Knowledge and attitudes toward anaphylaxis to local anesthetics in dental practice.

OBJECTIVE/AIM: The absence of a comprehensive understanding of potential anaphylactic reactions to local anesthetics (LAs) and management can result in grave consequences. For this reason we aim to assess Latin American dentists' knowledge, preparedness, and competency in managing anaphylactic reactions to LAs. MATERIALS AND METHODS: Design: A cross-sectional study was conducted from November 2021 to February 2022. Board-certified dentists answered a survey comprising 26 structured questions. Chi-square tests and logistic regression models were performed in Stata 17.0. SETTING: Argentina, Brazil, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Peru, Venezuela, and other Latin American countries. RESULTS: Of 507 respondents, lidocaine was the most frequently used LA (88.1%). While 85.2% could identify dyspnea as a symptom of anaphylaxis, only 50.1% knew the correct route for epinephrine administration, and just 43.5% had epinephrine in their emergency kits. Confidence in managing anaphylactic reactions was low (9.6%). Older age was inversely related to both knowledge of anaphylaxis management and the possession of epinephrine (P = 0.003 and P = 0.0001, respectively). DISCUSSION: Our study highlights a concerning discrepancy between the practical readiness of Latin American dentists in handling anaphylaxis. CONCLUSION: The study's findings underscore the need for educational interventions to improve the readiness to identify and handle anaphylactic emergencies in dental practice.

Assessing Cognitive Workload in Motor Decision-Making through Functional Connectivity Analysis: Towards Early Detection and Monitoring of Neurodegenerative Diseases.

Neurodegenerative diseases (NDs), such as Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, and frontotemporal dementia, among others, are increasingly prevalent in the global population. The clinical diagnosis of these NDs is based on the detection and characterization of motor and non-motor symptoms. However, when these diagnoses are made, the subjects are often in advanced stages where neuromuscular alterations are frequently irreversible. In this context, we propose a methodology to evaluate the cognitive workload (CWL) of motor tasks involving decision-making processes. CWL is a concept widely used to address the balance between task demand and the subject's available resources to complete that task. In this study, multiple models for motor planning during a motor decision-making task were developed by recording EEG and EMG signals in n=17 healthy volunteers (9 males, 8 females, age 28.66±8.8 years). In the proposed test, volunteers have to make decisions about which hand should be moved based on the onset of a visual stimulus. We computed functional connectivity between the cortex and muscles, as well as among muscles using both corticomuscular and intermuscular coherence. Despite three models being generated, just one of them had strong performance. The results showed two types of motor decision-making processes depending on the hand to move. Moreover, the central processing of decision-making for the left hand movement can be accurately estimated using behavioral measures such as planning time combined with peripheral recordings like EMG signals. The models provided in this study could be considered as a methodological foundation to detect neuromuscular alterations in asymptomatic patients, as well as to monitor the process of a degenerative disease.

Epidemiological characterization of ischemic heart disease at different altitudes: A nationwide population-based analysis from 2011 to 2021 in Ecuador.

BACKGROUND: Cardiovascular diseases, including ischemic heart disease, are the leading cause of premature death and disability worldwide. While traditional risk factors such as smoking, obesity, and diabetes have been thoroughly investigated, non-traditional risk factors like high-altitude exposure remain underexplored. This study aims to examine the incidence and mortality rates of ischemic heart disease over the past decade in Ecuador, a country with a diverse altitude profile spanning from 0 to 4,300 meters. METHODS: We conducted a geographic distribution analysis of ischemic heart disease in Ecuador, utilizing hospital discharge and mortality data from the National Institute of Census and Statistics for the years 2011-2021. Altitude exposure was categorized according to two distinct classifications: the traditional division into low (< 2,500 m) and high (> 2,500 m) altitudes, as well as the classification proposed by the International Society of Mountain Medicine, which delineates low (< 1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m), and very high (3,500-5,800 m) altitudes. FINDINGS: From 2011-2021, we analyzed 49,765 IHD-related hospital admissions and 62,620 deaths. Men had an age-adjusted incidence rate of 55.08/100,000 and a mortality rate of 47.2/100,000, compared to 20.77/100,000 and 34.8/100,000 in women. Incidence and mortality surged in 2020 by 83% in men and 75% in women. Altitudinal stratification revealed higher IHD rates at lower altitudes (<2500 m), averaging 61.65 and 121.8 per 100,000 for incidence and mortality, which declined to 25.9 and 38.5 at elevations >2500 m. Men had more pronounced rates across altitudes, exhibiting 138.7% and 150.0% higher incidence at low and high altitudes respectively, and mortality rates increased by 48.3% at low altitudes and 23.2% at high altitudes relative to women. CONCLUSION: Ecuador bears a significant burden of ischemic heart disease (IHD), with men being more affected than women in terms of incidence. However, women have a higher percentage of mortality post-hospital admission. Regarding elevation, our analysis, using two different altitude cutoff points, reveals higher mortality rates in low-altitude regions compared to high-altitude areas, suggesting a potential protective effect of high elevation on IHD risk. Nevertheless, a definitive dose-response relationship between high altitude and reduced IHD risk could not be conclusively established.

