enfermedades cardiovasculares, consumo de tabaco, edad y estado civil. La técnica empleada para la recolección de los datos fue la encuesta. El análisis de los datos se realizó mediante la estadística descriptiva y la correlación (coeficiente Phi) entre las variables. Resultados: de los 184 pacientes, el 58,2 % fueron fumadores y el 57,6 % presentó enfermedades cardiovasculares. La edad media fue de 80,9. El 46,2 % de los participantes estaban casados y el 35,3 %, viudos. Se encontró una asociación significativa moderada entre el tabaquismo y la presencia de enfermedades cardiovasculares en adultos mayores (coeficiente Phi = 0,342; p < 0,01). Conclusiones: se encontró asociación significativa moderada entre el tabaquismo y la presencia de enfermedades cardiovasculares en adultos mayores de Tungurahua.

Introducción: Los trastornos cognitivos en el postoperatorio adquieren relevancia, debido al acelerado envejecimiento poblacional. El delirium postoperatorio se caracteriza por alteraciones de la memoria, concentración, atención, comprensión; posterior al uso de anestésicos. Objetivo: determinar la posible relación de las variables seleccionadas y la aparición del delirium postoperatorio en pacientes geriátricos operados de fractura extracapsular de cadera con anestesia subaracnoidea. Método: Se realizó un estudio analítico transversal en el Hospital Clínico Quirúrgico “Lucia Iñiguez Landín” de Holguín, de diciembre 2020 a octubre 2022. El universo estuvo representado por 386 pacientes operados en el período definido. La muestra se seleccionó por un muestreo intencional que incluyó a los pacientes mayores de 60 años operados de urgencia y con estado físico ASA II y ASA III; y excluyó a los pacientes con demencia y/o trastornos psiquiátricos, así la muestra quedó constituída por 124 pacientes. Resultados: El 51,61 % fueron mayores de 80 años, el 58,16 % de las mujeres presentó el síndrome, el 33,06% presentó escolaridad secundaria básica terminada. El 70,16 %, resultó evaluado como ASA II, el 31,63 % de los pacientes con bajo peso presentaron el síndrome, predominaron la hipoglucemia (66,94%), hematocrito disminuido en el 73,39 %, la hipopotasemia (74,19%) y la hiponatremia en el 76,61%. Conclusiones: Se encontró asociación estadísticamente significativa de: el sexo, la baja escolaridad, la hipoglucemia, hematocrito disminuido, la hipopotasemia, la hiponatremia y el dolor, con la ocurrencia del síndrome confusional agudo en los pacientes operados de fractura de cadera extracapsular. Palabras clave: Envejecimiento, fractura extracapsular de cadera, delirium postoperatorio.

Resumen: Introducción: la redacción de historias clínicas (HC) es una competencia básica en la formación del médico. Es el fundamento para construir hipótesis diagnósticas y garantizar una atención adecuada, segura y efectiva. Además, la HC tiene implicaciones legales, epidemiológicas y de calidad asistencial. Con este estudio pretendimos conocer la concordancia entre la información recogida del paciente en la consulta y la registrada en la HC por alumnos de Medicina. Métodos: estudio observacional descriptivo transversal sobre una consulta con pacientes simulados y la HC redactada posteriormente. Participaron 112 alumnos de 5.° año de Medicina. Los evaluadores comprobaron en las HC 59 ítems de anamnesis, anamnesis por órganos y aparatos, exploración física y juicio clínico, contrastándolos con las videograbaciones de las consultas y clasificando la concordancia entre ambas. Resultados: la población final fueron 109 alumnos (97,3%). El área competencial con mayor concordancia fue juicio clínico (94,1%). Todos los ítems superaron el 65% de concordancia. Más del 20% de los alumnos no habían registrado en sus HC algunos ítems, aunque los habían recogido en la consulta. Anamnesis por órganos y aparatos fue el área competencial con más ítems omitidos o incorrectos. El único ítem que ningún alumno olvidó recoger y registrar fue «antecedentes personales de dislipidemia». Exploración física fue el área donde más alumnos registraron hallazgos en la HC sin haberlos realizado en la entrevista. Conclusión: el estudio demuestra la alta concordancia de la HC con la información recogida en la consulta y descubre aspectos que nos permitirán mejorar la formación en semiología médica de los alumnos. Abstract: Introduction: Writing medical histories (MH) is a basic competence in the physician's training. It is the cornerstone for constructing diagnostic hypotheses and guaranteeing adequate, safe and effective care. In addition, MH has legal, epidemiological and quality of care implications. The aim of this study was to determine the concordance between the information collected from the patient in the consultation room and that recorded in the MH by medical students. Methods: This is a cross-sectional descriptive observational study on a consultation with simulated patients and the subsequently written MH. A total of 112 5th-year medical students participated. The evaluators checked 59 items of anamnesis, anamnesis by organs and apparatus, physical examination and clinical judgment in the MH, contrasting them with the video recordings of the consultations, and classifying the concordance between both. Results: Final population was 109 students (97.3%). The competency area with the highest concordance was clinical judgment (94.1%). All items exceeded 65% agreement. More than 20% of the students had not recorded some items in their MH, although they had collected them in the consultation. Anamnesis by organs and apparatus was the competency area with the most omitted or incorrect items. The only item that no student forgot to collect and record was “personal history of dyslipidemia”. Physical examination was the area where most students recorded findings in the MH without having made them in the interview. Conclusion: The study demonstrates high concordance in the MH with the information collected in the consultation and shows aspects that will allow us to improve the medical semiology training of students.

