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COVID-19 has had an unprecedented worldwide impact, and Peru has had one of the highest COVID-19 case rates despite implementation of an early strict nationwide quarantine. Repercussions on Peru's healthcare system may impact vulnerable populations, particularly people with HIV (PWH). We explored knowledge of COVID-19 and the socioeconomic and health impact of the pandemic among middle-aged and older PWH. A cross-sectional telephone survey was administered to 156 PWH age ≥40 years receiving care in one of two large HIV clinics in Lima, Peru. The majority of PWH (age 52 ± 7.7 years, 41% female, 65% completed secondary school or less) were knowledgeable regarding COVID-19 symptoms and prevention methods. Nearly half of those employed prior to the pandemic reported job loss. Female sex (unadjusted prevalence ratio [PR] 1.85 [95%CI 1.27-2.69]), low educational level (PR 1.62 [1.06-2.48]) and informal work (PR 1.58 [1.06-2.36]) were risk factors for unemployment but not in adjusted models. Increased anxiety was reported in 64% and stress in 77%. COVID-19 has had a substantial socioeconomic and mental health impact on PWH living in Lima, Peru, particularly those with lower educational levels and informal workers. Efforts are needed to ensure continued medical care and socioeconomic support of PWH in Peru.

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COVID-19 has had an unprecedented worldwide impact, and Peru has had one of the highest COVID-19 case rates despite implementation of an early strict nationwide quarantine. Repercussions on Peru's healthcare system may impact vulnerable populations, particularly people with HIV (PWH). We explored the knowledge of COVID-19 and the socioeconomic and health impact of the pandemic among middle-aged and older PWH. A cross-sectional telephone survey was administered to 156 PWH age ≥40 years receiving care in one of two large HIV clinics in Lima, Peru. The majority of PWH (age 52±7.7 years, 41% female, 65% completed secondary school or less) were knowledgeable regarding COVID-19 symptoms and prevention methods. Nearly half of those employed prior to the pandemic reported job loss. Female sex (unadjusted prevalence ratio [PR] 1.85 [95%CI 1.27-2.69]), low educational level (PR 1.62 [1.06-2.48]) and informal work (PR 1.58 [1.06-2.36]) were risk factors for unemployment but not in adjusted models. Increased anxiety was reported in 64% and stress in 77%. COVID-19 has had a substantial socioeconomic and mental health impact on PWH living in Lima, Peru, particularly those with lower educational levels and informal workers. Efforts are needed to ensure continued medical care and socioeconomic support of PWH in Peru.

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There is a high prevalence of knee osteoarthritis that affects only the medial tibiofemoral compartment. In this group of patients with severe disease, the medial unicompartmental knee arthroplasty (UKA) is an excellent choice. However, this technique has a great learning curve due to the lower tolerance of improper positioning and alignment. In this context, the robotic-assisted surgery (RAS) arises as an option to improve the accuracy and secondarily enhance the clinical outcomes related to the UKA. The objective in this study is to determine if there are significant advantages with the use of RAS over conventional surgery (CS). In the systematic review of the literature, classification of the results in three main subjects: (A) precision and alignment; (B) functional results and clinical parameters; (C) survivorship. We found 272 studies, of which 15 meet the inclusion and exclusion criteria. There is mostly described that RAS significantly improves the accuracy in position (80-100% of planned versus performed P < 0.05), alignment (2-3 times less error variance P < 0.05) and selection of the proper size of the implants (69.23% of correct size femoral implants versus 16.67% using CS P < 0.0154). Recently, there is mild evidence about benefits in the early rehabilitation and post-operative pain, but in all studies reviewed, there is no advantages of RAS in the long-term functional evaluation. There is no strong literature that supports a longer survival of the prothesis with RAS, being the longest mean follow-up reported of 29.6 months. RAS is a useful tool in increasing the precision of the medial UKA implant placement. However, there is still a lack of evidence that properly correlates this improvement in accuracy with better clinical, functional and survival results.