Removal efficiency of As(III) from aqueous solutions using natural and Fe(III) modified bentonites.

Contamination of water with arsenic is a major global health problem. The use of adsorbent materials for the removal of As from aqueous systems is a plausible solution to this problem. In this work, the use of commercial bentonites (purified and modified with iron (III)) for the removal of As from water was studied. The samples were characterized by X-ray fluorescence (XRF), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Fourier Transformed Infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and nitrogen adsorption/desorption isotherms to determine their physicochemical properties. The arsenic removal capacities of adsorbent materials were studied from 1 mg/L solutions of As (III) using the colorimetric technique of molybdenum blue. High adsorption capacity (0.33 mg/g) of As (III) was obtained in aqueous systems after 1 h of treatment with unmodified bentonite. The incorporation of iron improved the removal performance in short times. The obtained results could be the starting point for the development of a low-cost filtration system that contributes to solve the problem of arsenic in water.

Radiation-free monitoring in the long-term follow-up of pyeloplasty: Are ultrasound new parameters good enough to evaluate a successful procedure?

INTRODUCTION: Long-term evolution of residual hydronephrosis after successful pyeloplasty is not common. In this report, we have studied new ultrasound parameters, and have investigated the frequency of residual hydronephrosis. We highlight alternative radiation-free monitoring of pediatric pyeloplasties with ultrasound alone. PATIENTS AND METHODS: Children who had undergone successful open Anderson-Hynes pyeloplasties in the period 2001-2010 were followed up. Exclusion criteria included non-clearly obstructed renography scans (tracer clearance half-time < 20 min), crossing vessels, failed pyeloplasty, bilateral disease, other renal concomitant anomaly, absence of ultrasound measurements, and loss to follow up (<1 year). Postoperative (postoperative) ultrasound parameters were anteroposterior (AP) diameter, pelvis-cortex (P/C) ratio, a proportion that takes in account these two values, enhancing sensitivity to evaluate minimal evolutive changes), and percentage of improvement (PI) in AP diameter (which reflects in relative means the evolution of each AP diameter, being 0% no change, and 100% absence of hydronephrosis) (Figure). Echographic checks were made at 3 and 6 months postoperatively and then yearly afterwards. SPSS software (v. 17.0 IBM, College Station, TX, USA) was used. RESULTS: Out of 80 pyeloplasties performed in the above-mentioned period, 44 patients (i.e., 44 renal units) fulfilled the inclusion criteria for the main study. The median age at time of operation was 15 months (range 2 months-10.3 years). The median follow-up was 4.5 years (range 1-12 years). The mean preoperative anteroposterior diameter was 26 mm (range 16-54 mm). At the third postoperative check, the mean the PI was 29%, and rose to 53% at 6 months (p=0.027). Posterior controls showed a stable yearly PI during follow-up, without statistically significant variations (40-59% in subsequent years, p>0.5). The P/C ratio had already downgraded significantly at the third postoperative check (4.6 preoperative vs. 1.8 postoperative; p=0.03). A subgroup analysis of failed pyeloplasty (4 renal units) showed all PI < 15% at the third postoperative month (sensitivity 100%, specificity 86%). Complete resolution of hydronephrosis occurred in nine patients (20%). DISCUSSION: The P/C ratio and PI are new feasible ultrasound parameters in pyeloplasty follow-up. Early improvement in the P/C ratio can be expected and might avoid repeated ionizing scans. A PI>15% in subsequent postoperative checks might be enough for safe monitoring with ultrasound alone. Thus, renograms may be solicited only in these cases where ultrasound parameters do not improve in the first 6 postoperative months. Afterwards, ultrasound parameters often remain stable in the long term. Absence of hydronephrosis could only be documented in the long term in one out of every five patients.

Edwards's statistical mechanics of crumpling networks in crushed self-avoiding sheets with finite bending rigidity.

This paper is devoted to the crumpling of thin matter. The Edwards-like statistical mechanics of crumpling networks in a crushed self-avoiding sheet with finite bending rigidity is developed. The statistical distribution of crease lengths is derived. The relationship between sheet packing density and hydrostatic pressure is established. The entropic contribution to the crumpling network rigidity is outlined. The effects of plastic deformations and sheet self-contacts on crumpling mechanics are discussed. Theoretical predictions are in good agreement with available experimental data and results of numerical simulations. Thus, the findings of this work provide further insight into the physics of crumpling and mechanical properties of crumpled soft matter.

Retrocaval ureter in children. Case report and bibliographic review.

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases. METHOD: We present a case of retrocaval ureter and a revision of the literature. RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MR). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis. CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated.