El desgaste por empatía es un concepto relativamente reciente y en evolución que ha captado el interés de los profesionales sanitarios debido a que el trabajo en el ámbito de la salud implica un coste emocional que repercute en la misma salud del trabajador y en su labor profesional. Según la literatura revisada, los programas en prevención en todos los niveles de este tipo de estrés son escasos, por lo tanto, el objetivo de este trabajo es proponer un programa de prevención del desgaste por empatía en profesionales sanitarios de una unidad de diálisis de hospital. La idea surgió de la necesidad manifiesta por la Unidad de Diálisis del Hospital Universitario Infanta Sofía (HUIS), hacia la Unidad de Salud Mental del mismo Hospital y de la confianza depositada en la investigación académica, relacionada con la dificultad en el afrontamiento a la muerte de pacientes de la Unidad, por parte del personal asistencial. El propósito es entonces entrenar a los profesionales en estrategias de regulación emocional del desgaste por empatía, con el fin de disminuir los niveles de este tipo de estrés y prevenir su futura aparición, por medio del desarrollo de 6 módulos, que se llevarán a cabo a través de diferentes ciclos y que puede tener continuidad a través de una modalidad de Formación Continuada. Se ha diseñado una evaluación estandarizada con el fin de medir la presunta efectividad del programa para prevenir el desgaste por empatía. Se realiza una valoración sobre los resultados esperados, las conclusiones del diseño de la propuesta del programa, así como de sus limitaciones y sobre futuras líneas de investigación. Abstract: The compassion fatigue is a relatively recent and evolving concept that has captured the interest of health professionals because working in health implies an emotional cost that affects the health and the worker performance. According to the revised literature, prevention programs at all levels of this kind of stress are scarce, therefore, the objective of this work is to propose a program of prevention of compassion fatigue in healthcare professionals of a dialysis unit of a hospital. The idea came up from the necessity exposed by the Dialysis Unit of the Hospital Universitario Infanta Sofia (HUIS), towards the Mental Health Unit of the same Hospital and from the confidence placed in the academic research, related to the difficulty of facing death of patients of the unit, by the assistance personnel. The purpose is then to train professionals in strategies of emotional regulation of compassion fatigue, in order to reduce the levels of this type of stress and prevent its future emergence, through the development of 6 modules, which will be carried out through different cycles and that can have continuity through a continuous training modality. A standardized assessment has been designed to measure the presumed effectiveness of the program to prevent the compassion fatigue. An assessment is made of the expected results, the conclusions of the design of the program proposal, as well as its limitations and future lines of research.

Organotypic brain culture is an experimental tool widely used in neuroscience studies. One major drawback of this technique is reduced neuronal survival across time, which is likely exacerbated by the loss of blood flow. We have designed a novel, tube flow system, which is easily incorporated into the commonly-used, standard semi-permeable membrane culture methodology which has significantly enhanced neuronal survival in a brain stem nucleus involved in control of motivated and arousal states: the laterodorsal tegmental nucleus (LDT). Our automated system provides nutrients and removes waste in a comparatively aseptic environment, while preserving temperature, and oxygen levels. Using immunohistochemistry and electrophysiology, our system was found superior to standard techniques in preserving tissue quality and survival of LDT cells for up to 2 weeks. In summary, we provide evidence for the first time that the LDT can be preserved in organotypic slice culture, and further, our technical improvements of adding a flow system, which likely enhanced perfusion to the slice, were associated with enhanced neuronal survival. Our perfusion system is expected to facilitate organotypic experiments focused on chronic stimulations and multielectrode recordings in the LDT, as well as enhance neuronal survival in slice cultures originating from other brain regions.

Background: Treatment abandonment is a leading cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. It compromises the outcome of 1 in 7 children with cancer globally, it has an estimated prevalence of about 15%. In Mexico, Prior to the creation of medical insurance in 2005, the rate of treatment abandonment was reported as >20% (data from 2000-2004), more recently, the rate of treatment abandonment has been reported at 15.5% (data from 2008 -2017). Methods: Case and control study was performed. We retrospectively reviewed the sociodemographic and clinical data of children with a diagnosis with cancer in the Hospital Civil of Guadalajara- Mexico, between January 2006 and December 2018, this a reference in childhood cancer for western of Mexico. The definition of treatment abandonment followed the International Society of Paediatric Oncology. Results: Data from 1812 patients diagnosed with cancer were analyzed, of which 183 (10%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children level of education of the parents; basic education (OR 0.36; p 0.058), Time to travel to hospital > 3 hr. (OR 11.95; p 0.001), single parent (OR 2.50; p 0.003), rural area (OR 0.597; p 0.040), Primary Caregiver Age < 20 years old (OR 4.04; p 0.023). Conclusion: Treatment abandonment prevalence in Hospital Civil of Guadalajara Mexico is high and closely related to socio-demographic factors. This study will create a risk score for the abandonment of treatment in our population, validating it and managing to reduce the percentage of this problem. Resumen. Antecedentes: el abandono del tratamiento es una de las principales causas de fracaso del tratamiento y una pobre supervivencia en niños con cáncer en países de bajos y medianos ingresos. Actualmente 1 de cada 7 niños con cáncer a nivel mundial, tiene una prevalencia estimada de aproximadamente el 15% de abandono. En México, antes de la creación del seguro médico en 2005, la tasa de abandono del tratamiento se informó como> 20% (datos de 2000-2004), más recientemente, la tasa de abandono del tratamiento se reportó en 15.5% (datos de 2008 -2017). Métodos: se realizó un estudio de casos y controles. Revisamos retrospectivamente los datos sociodemográficos y clínicos de niños con diagnóstico de cáncer en el Hospital Civil de Guadalajara- México, entre enero de 2006 y diciembre de 2018, este es un hospital de referencia en cáncer infantil para el oeste de México. La definición de abandono del tratamiento se baso en el de la Sociedad Internacional de Oncología Pediátrica. Resultados: Se analizaron datos de 1812 pacientes diagnosticados con cáncer, de los cuales 183 (10%) abandonaron el tratamiento. El análisis de regresión logística bivariada mostró tasas de abandono significativamente más altas en el nivel de educación de los padres de los niños; educación básica (OR 0.36; p 0.058), Tiempo para viajar al hospital> 3 h (OR 11.95; p 0.001), familia monoparental (OR 2.50; p 0.003), área rural (OR 0.597; p 0.040), Edad del cuidador primario < 20 años (OR 4.04; p 0.023). Conclusión: La prevalencia del abandono del tratamiento en el Hospital Civil de Guadalajara México es alta y está estrechamente relacionada con factores sociodemográficos. Este estudio creará una puntuación de riesgo para el abandono del tratamiento en nuestra población, validándolo y logrando reducir el porcentaje de este problema.

Waterborne diseases are transmitted by the faecal-oral route when water contaminated with faeces is ingested. Cryptosporidiosis is one of these diseases and is caused by one of the most widespread enteric parasites in the world; Cryptosporidium. To reduce the waterborne diseases, domestic wastewater needs to be treated sufficiently to reduce its pathogenic content. One of the recently introduced technologies for wastewater treatment is Aerobic Granular Sludge (AGS). AGS has proven to produce effluents with high chemical quality standards. However, little is known regarding the pathogen removal efficiencies or their removal mechanisms. In addition, there is a worldwide need to treat domestic wastewater appropriately to reduce pathogens causing waterborne diseases. The removal efficiencies and fate of some pathogens, such as Cryptosporidium, have not been studied in detail within wastewater treatment processes. Indicator microorganisms such as Escherichia coli (E. coli), have been used to understand the removal mechanisms and fate of pathogens in wastewater. However, it was found there is a miscorrelation between indicators and pathogens, and therefore there is a need for studies with pathogens themselves. Due to these reasons, this research aimed to develop a fluorescent staining method for E. coli and Cryptosporidium parvum (C. parvum) oocysts to allow their detection in AGS batch reactors, and evaluate the fate of fluorescently stained E. coli and C. parvum in these reactors. Pre-staining of E. coli and C. parvum was