To compare the encapsulation of annatto extract by external gelation (EG) and internal gelation (IG) and to maximize process yield (% Y), two central composite designs were proposed. Calcium chloride ...(CaCl
) concentration (0.3-3.5%), alginate to gelling solution ratio (1:2-1:6); acetic acid (CH
COOH) concentration (0.2-5.0%) and alginate to gelling solution ratio (1:2-1:6) were taken as independent variables for EG and IG respectively. Release studies were conducted under different conditions; morphology, particle size, the encapsulation efficiency (EE), and release mechanism were evaluated under optimized conditions. The optimized EG conditions were 0.3% CaCl
and 1:1.2 alginate to gelling solution ratio, whereas a 0.3% CH
COOH and 1:5 alginate to gelling solution ratio were optimized conditions for IG. When 20% extract was employed, the highest EE was achieved, and the largest release was obtained at a pH 6.5 buffer. The Peppas-Sahlin model presented the best fit to experimental data. Polyphenol release was driven by diffusion, whereas bixin showed anomalous release. These results are promising for application as modulated release agents in food matrices.
•This systematic review (SR) aims to summarize the evidence about screening strategies to detect carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), ...and carbapenem-resistant Pseudomonas aeruginosa (CRPA) to prevent healthcare-associated infections (HAIs).•No randomized trials were identified. Sixteen studies met our inclusion criteria and were included in the review.•Studies showed a decline of CRE, CRAB, CRPA infection and colonization rates after the implementation of screening strategies.•The certainty of the evidence was assessed as low for all outcomes, mainly due to the serious risk of bias and co-interventions.•Most studies included active surveillance cultures as part of a bundle intervention which precludes determining the independent effect of screening strategies.
This systematic review aims to summarize the evidence on the effects of screening strategies to detect carbapenem-resistant gram-negative bacteria (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa).
Eligible studies were randomized trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. We conducted searches in CENTRAL, PUBMED, Embase, Epistemonikos, and in multiple databases available in the Virtual Health Library (LILACS, Scielo, WHO IBECS, and PAHO IBECS). All the searches covered the period until 4 June 2021. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned standardized form. When possible, we intended to conduct meta-analyses using a random-effect model. We assessed the certainty of the evidence (CoE) and summarized the results using the GRADE approach.
Our search strategy yielded 57,451 references. No randomized trials were identified. Sixteen studies (one controlled before-after study and 15 interrupted time series) met our inclusion criteria and were included in the review. Most studies were conducted in tertiary care general hospitals from the United States, Europe, and Asia. Eleven studies included adult patients hospitalized in general wards and intensive care units, one was carried out in a neonatal intensive care unit, two in hematology or oncology units, and one in a solid organ transplantation department. Eleven studies were conducted in the setting of an outbreak. Regarding the detection strategy used, all studies included screening strategies for high-risk patients at the moment of admission and 7 studies reported a contact surveillance strategy. Most studies were conducted in settings where infection prevention and control measures were concomitantly installed or reinforced. Data were not suitable for meta-analysis, so the results were presented as a narrative synthesis. Most studies showed a decline in the prevalence of both infection and colonization rates after the implementation of a policy of active surveillance, but the CoE is low. Screening strategies may result in little to no difference in the risk of all-cause mortality and the length of hospital stay.
Existing evidence may favor the use of surveillance culture to carbapenem-resistant gram-negative bacteria, but its quality is poor, so solid conclusions cannot be drawn. Well-conducted randomized trials or high-quality quasi-experimental studies are needed to improve the certainty of the existing evidence. These studies should assess the effect of the addition of screening strategies as a single intervention and measure clinically important outcomes such as infection, length of hospital stay, and mortality.