Introduction: Thyroid cancer, considered one of the most frequent malignant tumors of the endocrine system, accounts for 80%–90% of cases. The most common histological type observed in most studies is papillary cancer. Objective: To determine the frequency of thyroid cancer in patients undergoing total thyroidectomy at the Otorhinolaryngology Department of the Hospital de Clínicas between the period 2018-2022. Methodology: This retrospective study included 260 patients treated during the study period. Data were obtained from the patients' medical records, and sociodemographic and clinical variables related to thyroid cancer were analyzed. Data were analyzed with the SPSS v25 program, using descriptive statistics. Results: The frequency of thyroid cancer was 48.1%. The mean age of the cancer patients was 42.10±13.10 years. A higher frequency was observed in females 34.2%, n=89) and among those aged 25-44 years 20.0%, n=52). The most frequent were papillary (36.9%), follicular (2.7%), medullary (1.5%), and anaplastic (1.2%) types. Discussion: The frequency of thyroid cancer is high; it is more common in women and as age increases.

Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

Introducción: Las enfermedades neoplásicas causan gran preocupación en la comunidad científica mundial, entre ellas el cáncer de mama muestra una elevada incidencia. Objetivo: Caracterizar el estado nutricional de estas pacientes antes y después del tratamiento. Método: Se realizó un estudio cuasi experimental tipo antes-después, en pacientes diagnosticadas con cáncer de mama que recibieron quimioterapia en el Centro Oncológico Territorial de Holguín, desde octubre 2019 a noviembre 2021. De las 89 pacientes atendidas, después de aplicar los criterios de inclusión (pacientes mayores de 40 años con cáncer de mama) y los criterios de exclusión (pacientes con trastornos psiquiátricos), el universo quedó constituido por 65 pacientes. La muestra se seleccionó por muestreo no probabilístico intencional, que consideró las pacientes con indicación de quimioterapia y quedó constituida por 49 pacientes. Resultados: Las pacientes entre 55 y 69 años constituyeron el 42,8 %, predominó la raza blanca con el 81,63 %, la historia familiar de cáncer de mama estuvo presente en 41 pacientes y el antecedente de riesgo más frecuente se manifestó en la menarquía precoz en 26 pacientes, para un 53,06 %, la ingestión de café significó el hábito tóxico más frecuente (75,51 %). Conclusiones: Las mujeres con cáncer de mama presentan un biotipo endomorfo con una concentración específica del tejido graso en las partes central y superior del cuerpo. Estas características guardan relación con el desequilibrio hormonal que juega un papel importante en la carcinogénesis de la mama. Palabras clave: cáncer de mama, valoración nutricional, quimioterapia

Background: changes in medical practice and research, derived from the Human Genome Project, and the progressive implementation of the precision medicine model, pose new demands for healthcare personal education. Objective: to assess the extent omics contents have been integrated to current syllabi for undergraduate medical studies in Cuba. Methods: syllabi D and E, in use in undergraduate medical studies in Cuba, were reviewed, as well as subjects programs in basic, own and optative/ elective curricula at the University of Medical Sciences of Las Tunas. Terms related to omics contents were used for search strategies. Results: five subjects were found to include such contents: Medical Genetics, Pharmacology I, Morphophysiology I, Medical Informatics and Molecular Biology. No subjects from the clinical area, not even those related to surgical rotations, treated omics contents, as it was the case for basic bibliography in each case. Only definitions, descriptions and relations were found, as well as certain applications, but no skills or values were presented. Conclusions: it has been limited the integration of omics contents in the syllabi of medical studies, circumscribed to some subjects from the basic and preclinical areas in the teaching and learning process, but absent in the subjects of the clinical areas.

Summary: Background: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19. Methods: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care). Findings: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61–1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64–1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09–0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality. Interpretation: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19. Funding: Hellenic Foundation for Research and Innovation.

Abstract Triple‐negative breast cancer (TNBC) often develops resistance to single‐agent treatment, which can be circumvented using targeted combinatorial approaches. Here, we demonstrate that the simultaneous inhibition of LOXL2 and BRD4 synergistically limits TNBC proliferation in vitro and in vivo. Mechanistically, LOXL2 interacts in the nucleus with the short isoform of BRD4 (BRD4S), MED1, and the cell cycle transcriptional regulator B‐MyB. These interactions sustain the formation of BRD4 and MED1 nuclear transcriptional foci and control cell cycle progression at the gene expression level. The pharmacological co‐inhibition of LOXL2 and BRD4 reduces BRD4 nuclear foci, BRD4‐MED1 colocalization, and the transcription of cell cycle genes, thus suppressing TNBC cell proliferation. Targeting the interaction between BRD4S and LOXL2 could be a starting point for the development of new anticancer strategies for the treatment of TNBC.

School bullying or bullying is a social problem that has increased in such a way that it represents a worldwide concern, from which Cuba is not exempt. This paper reflects on the conditions and risks that can generate negative consequences in vulnerable people to suffer this type of aggression. Depression, anxiety and certain physical and social conditions stand out in those affected and, among these, the suffering from obesity that could increase, as a cumulative risk, sleep disorders in children and adolescents. A review was carried out about the possible impacts of linking obesity and bullying in terms of sleep disorders in children and adolescents. It is concluded that there is an association between obesity, bullying and the risk of suffering from sleep disorders, which, fundamentally from Primary Health Care, should be considered so that the corresponding protocols can be detected and applied to this population at risk and its environment, for which psycho-pedagogical actions and intersectoral coordination are recommended.

Background and Objectives: The aim of the following cross-sectional study is to determine the association between human leukocyte antigen (HLA) alleles and outcomes in patients presenting to the emergency department (ED) with SARS-CoV-2 infection. Methods and Materials: Genotyping was made using the Axiom Human Genotyping SARS-CoV-2 Research Array. Statistical analysis was made with Fisher’s exact test and multivariable logistic regression, adjusted for sex, age and clinical variables. Results: Of 190 patients, 11.1% were discharged from the ED; 57.9% were admitted to the COVID-19 ward, without intensive care unit (ICU) admission; 15.3% survived an ICU admission; and 15.8% died. After multivariable analysis, two HLA alleles protected against hospital admission (HLA-C*05:01, adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.055–0.731; and HLA-DQB1*02:02, aOR 0.046, CI 0.002–0.871) and one was associated with higher risk for ICU admission or death (HLA-DQA1*05:01, aOR 2.517, CI 1.086–5.833). Conclusions: In this population, HLA-C*05:01 and HLA-DQB1*02:02 are associated with a protective effect against hospital admission and HLA-DQA1*05:01 is associated with higher risk of ICU admission or death in the multivariable analysis. This may help stratify risk in COVID-19 patients.

Background and Objectives: Atrial fibrillation (AF) is the most frequent arrhythmia and the main cause of hospital admissions for cardioembolic stroke. The SIMETAP research project aims to update the prevalence rates of cardiovascular, renal, or metabolic factors and to evaluate their respective associations with factors that could be related. The present study aims to assess the AF prevalence rates in an adult population and its association with cardiovascular–kidney–metabolic (CKM) factors. Materials and Methods: This cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0–102.8 years. Crude and adjusted prevalence rates of AF were calculated. The associations of CKM factors with AF were assessed using bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of AF were 2.9% in the overall adult population, 6.1% in the population aged ≥50 years, and 12.9% in the population aged ≥70 years, with no significant differences by sex. AF prevalence in the population under 50 years of age barely reached 1‰. Heart failure (HF), hypertension, chronic kidney disease (CKD), stroke, low HDL-cholesterol, and prediabetes were independent CKM factors associated with AF in the overall population, as were the same factors, except prediabetes, in the population ≥50 years old (p < 0.001). High or very high vascular risk was present in 92.4% [95% CI: 89.1–95.7]) of the population with AF. Conclusions: The adjusted prevalence rate of AF in the population aged 50 years or older was 6.1%, twice that of the overall adult population and half that of the population aged 70 years or older. The main independent CKM factors associated with AF were HF, stroke, CKD, hypertension, and low HDL-cholesterol.