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Resumen La emergencia sanitaria provocada por el coronavirus evidencia que los regímenes de responsabilidad deben ser capaces de diferenciar los instrumentos conceptuales disponibles para lidiar con una enfermedad nueva que, además, devino en pandemia. Este trabajo postula que, tratándose de enfermedades nuevas, los principios de la responsabilidad por culpa evitarán que los prestadores médicos sean condenados por hechos o circunstancias que no se hubieran podido prever o evitar según el estado de los conocimientos de la ciencia. Además, en cuanto al problema de salud pública, todo juicio de responsabilidad deberá tomar en cuenta los cambios que se producirán en la lex artis médica, y diferenciar la eventual responsabilidad de los prestadores de salud de aquella que corresponda a la autoridad encargada de controlar los efectos de la pandemia.

Abstract The coronavirus health-emergency shows that liability schemes need to discriminate the conceptual instruments available to address a new disease that, additionally, has become a pandemic. This article argues that, regarding new diseases, a fault-based liability schemes prevents health providers from being held liable for consequences that could not have been foreseen or avoided according to the state of knowledge of science. Besides, regarding the public health problem, any liability judgment must take into account changes to the medical lex artis; distinguishing also the eventual liability of health providers from the one that belongs to the authority in charge of the response to the pandemic.

Resumo A emergência sanitária provocada pelo corona vírus evidencia que os regimes de responsabilidade devem ser capazes de diferenciar os instrumentos conceituais disponíveis para lidar com uma enfermidade nova que, além disto, se transformou em pandemia. Este trabalho postula que, tratando-se de enfermidades novas, os princípios de responsabilidade por culpa evitarão que os prestadores médicos sejam condenados por fatos ou circunstancias que não se podia prever ou evitar segundo o estado dos conhecimentos da ciência. Além disto, quanto ao problema de saúde pública, todo juízo de responsabilidade deverá ter em conta as mudanças que se produzirão na lex artis médica e diferenciar a eventual responsabilidade dos prestadores de saúde da que corresponda à autoridade encarregada de controlar os efeitos da pandemia.

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Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population.The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears.Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined.Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus.Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears.Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus. Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023.

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INTRODUCCIÓN: Curcuma longa L. se comenzó a cultivar en Cuba en la década de los noventa del pasado siglo, a esta planta se le atribuyen propiedades anticancerígenas, antioxidantes, antibacterianas, entre otras. Su principio activo principal es la curcumina, un pigmento amarillo a partir del cual se pueden obtener diversos derivados de gran interés farmacológico. OBJETIVO: demostrar la factibilidad del uso de curcumina extraída de su fuente natural como precursor de fármacos. MÉTODOS: los rizomas de Curcuma longa L. fueron previamente tratados; después de estar secos, se pulverizaron y la extracción se realizó con metanol en un baño ultrasónico. El producto deseado (curcumina) se purificó por cromatografía de columna, para ser usado posteriormente como la materia de partida en la obtención de un análogo semisintético. Los compuestos aislados y sintetizados se caracterizaron por métodos espectroscópicos. RESULTADOS: se logró aislar curcumina con alto grado de pureza a partir de la Curcuma longa L. cultivada en Cuba, mediante un novedoso método de extracción asistido por ultrasonido. Se obtuvo y fue caracterizado un nuevo compuesto de gran interés farmacológico, a partir de la curcumina obtenida de materias primas nacionales. CONCLUSIONES: el empleo de ultrasonido hace más eficiente la extracción de la curcumina a partir de su fuente natural. Curcuma longa L. puede constituir una fuente de materias primas para la industria farmacéutica.

INTRODUCTION: cultivation of Curcuma longa L. in Cuba started in the 1990s. This plant has been attributed anticancer, antioxidant and antibacterial properties, among others. Its main active principle is curcumin, a yellow pigment from which various derivatives of great pharmacological interest may be obtained. OBJECTIVE: demonstrate the feasibility of the use of curcumin extracted from its natural source as a drug precursor. METHODS: Curcuma longa L. rhizomes were previously treated. Once dry, they were pulverized, and extraction was carried out with methanol in an ultrasonic bath. The desired product (curcumin) was purified by column chromatography to be used later on as the starting material to obtain a semisynthetic analogue. The isolated and synthesized compounds were characterized by spectroscopic methods. RESULTS: curcumin of a high degree of purity could be isolated from Curcuma longa L. cultivated in Cuba by means of a novel ultrasound-assisted extraction method. A new compound of great pharmacological interest was obtained and characterized, starting from curcumin obtained from national raw materials. CONCLUSIONS: ultrasound improves the efficiency of curcumin extraction from its natural source. Curcuma longa L. may constitute a source of raw materials for the pharmaceutical industry.