carried out using two fluorescent stains: dsGreen and SYBR. Experiments were carried out to test different pre-staining conditions. The stains were serial diluted, TWEEN was used to determine if it improved the staining, and the prestained microorganisms were incubated at 4 ºC, room temperature and 37 ºC. Two different batch reactors, 250 mL and 2 mL, were set up with AGS and were spiked with pre-stained microorganisms. Both reactors were run for 120 mins and sludge samples were collected and analysed using fluorescent microscopy. The filtered supernatant samples from the 250 mL were also analysed using the fluorescent microscope and the fluorescent cell count method. The best staining conditions for E. coli and C. parvum oocysts with dsGreen proved to be: 1,000x dilution of dye, incubation of stained microorganisms at room temperature for 15 mins and no need of TWEEN. SYBR photobleached rapidly and was therefore not an appropriate stain for this research. With the experiments in batch reactors, the fluorescent cell count method proved to be a generic and faster quantitative alternative to estimate E. coli concentrations in filtered supernatant samples than the E. coli agar plate method. In addition, it was qualitatively confirmed that fluorescently stained E. coli was removed by the predation of different species of protozoa. However, no conclusive results regarding protozoan predation of C. parvum oocysts were observed. Resumen: Las enfermedades transmitidas por el agua se transmiten por la ruta fecal-oral cuando se ingiere agua contaminada con heces. La criptosporidiosis es una de estas enfermedades y es causada por uno de los parásitos entéricos más extendidos del mundo; Cryptosporidium. Para reducir las enfermedades transmitidas por el agua, las aguas residuales domésticas deben tratarse lo suficiente como para reducir su contenido patógeno. Una de las tecnologías recientemente introducidas para el tratamiento de aguas residuales es el lodo granular aeróbico (AGS por sus siglas en inglés). AGS ha demostrado producir efluentes con altos estándares de calidad química. Sin embargo, se sabe poco sobre las eficiencias de eliminación de patógenos o sus mecanismos de eliminación. Además, existe una necesidad mundial de tratar las aguas residuales domésticas de manera adecuada para reducir los patógenos que causan enfermedades transmitidas por el agua. Las eficiencias de eliminación y el destino de algunos patógenos, como el Cryptosporidium, no se han estudiado en detalle en los procesos de tratamiento de aguas residuales. Se han utilizado microorganismos indicadores como Escherichia coli (E. coli) para comprender los mecanismos de eliminación y el destino de los patógenos en las aguas residuales. Sin embargo, se descubrió que existe una mala correlación entre los indicadores y los agentes patógenos y, por lo tanto, es necesario realizar estudios con los mismos agentes patógenos. Debido a estas razones, esta investigación tuvo como objetivo desarrollar un método de tinción fluorescente para E. coli y ooquistes de Cryptosporidium parvum (C. parvum) para permitir su detección en reactores discontinuos de AGS, y evaluar el destino de E. coli y C. parvum teñidos con fluorescencia en estos reactores. La tinción previa de E. coli y C. parvum se llevó a cabo utilizando dos tinciones fluorescentes: dsGreen y SYBR. Se llevaron a cabo experimentos para probar diferentes condiciones de pre-tinción. Las tintas se diluyeron en serie, se utilizó TWEEN para determinar si mejoraba la tinción, y los microorganismos pre-teñidos se incubaron a 4 ºC, temperatura ambiente y 37 ºC. Se prepararon dos reactores discontinuos diferentes, 250 ml y 2 ml, con AGS y se añadieron microorganismos previamente teñidos. Ambos reactores funcionaron durante 120 minutos y las muestras de lodo se recogieron y analizaron usando microscopía fluorescente. Las muestras de sobrenadante filtradas de 250 ml también se analizaron utilizando el microscopio fluorescente y el método de recuento de células fluorescentes. Las mejores condiciones de tinción para la E. coli y los ooquistes de C. parvum con dsGreen demostraron ser: dilución de colorante a 1,000x, incubación de microorganismos teñidos a temperatura ambiente durante 15 minutos y sin necesidad de TWEEN. SYBR se blanqueó rápidamente y, por lo tanto, no fue una tinta adecuada para esta investigación. Con los experimentos en reactores discontinuos, el método de recuento de células fluorescentes demostró ser una alternativa cuantitativa genérica y más rápida para estimar las concentraciones de E. coli en muestras de sobrenadante filtradas que el método de la placa de agar de E. coli. Además, se confirmó cualitativamente que E. coli teñida con fluorescencia se removió por la predación de diferentes especies de protozoos. Sin embargo, no se observaron resultados concluyentes con respecto a la predación de protozoos de los ooquistes de C. parvum.

El síndrome de Treacher Collins o disostosis mandibulofacial, es un desorden congénito craneofacial poco frecuente y se caracteriza por tener malformaciones en cabeza y cuello. Presentan vía aérea difícil predicha, alta incidencia de síndrome de apnea obstructiva del sueño; así como; pueden debutar con edema faríngeo y laríngeo transoperatorio, ocasionando distrés respiratorio y muerte súbita. La planificación de la vía aérea en estos pacientes es muy importante para el abordaje de la vía aérea por el anestesiólogo. Objetivo general: Determinar la frecuencia y manejo de la vía aérea difícil en los pacientes con síndrome de Treacher Collins intervenidos en el Hospital Dr. Manuel Gea González entre 1998 al 2018. Material y métodos: Se llevó a cabo un estudio observacional descriptivo, transversal y retrolectivo. El tamaño de la muestra fue de 134 eventos anestésicos con una población de 25 pacientes con síndrome de Treacher Collins que fueron atendidos entre 1998 al 2018 en el Hospital General “Dr. Manuel Gea González”. Resultados: De un total de 41 pacientes con síndrome de Treacher Collins atendidos en el hospital, sólo 25 requirieron de alguna intervención con manejo anestésico. En esta población se contabilizó un total de 134 eventos anestésicos, principalmente cirugías reconstructivas craneofaciales. Dentro de las características de la población el 52% fueron hombres; la media del número de cirugías por paciente fue de 5.36. La media de edad en la que fueron intervenidos fue de 12.36 años. La frecuencia de vía aérea difícil fue de 93.3% (125/134). La laringoscopia directa fue la principal técnica definitiva de abordaje de la vía aérea 42.5%, seguido del fibroscopio 35.1%, mascarilla laríngea 4.5%, tubo laríngeo 0.7% y traqueostomía 0.7%. La escala de Cormack-Lehane se reportó en el 34.3% de los eventos anestésicos, predominando el grado 4 (19.4%). Se realizó intubación exitosa en el 87.3% de los casos y los principales eventos adversos fueron sangrado de la vía aérea, edema de glotis y laringoespasmo. Se cancelaron 5 cirugías relacionado al manejo de la vía aérea, ningún paciente falleció y el uso del fibroscopio se asoció a menores complicaciones. Conclusiones: En esta población de estudio donde se realizaron 134 eventos anestésicos, en 125 se presentó vía área difícil, lo que corresponde a un 93.3%, así mismo un 59.5% (80/134) fue intubación difícil. Sin embargo, en el 87.3%, se logró una intubación exitosa (117/134). En relación a eventos adversos el más frecuente fue el sangrado con un 20.1% (27/134). De los 47 pacientes intubados con fibroscopio en 25 se resolvió con el plan A y al primer intento. Con base a esta información, observamos que en estos pacientes hay una alta frecuencia de vía aérea difícil, por lo que se tiene que tener presente que la preparación anticipada es esencial para ser abordados, contemplando dispositivos avanzados de vía aérea y personal experto en el manejo de esta situación. A mayor número de laringoscopias y utilización de diferentes aditamentos, aumenta el riesgo de eventos adversos. El fibroscopio según nuestros hallazgos es una opción ideal como plan A en el aseguramiento de la vía aérea de estos pacientes. Nuestra serie de casos es la más grande actualmente en México y Latinoamérica y es un preámbulo para realización de guías de vía aérea difícil en los pacientes con Síndrome de Treacher Collins en el futuro.