The International Consensus Classification of Myeloid Neoplasms and Acute Leukemias (ICC) and the 5th edition of the WHO classification (WHO 2022) have refined the diagnosis of myelodysplastic syndromes (MDS). Both classifications segregate MDS subtypes based on molecular or cytogenetic findings but rely on the subjective assessment of blast cell percentage and dysplasia in hematopoietic cell lineages. This study aimed to evaluate interobserver concordance among 13 cytomorphologists from eight hospitals in assessing blast percentages and dysplastic features in 44 MDS patients. The study found fair interobserver agreement for the PB blast percentage and moderate agreement for the BM blast percentage, with the best concordance in cases with 10% BM blasts. Monocyte count agreement was fair, and dysplasia assessment showed moderate concordance for megakaryocytic lineage but lower concordance for erythroid and granulocytic lineages. Overall, interobserver concordance for MDS subtypes was moderate across all classifications, with slightly better results for WHO 2022. These findings highlight the ongoing need for morphological evaluation in MDS diagnosis despite advances in genetic and molecular techniques. The study supports the blast percentage ranges established by the ICC but suggests refining BM blast cutoffs. Given the moderate interobserver concordance, a unified classification approach for MDS is recommended.

Summary: Background: While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. Methods: We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. Findings: The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio

Abstract Background Chronic limb-threatening ischemia (CLTI) represents the final stage of peripheral arterial disease. Approximately one-third of patients with CLTI are not eligible for conventional surgical treatments. Furthermore, patients with advanced stage of CLTI are prone to amputation and death. Thus, an effective therapeutic strategy is urgently needed. In this context, autologous bone marrow mononuclear cell (auto-BM-MNC) and allogeneic mesenchymal stem cells represent a promising therapeutic approach for treating CLTI. In this study, we compared the safety and beneficial therapeutic effect of auto-BM-MNC versus allogeneic Wharton jelly-derived mesenchymal stem cells (allo-WJ-MSCs) in diabetic patients with CLTI. Methods We performed a randomized, prospective, double-blind and controlled pilot study. Twenty-four diabetic patients in the advanced stage of CLTI (4 or 5 in Rutherford’s classification) and a transcutaneous oxygen pressure (TcPO2) below 30 mmHg were randomized to receive 15 injections of (i) auto-BM-MNC (7.197 × 106 ± 2.984 × 106 cells/mL) (n = 7), (ii) allo-WJ-MSCs (1.333 × 106 cells/mL) (n = 7) or (iii) placebo solution (1 mL) (n = 10), which were administered into the periadventitial layer of the arterial walls under eco-Doppler guidance. The follow-up visits were at months 1, 3, 6, and 12 to evaluate the following parameters: (i) Rutherford’s classification, (ii) TcPO2, (iii) percentage of wound closure, (iv) pain, (v) pain-free walking distance, (vi) revascularization and limb-survival proportion, and (vii) life quality (EQ-5D questionnaire). Results No adverse events were reported. Patients with CLTI who received auto-BM-MNC and allo-WJ-MSCs presented an improvement in Rutherford’s classification, a significant increase in TcPO2 values‬, a reduction in the lesion size in a shorter time, a decrease in the pain score and an increase in the pain-free walking distance, in comparison with the placebo group. In addition, the participants treated with auto-BM-MNC and allo-WJ-MSCs kept their limbs during the follow-up period, unlike the placebo group, which had a marked increase in amputation. Conclusions Our results showed that patients with CLTI treated with auto-BM-MNC and allo-WJ-MSCs conserved 100% of their limb during 12 months of the follow-up compared to the placebo group, where 60% of participants underwent limb amputation in different times. Furthermore, we observed a faster improvement in the allo-WJ-MSC group, unlike the auto-BM-MNC group. Trial registration This study was retrospectively registered at ClinicalTrials.gov (NCT05631444).

Abstract Background Mesenchymal stromal cells (MSCs) have been shown to exert their therapeutic effects through the secretion of broad spectrum of paracrine factors, including extracellular vesicles (EVs). Accordingly, EVs are being pursued as a promising alternative to cell-based therapies. Menstrual blood-derived stromal cells (MenSCs) are a type of MSC that, due to their immunomodulatory and regenerative properties, have emerged as an innovative source. Additionally, new strategies of cell priming may potentially alter the concentration and cargo of released EVs, leading to modification of their biological properties. In this study, we aimed to characterize the EVs released by MenSCs and compare their therapeutic potential under three different preconditioning conditions (proinflammatory stimuli, physioxia, and acute hypoxia). Methods MenSCs were isolated from five healthy women. Following culturing to 80% confluence, MenSCs were exposed to different priming conditions: basal (21% O2), proinflammatory stimuli (IFNγ and TNFα, 21% O2), physioxia (1–2% O2), and acute hypoxia (

Introducción: La hipertensión arterial es la comorbilidad cardiovascular más prevalente, en los pacientes infectados, por la COVID-19. Objetivo: Describir los mecanismos de la hipertensión arterial, con la gravedad de la infección viral por SARS-CoV-2. Métodos: Las bases de datos seleccionadas fueron: PubMed, Scientific Electronic Library Online, Scielo y Google Académico. Se realizó una revisión independiente y se propusieron 50 referencias. No se pusieron restricciones en cuanto al tipo de trabajo, en idioma español e inglés. Se seleccionaron 44 referencias de la propuesta inicial, por mayoría simple. Conclusiones: La hipertensión arterial aumenta el riesgo de hospitalización y muerte, por la COVID-19. Se explica la enfermedad e infección por SARS-CoV-2 que coexiste con la hipertensión, entre los que se destacan el papel de la enzima convertidora de angiotensina 2, los trastornos del sistema renina-angiotensina-aldosterona, la disfunción inmune con excesiva inflamación y la disfunción gastrointestinal.

The case report of a 39 years woman is presented, who was assisted in Guillermo Domínguez López Teaching General Hospital from Puerto Padre, Las Tunas province, due to a tumoral mass of around 10 cm in the hypogastrium. After the clinical exam and the pertinent complementary studies, it was decided to practice the complete resection of the tumor. During the surgical procedure, a sample for biopsy was taken which result indicated the existence of a symplastic leiomyoma in the Retzius space. The patient had a favorable clinical course and she was discharged from the institution 5 days later, but continued with follow up in outpatient department.

Summary: Background: There is a need for more sustainable interventions and for assessing the effectiveness of school-based universal anti-bullying programmes in vulnerable populations. We assessed the efficacy of a multicomponent, web-enabled, school-based intervention that aims to improve school climate and reduce bullying (LINKlusive) relative to conventional practices (control condition). Methods: We conducted a cluster randomised controlled trial in primary and secondary schools in Madrid, Spain. The primary outcome measure was peer-reported bullying victimisation after the 12-week intervention (study endpoint). We analysed data using longitudinal mixed-effects models. The trial was registered with the ISRCTN registry (15719015). Findings: We included 20 schools (10 in each group); 6542 students participated at baseline; 6403 were assessed at study endpoint. After the intervention, there was a statistically significant reduction in bullying victimisation in both the intervention (OR 0.61, 95% CI [0.41, 0.90]) and control groups (OR 0.69, 95% CI [0.51, 0.92]), with no evidence of differences in the whole sample (OR 0.89, 95% CI [0.58, 1.36]; aOR 0.89, 95% CI [0.58, 1.37]). Subgroup analyses showed a statistically significant effect of LINKlusive on bullying victimisation in primary education (aOR 0.68, 95% CI [0.47, 0.98]). In students with peer-reported bullying victimisation at baseline, LINKlusive showed a statistically significant effect on depression (−1.43, 95% CI [−2.46, −0.40], adjusted standardised mean difference (SMD) −0.41) and quality of life (2.18, 95% CI [0.80, 3.56], adjusted SMD 0.45). Interpretation: LINKlusive could be effective in reducing bullying victimisation in primary school students. Sustainable whole-school interventions to promote mental health and reduce risk factors are warranted to improve outcomes in young people, especially in the early years of education. Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.

Aims: The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. Design: Epidemiological, descriptive, cross-sectional study. Site: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. Participants: 281 patients over 18 years old with type 2 diabetes and obesity are included. Main measurements: Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. Results: Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p