Abstract Background Oral diseases are a major global public health problem, impacting the quality of life of those affected. While consensus exists on the importance of high-quality, ...evidence-informed guidelines to inform practice and public health decisions in medicine, appropriate methodologies and standards are not commonly adhered to among producers of oral health guidelines. This study aimed to systematically identify organizations that develop evidence-informed guidelines in oral health globally and survey the methodological process followed to formulate recommendations. Methods We searched numerous electronic databases, guideline repositories, and websites of guideline developers, scientific societies, and international organizations (January 2012–October 2023) to identify organizations that develop guidelines addressing any oral health topic and that explicitly declare the inclusion of research evidence in their development. Pairs of reviewers independently evaluated potentially eligible organizations according to predefined selection criteria and extracted data about the organization’s characteristics, key features of their guidelines, and the process followed when formulating formal recommendations. Descriptive statistics were used to analyze and summarize data. Results We included 46 organizations that developed evidence-informed guidelines in oral health. The organizations were mainly professional associations and scientific societies (67%), followed by governmental organizations (28%). In total, organizations produced 55 different guideline document types, most of them containing recommendations for clinical practice (77%). Panels were primarily composed of healthcare professionals (87%), followed by research methodologists (40%), policymakers (24%), and patient partners (18%). Most (60%) of the guidelines reported their funding source, but only one out of three (33%) included a conflict of interest (COI) policy management. The methodology used in the 55 guideline document types varied across the organizations, but only 19 (35%) contained formal recommendations. Half (51%) of the guideline documents referred to a methodology handbook, 46% suggested a structured approach or system for rating the certainty of the evidence and the strength of recommendations, and 37% mentioned using a framework to move from evidence to decisions, with the GRADE-EtD being the most widely used (27%). Conclusion Our findings underscore the need for alignment and standardization of both terminology and methodologies used in oral health guidelines with current international standards to formulate trustworthy recommendations.
The coronavirus disease 2019 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains more than 430,000 articles ...as of September 20, 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews.
Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that was available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search.
We identified 83 eligible systematic reviews that included 2,132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2,125/2,132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2,057/2,132). Both the comprehensiveness and the currency were 100% for randomized trials (82/82).
The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes.
•The COVID-19 L·OVE is a free access repository and classification platform.•The comprehensiveness and currency of the repository were assessed.•We compared it against all the studies included in the SRs published during April 2021.•The COVID-19 L·OVE repository is highly comprehensive and current.•This evaluation addressed only primary studies and not the other types of articles.
Objective
To analyze the evolution of the cardiometabolic profile of patients with primary hyperaldosteronism (PA) after the treatment with surgery and with mineralocorticoid receptor antagonists ...(MRA).
Design
Retrospective multicentric study of patients with PA on follow-up in twelve Spanish centers between 2018 and 2020.
Results
268 patients with PA treated by surgery (
n
= 100) or with MRA (
n
= 168) were included. At baseline, patients treated with surgery were more commonly women (54.6% vs 41.7%,
P
= 0.042), had a higher prevalence of hypokalemia (72.2% vs 58%,
P
= 0.022) and lower prevalence of obesity (37.4% vs 51.3%,
P
= 0.034) than patients treated with MRA. Adrenalectomy resulted in complete biochemical cure in 94.0% and clinical response in 83.0% (complete response in 41.0% and partial response in 42.0%). After a median follow-up of 23.6 (IQR 9.7–53.8) months, the reduction in blood pressure (BP) after treatment was similar between the group of surgery and MRA, but patients surgically treated reduced the number of antihypertensive pills for BP control more than those medically treated (∆antihypertensives: −1.3 ± 1.3 vs 0.0 ± 1.4,
P
< 0.0001) and experienced a higher increased in serum potassium levels (∆serum potassium: 0.9 ± 0.7 vs 0.6 ± 0.8mEq/ml,
P
= 0.003). However, no differences in the risk of the onset of new renal and cardiometabolic comorbidities was observed between the group of surgery and MRA (HR = 0.9 0.5–1.5,
P
= 0.659).
Conclusion
In patients with PA, MRA and surgery offer a similar short-term cardiovascular protection, but surgery improves biochemical control and reduces pill burden more commonly than MRA, and lead to hypertension cure or improvement in up to 83% of the patients.
Background
Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of ...citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia.
Methods
This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures.
Results
Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h;
p
<0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39–5.72;
p
<0.00001).
Conclusions
Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT.
To compare the clinical and hormonal characteristics of patients with familial hyperaldosteronism (FH) and sporadic primary aldosteronism (PA).
A systematic review of the literature was performed for ...the identification of FH patients. The SPAIN-ALDO registry cohort of patients with no suspicion of FH was chosen as the comparator group (sporadic group).