Insulin hormone is produced by pancreatic beta-cells and its biosynthesis, secretion, and intracellular degradation is tightly regulated. Newly formed SGs are preferentially released upon glucose stimulation while aged SGs are less competitive to be released and are more prompt to degradation mainly within lysosomes. The most assumed mechanism leading aged SGs to lysosome is autophagy, a degradation system for altered proteins and damaged organelles. The autophagic marker LC3 has facilitated the detection of autophagy through LC3-based biochemical and microscopic assays, as well as the possibility to experimentally manipulate the autophagy pathway. Here, we intended to establish a model for the further study of mechanism that target aged Ins-SNAPTMR-Star+ SGs to GFP-LC3+ autophagosomes in INS-1 cells by using three different approaches. Our results show that in INS-1 cells, modulation of autophagy with chemical agents can be detected by western blot. Likewise, TIRF Microscopy allowed for the detection of positive GFP-LC3+ aged Ins-SNAPTMR-Star+ objects in the cortical region of INS-1 cells. Additionally, we implemented SIM microscopy to gain more detail in the morphological aspect of autophagosomes vesicles. Despite some hints about the autophagosomal structures were uncovered through these approaches, further experiments should be performed to complement and confirm our findings. Thus, establishment of a suitable model for the study of autophagy, will allow us to further study the mechanisms behind the targeting process of aged SGs and to better understand how impairment of autophagy contributes to deterioration of pancreatic beta-cell function and subsequent onset of type 2 diabetes.

Abstract: Despite some epidemiological evidence on the protective effects of polyphenol intake on epithelial ovarian cancer (EOC) risk from case-control studies, the evidence is scarce from prospective studies and non-existent for several polyphenol classes. Therefore, we aimed to investigate the associations between the intake of total, classes and subclasses of polyphenols and EOC risk in a large prospective study. The study was conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which included 309,129 adult women recruited mostly from the general population. Polyphenol intake was assessed through validated country-specific dietary questionnaires and the Phenol-Explorer database. During a mean follow-up of 14 years, 1469 first incident EOC cases (including 806 serous, 129 endometrioid, 102 mucinous, and 67 clear cell tumours) were identified. In multivariable-adjusted Cox regression models, the hazard ratio in the highest quartile of total polyphenol intake compared with the lowest quartile (HRQ4vsQ1) was 1.14 (95% CI 0.94–1.39; p-trend = 0.11). Similarly, the intake of most classes and subclasses of polyphenols were not related to either overall EOC risk or any EOC subtype. A borderline statistically significant positive association was observed between phenolic acid intake (HRQ4vsQ1 = 1.20, 95% CI 1.01–1.43; p-trend = 0.02) and EOC risk, especially for the serous subtype and in women with obesity, although these associations did not exceed the Bonferroni correction threshold. The current results do not support any association between polyphenol intake and EOC in our large European prospective study. Results regarding phenolic acid intake need further investigation.

Abstract: Biological and physiological changes in response to stress are crucial to achieving adaption to environmental constraints. Typical stress responses activate the sympathetic nervous system and the hypothalamic-pituitary-adrenal cortical axis, which aim to maintain homeostasis in response to demands and influence various biological responses at neuroendocrine, cellular, and immune levels. In particular, there is compelling evidence showing the devastating effects of high-stress levels on immune responses and brain functionality. In that sense, data suggest that a sustained stress-physiological response predicts decreases in immunity and leads to allostatic load, the wear, and tear of biological systems. Similarly, in cancer research, chronic stress levels have been reported to impair the bodysurveillance systems and be related to cancer incidence, progression, and mortality. Despite the evidence demonstrating the associations between stress and cancer, there are limited data on whether lifetime stress exposure relates to clinical indicators of cancer aggressiveness. Considering the evidence showing the adverse effects of prolonged stress exposure on cancer disease, this thesis aimed to explore the relationship between lifetime stress exposure and the clinical characteristics of tumor-aggressiveness in a cohort of patients affected with triple-negative breast cancer (TNBC). Likewise, as research has shown that coping responses moderate the stress-physiological response, we aimed to investigate the role of coping responses in moderating the association between tumor aggressiveness and lifetime stress exposure. According to the scientific literature, high-stress levels would increase physiological arousal and allostatic load favoring a debilitated immune system. Thus, we hypothesized finding positive associations between lifetime stress exposure and tumor-aggressiveness. In the same line, we suspected that adaptative coping styles would be negatively related to tumoraggressiveness. The participants of this study were 29 women diagnosed with TNBC who were treated in the University Hospital for Gynecology Pius-Hospital (Oldenburg, Germany). Correlation and moderation regression analyses with the use of composite scores were conducted. Overall, we could not demonstrate significant associations between lifetime stress exposure and coping responses on the clinical indicators of tumor aggressiveness in this cohort of patients. Possible explanations for these results are discussed, and suggestions for future research are provided. This study was the first to investigate the effect of lifetime stress exposure and coping response on the aggressive tumor characteristics of TNBC. We provided a deep theoretical framework to understand the interplay between biological and psychological aspects of cancer disease, and we hope that our recommendations may serve as a base for upcoming studies.