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Introducción: la corteza del fuste de Cedrela adorata L (cedro) es utilizada por la población para el tratamiento del asma, como vermífuga, antibacteriana, febrífuga y en cocimiento para dolores cuando se sufren caídas o golpes. Objetivo: identificar los metabolitos secundarios presentes en esta parte de la planta y evaluar su posible actividad antibacteriana. Métodos: se recolectó la corteza del fuste de Cedrela adorata. El material vegetal fue lavado, desinfectado, secado y seguidamente se procedió a su pulverización. Este polvo se utilizó en la elaboración de los diferentes extractos y tintura. La tintura obtenida se concentró y se fraccionó sucesivamente con n-hexano, cloroformo, acetato de etilo y agua. A estos extractos se les realizó el tamizaje fitoquímico, ensayos microbiológicos y cromatografía de capa fina. Resultados: las pruebas in vitro efectuadas a los extractos obtenidos a partir de la tintura 20 por ciento, demostraron que estos presentan actividad antibacteriana frente a Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Shigella sp., Salmonella enterica y Enterobacter aerogene; destacándose los resultados obtenidos frente al Staphylococcus aureus, para el extracto hexánico de cedro. En estos extractos están presentes en mayor proporción alcaloides, triterpenos o esteroles, y quinonas, que son los responsables de esta actividad, lo cual se logró corroborar con la identificación de estos metabolitos secundarios mediante la cromatografía de capa fina y el tamizaje fitoquímico realizados. Conclusiones: mediante la cromatografía de capa fina y el tamizaje fitoquímico de los extractos se identificaron alcaloides, triterpenos o esteroles, y quinonas, que pueden ser los responsables de la actividad antibacteriana

Introduction: the stem bark of Cedrela adorata L (cedar) is used by the population to treat asthma, as vermifuge, antibacterial and febrifuge, and in the form of decoction to relieve the pain caused by falls or bumps. Objective: identify the secondary metabolites present in this part of the plant and evaluate their potential antibacterial activity. Methods: stem bark from Cedrela adorata was collected. The plant material was washed, disinfected, dried and pulverized. The powder obtained was used to make the various extracts and the tincture. The latter was concentrated and successively fractionated with n-hexane, chloroform, ethyl acetate and water. The extracts underwent phytochemical screening, microbiological assays and thin-layer chromatography. Results: in vitro tests of the extracts obtained from the 20 percent tincture showed antibacterial activity against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Shigella sp., Salmonella enterica and Enterobacter aerogen. Antibacterial activity of the hexanic cedar extract against Staphylococcus aureus was noteworthy. Alkaloids, triterpenes or sterols, and quinones, which are found in a large proportion in the extracts, are responsible for the above-mentioned antibacterial activity. Identification of these secondary metabolites was confirmed through thin-layer chromatography and phytochemical screening. Conclusions: the alkaloids, triterpenes or sterols, and quinones potentially responsible for antibacterial activity were identified through thin-later chromatography and phytochemical screening

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Introducción: tradicionalmente, los campesinos han empleado la resina del fuste de Rheedia aristata Griseb. para extraer espinas encarnadas y en la cura de enfermedades respiratorias como el asma y la pulmonitis. Objetivo: identificar los metabolitos secundarios presentes en la decocción, tintura 20 por ciento y el extracto fluido de hojas de Rheedia aristata Griseb., y establecer la estabilidad de la tintura 20 por ciento y del extracto fluido. Métodos: se recolectaron partes aéreas, se lavaron, desinfectaron, secaron, y pulverizaron. De estas se obtuvieron la decocción, tintura 20 por ciento y el extracto fluido, los cuales se filtraron. Finalmente, se realizaron ensayos fitoquímicos y control de calidad.Resultados: el tamizaje fitoquímico confirma la existencia de varias familias de metabolitos secundarios de interés biológico y farmacológico; entre otras, saponinas, quinonas, coumarinas y alcaloides. Los ensayos del control de calidad mostraron que son estables la tintura 20 por ciento y el extracto fluido bajo las condiciones aplicadas. Conclusiones: la tintura 20 por ciento y el extracto fluido de las hojas de Rheedia aristata son formulados ricos en metabolitos secundarios, que pudieran ser los principios activos responsables del uso como medicamento, reportado en estudios etnobotánicos. Esto, unido a la gran estabilidad que muestran y a la no existencia de reportes de toxicidad, convierten a esta planta en fuente potencial de fitomedicamentos

Introduction: traditionally, farmers have used the resin of the shaft of Rheedia aristata Griseb. to remove penetrated thorns in the body and cure respiratory diseases such as asthma and lung inflammatory process. Objective: to identify the secondary metabolites in the decoction, tincture at 20 percent and fluid extract of the leaves of Rheedia aristata Griseb. and to establish the tincture and the fluid extract stability at a 20 percent. Methods: air parts of the plant were collected; they were washed, disinfected, dried and pulverized. The decoction, tincture at 20 percent, and extract were obtained and they were filtered. Finally, phytochemical screenings and quality control tests were performed. Results: phytochemical screening confirms the existence of several families of secondary metabolites of biological and pharmacological interest; among others, saponins, quinones, coumarins and alkaloids. The quality control tests carried out to the tincture at 20 percent and flowing extract indicated that, under the conditions applied, the elaborated products are stable. Conclusions: the 20 percent tincture and the fluid extract of the leaves of Rheedia aristata are rich formulations in secondary metabolites that could be the active principles responsible for the use of the plant as medicine, as reported in ethnobotanical studies. This fact, together with the great stability and absence of toxicity reports, converts this plant in a potential source of phytomedicines

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Introducción: el mamey amarillo (Mammea americana L.) se utiliza ampliamente en la curación de diversos tipos de enfermedades producidas por parásitos e insectos. Objetivo: realizar el tamizaje fitoquímico y determinar la actividad antibacteriana de los extractos secos de la tintura al 20 por ciento de las hojas y corteza del fuste de esta planta. Métodos: se recolectaron hojas y corteza del fuste de la planta objeto de estudio, que fueron lavadas, desinfectadas, secadas y pulverizadas. Luego se procedió a la elaboración de las tinturas al 20 por ciento por el método de maceración de la droga. Los extractos secos de las partes estudiadas de la planta se obtuvieron a partir de las tinturas al 20 por ciento y se emplearon para los ensayos del tamizaje fitoquímico y la evaluación de la actividad antibacteriana. Resultados: se comprobó la existencia de una alta diversidad de metabolitos secundarios, con predominio de los alcaloides, coumarinas, fenoles o taninos, quinonas y flavonoides. Los extractos secos mostraron actividad antibacteriana in vitro frente a la cepa de Staphylococcus aureus (ATCC 29737). Conclusiones: se destacan, por su significativa presencia, flavonoides, alcaloides, taninos y cumarinas, los cuales resultan de interés biológico y farmacológico por sus posibles aplicaciones terapéuticas

Introduction: the yellow mammee (Mammea americana L.) is widely used to cure different diseases caused by parasites and insects. Objective: to perform a phytochemical screening and to determine antibacterial activity of dry extracts of 20 percent tincture from the leaves and the bark of this plant. Methods: the leaves and stem bark of the plant were harvested, washed, disinfected, dried and crushed. Then it proceeded to the preparation of 20 percent tinctures through drug maceration. The dried extracts of the studied parts were obtained from the 20 percent tinctures and used to evaluate the phytochemical screening tests and the antibacterial activity. Results: the existence of a high diversity of secondary metabolites, predominantly alkaloids, coumarins, phenols and / or tannins, quinones, and flavonoids were confirmed. The dried extracts showed antibacterial activity in vitro against Staphylococcus aureus (ATCC 29737). Conclusions: flavonoids, alkaloids, tannins and coumarins, which are of biological and pharmacological interest for their potential therapeutic applications, were significantly present in these extracts

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Introducción: las hojas de Anacardium occidentale L. (marañón) tienen contenidos óptimos de nutrientes; se ha utilizado como antidiarreico y nutracéutico en animales, sin embargo, la caracterización fitoquímica y antimicrobiana de sus extractos son insuficientes. Objetivo: determinar los metabolitos secundarios y la actividad antimicrobiana in vitro de extractos de hojas de Anacardium occidentale L. Métodos: del polvo de las hojas de Anacardium occidentale L. se obtuvo inicialmente el extracto fluido y la tintura al 20 por ciento. Se realizó tamizaje fitoquímico y pruebas de calidad de las preparaciones farmacéuticas. Se determinó la actividad antibacteriana (Escherichia coli, Staphylococcus aureus Bacillus subtilis, Salmonella entérica, Shigella sp.) de tres diluciones del extracto seco (50, 100 y 200 mg/mL) de la tintura al 20 por ciento y de los extractos n-hexánico, clorofórmico y acetato de etilo (Escherichia coli, Shigella sp., Staphylococcus aureus, Salmonella entérica, Pseudomonas aeruginosa y Enterobacter aerogenes), con posterior caracterización fitoquímica. Resultados: en el extracto fluido y en la tintura al 20 por ciento se detectaron cumarinas y otros metabolitos como saponinas, flavonoides, azúcares reductores, aminoácidos libres, triterpenos/esteroides, fenoles/taninos. El índice de refracción, la densidad, el pH y los sólidos totales mostraron resultados similares para el extracto fluido y la tintura al 20 por ciento. Además, para estos indicadores no se encontraron diferencias significativas 6 meses después. El extracto seco mostró actividad antibacteriana contra Staphylococcus aureus, con los mayores halos de inhibición para la dilución de 200 mg/mL. Asimismo, el extracto de acetato de etilo indicó el menor crecimiento de esta bacteria patógena, según los halos de inhibición. En los extractos, clorofórmico y acetato de etilo

Introduction: the leaves of Anacardium occidentale L. (cashew tree) have optimal contents of nutrients and have been used as antidiarrheal and nutraceutical in animals; however, the phytochemical characterization and antimicrobial of the extracts are insufficient. Objective: to determine secondary metabolites and in vitro antimicrobial activity of Anacardium occidentale L. leaf extracts. Methods: fluid extract and 20% tincture were initially obtained from powdered leaves of Anacardium occidentale L. Phytochemical screening and quality testing of pharmaceuticals were performed. The antibacterial activity was determined (Escherichia coli, Staphylococcus aureus Bacillus subtilis, Salmonella enteric and Shigella sp.) in three dilutions of the dry extract (50, 100, and 200 mg/mL) from the 20 percent tincture and from the n-hexane, chloroform and ethyl acetate extracts (Escherichia coli, Staphylococcus aureus, Shigella sp., Salmonella enteric, Pseudomonas aerugiosa and Enterobacter aerogenes), with subsequent phytochemical characterization. Results: high content of coumarins and other metabolites such as saponins, flavonoids, reducing sugars, free aminoacids, triterpenes and/or steroids, phenols and/or tannins were detected in the fluid extract and the 20 percent tincture. The refractive index, the density, the pH and the total solids showed similar results for the fluid extract and for the 20 percent tincture. Besides, no significant differences were found in these parameters six months after the study. The dry extract showed antibacterial activity against Staphylococcus aureus, with the largest inhibition zones for dilution of 200 mg/mL. Furthermore, the ethyl acetate extract indicated the slowest growth of this bacterial pathogen, according to inhibition hales. In the chloroform and ethyl acetate extracts, abundant coumarins and reducing sugars were found. Conclusions: the fluid extract and the 20 percent tincture from Anacardium occidentale leaves contained

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