A total of 360 FH (246 FH type I, 73 type II, 29 type III, and 12 type IV) cases and 830 sporadic PA patients were included. Patients with FH-I were younger than sporadic cases, and women were more commonly affected (P = 0.003). In addition, the plasma aldosterone concentration (PAC) was lower, plasma renin activity (PRA) higher, and hypokalemia (P < 0.001) less frequent than in sporadic cases. Except for a younger age (P < 0.001) and higher diastolic blood pressure (P = 0.006), the clinical and hormonal profiles of FH-II and sporadic cases were similar. FH-III had a distinct phenotype, with higher PAC and higher frequency of hypokalemia (P < 0.001), and presented 45 years before sporadic cases. Nevertheless, the clinical and hormonal phenotypes of FH-IV and sporadic cases were similar, with the former being younger and having lower serum potassium levels.
In addition to being younger and having a family history of PA, FH-I and III share other typical characteristics. In this regard, FH-I is characterized by a low prevalence of hypokalemia and FH-III by a severe aldosterone excess causing hypokalemia in more than 85% of patients. The clinical and hormonal phenotype of type II and IV is similar to the sporadic cases.
The design of controlled grafting copolymers is critical in synthesizing effective artificial cellular matrices because of their regulatory role in cellular behavior. However, it is unclear whether ...poly(2-aminoethyl methacrylate) grafted onto chitosan generated by gamma-radiation-induced graft polymerization in different solvents can influence the physicochemical properties and biotech applicability of the copolymer. This work aims to demonstrate for the first time the effect of various solvents on the synthesis, properties, and biological performance of grafted chitosan using the simultaneous irradiation method. The results proved that the solvent is one of the critical factors affecting the properties of the modified polysaccharide. The degree of grafting showed a solvent-dependent profile. Hexane presented utmost importance concerning the degree of grafting. Ethyl acetate showed the best results in grafting extent and human dermal fibroblast growth. These findings indicate that proper solvent selection determines the possible copolymer use for in vitro engineered skin substitute models.
Display omitted
•The effect of solvent on CS-g-PAEMA synthesis and performance was investigated.•The degree of grafting and grafting extent showed a solvent-dependent profile.•The choice of the solvent also influenced the in vitro HDFs grown in the copolymer.•Hexane presented utmost importance concerning the degree of grafting dependence.•Ethyl acetate showed maximum graft extent, cell growth, and proliferation results.
El artículo tiene por objetivo analizar el rol de la universidad en los procesos de transformación de la sociedad latinoamericana. Bajo estos argumentos, la investigación centra su interés en tres ...aspectos fundamentales: 1. El compromiso ético de la universidad con la investigación, con la universalización del saber y la construcción de conocimiento bajo estándares de responsabilidad, integridad, de acuerdo a las normativas nacionales e internacionales, de modo que se mantenga una visión humana en la investigación. 2. Cuestiona el papel de la universidad, condicionada por la globalización y por los intereses del Estado, lo que ha llevado a su masificación y a medir su calidad de acuerdo al número de egresados, dejando de lado a investigación con pertinencia social. 3. Plantea la urgencia de la transformación social, lo que implica la transformación interna de la universidad, de pensar en el beneficio colectivo, en el desarrollo de estudiantes como ciudadanos destinados a impulsar el progreso social. Se concluye en la relevancia de romper con el paradigma de la masificación, invitando a formar estudiantes para la inserción social, a promover la investigación, a escuchar las comunidades, conduciendo a que la docencia sea una cualidad implícita del acto investigativo, un modo de divulgar y universalizar el saber.
RESUMEN Una gran parte de la búsqueda y consumo de información digital hoy depende de los motores de búsqueda. Muchos usuarios lo utilizan como el primer paso o punto de acceso para comenzar su ...consulta de información. Por ello, la optimización y al mismo tiempo la visibilidad en estos buscadores, pasa a ser asunto de prioridad para elaboradores o productores de recursos de información. La optimización para los motores de búsqueda (SEO, por sus siglas en inglés) se refiere al proceso por el cual una página web obtiene y mantiene posiciones notables en las páginas de resultados naturales de los buscadores, también llamados resultados orgánicos o algorítmicos. Este trabajo aborda la importancia que esto reviste para lograr una mejor visualización de la información que se genera en las revistas médicas y en el mundo de la documentación en general.
PDF