Abstract: Background: Seasonal Influenza is considered to be a cyclic and ordered sequence of values, influenced by external factors that can be predicted and used to detect disease outbreaks and monitoring. In machine learning, the key challenges that limit these analyses are in model explainability and limitations associated with ecological bias. Aim: Determine the best environmental variable selection method to predict Seasonal Influenza in Norway, using an environmental medicine approach combined with machine learning techniques. Methods: This is a quasi-experimental study that compares three approaches (non-variable selection, isolate component, and multipollutant mixture), represented in five methods (univariable, bivariable, multivariable AME, multivariable PCA, multivariable LDA). Per method, the best co-variable combination will be performed, following the internal rules of each method. The best covariable combination is the result of three components: variable selection, validation data set and lag. The first one involves 13 environmental variables (temperature, relative humidity, specific humidity, air pressure, wind speed, precipitation, CO, NO, NO2, O3, PM10, PM2,5 and SO2); second one compares a test dataset compiled from the data from 2019, last year (2018) and a synthetic environmental (avg. 2013-2018) data set in the validation process; and the third one compares a combination of lag from 0 to 12. All the predictions are made using ARIMA algorithm. The evaluation is given in terms of MAE, MSE, RMSE, OR. The training set is from 2 Jun 2013 (week 22/2013) to 28 May 2018 (week 21/2018), and test set is from (week 22/2018) to (week 21/2019) with a window of predictions of 52 weeks. Results: The increment of dimensionality in the environmental variable selection introduce different noise levels and optimize the prediction. Considerations that impact the explainability, usability, ecological bias and performance will be described. Conclusion: The increment of dimensionality in the variable selection has a better impact on performance than using complex algorithms.

Abstract: Objective: To analyze the population prevalence and birth prevalence of oral clefts in Colombia from 2009 to 2017. Methods: A cross-sectional study using information from the National Administrative Records of Colombia. The data came from 2 types of administrative records (Surveillance System and the Individual Registry of Service Provision) and the oral health national survey. Population prevalence and birth prevalence by type of cleft lip and/or cleft (CL/P) ratios were calculated using Poisson distribution for count data and to assess stationary tests on time series (Dickey-Fuller) and (Phillips-Perron) was used. Results: Population prevalence in Colombia was 3.27 per 10 000 inhabitants (95% confidence interval [CI], 3.21-3.32) and birth prevalence was 6.0 per 10 000 live births (95% CI, 5.67-6.35). Bogot´a have the highest population prevalence with CL/P. In the analysis of trends for the prevalence proportion by type of clefts in newborn babies with cleft, it was observed that the highest proportion was for babies with CLP. Cleft lip (CL) has increased from 17.4% in 2014 to 34.2% in 2017, cleft palate (CP) has decreased from 32.9% to 20.2%; and CLP changed from 49.6% to 45.5% in the same period. Conclusions: The population prevalence was 3.27 per 10 000 inhabitants. Births prevalence was 6.0 per 10 000 live births, and Orinoquia and Amazonia have higher rates than the national average. The administrative registers are adequate systems to know the behavior of oral clefts. The CL/P had a nonstationary trend during the period 2014 to 2017.