Anxiety and facial self-contacts: possible impact on COVID-19 transmission in dental practice.

BACKGROUND: The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact). METHODS: A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients' movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire. RESULTS: Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact. CONCLUSIONS: Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.

Crecimiento y mortalidad de Haemulon plumieri (Perciformes: Haemulidae) en el archipiélago Los Frailes, Venezuela

El corocoro margariteño Haemulon plumieri es muy abundante en la región nororiental de Venezuela, pero los aspectos biológicos y pesqueros han sido poco estudiados en este país. El objetivo de este estudio fue estimar el crecimiento y la mortalidad de este recurso. De enero a diciembre 2014 se realizaron muestreos mensuales y se obtuvieron 2 967 ejemplares, de los cuales se registró la longitud total (cm) y peso (g) de cada uno. Se encontró que no existe diferencia entre sexos con respecto a la longitud (ts = 0.093; P > 0.05), por lo que se estimó la relación longitud-peso para ambos sexos: P = 1.4x10-3 * L2.99, mostrando un crecimiento isométrico. Se utilizaron las rutinas del paquete FiSAT para estimar los parámetros del modelo de crecimiento individual de von Bertalanffy: L∞ = 30.95 cm, k = 0.67/año, P∞ = 418.17 g, t0 = -0.24 años. Se calculó una edad máxima de 4 años. El coeficiente de variación del índice de desempeño de crecimiento (Ø′) para el método directo (CV = 5.26 %) mostró una variabilidad en el patrón de crecimiento según la región. La tasa de mortalidad natural (M = 1.36/año) fue alta, posiblemente por causa de depredación y enfermedades, entre otros. Las tasas de mortalidad por pesca (F = 1.95/año) y mortalidad total (Z = 3.31/año) fueron altas. La tasa de explotación (E = 0.59/año) indica que es probable que H. plumieri esté sobreexplotado.

The white grunt Haemulon plumieri is abundant in northeastern Venezuela, but the biological and fishery aspects of this species have been little studied in the country. The objective of this study was to estimate the growth and mortality of this resource. We collected samples monthly from January to December 2014, obtaining 2 967 specimens. Total length (cm) and weight (g) were determined for each specimen. No sexual dimorphism was shown with respect to length (tS = 0.093; P > 0.05). Thus, one length-weight ratio was established for both sexes: W = 1.4×10-3* L2.99, which showed isometric growth. FiSAT package routines were used to estimate the growth parameters of the individual growth model of von Bertalanffy: L ∞ = 30.95 cm, k = 0.67/year, W ∞ = 418.17 g, t0 = -0.24 years. We estimated a max age of 4 years. The coefficient of variation of the growth performance index (Ø′) for the direct method (CV = 5.26 %) showed a variability in growth patterns according to region. The rate of natural mortality (M = 1.36/year) was high, possibly due to predation and disease, among others. Rates of fishing mortality (F = 1.95/year) and total mortality (Z = 3.31/year) were high. The exploitation rate (E = 0.59/year) indicates that H. plumieri is likely overexploited.

Autonomic dysfunction is frequent and disabling in non-paraneoplastic sensory neuronopathies.

INTRODUCTION: Sensory neuronopathies (SN) are characterized by asymmetric non-length dependent sensory deficits and sensory ataxia. Autonomic dysfunction in SN was not yet evaluated regarding its frequency, characteristics and relationship to sensory deficits. To address these issues, we performed a comprehensive clinical and neurophysiological evaluation of a large cohort of patients with non-paraneoplastic SN (np-SN). METHODS: We enrolled 50 consecutive patients with npSN and 32 age/sex-matched healthy controls. They were clinically evaluated (SCOPA-Aut scale) and underwent neurophysiological autonomic assessment (quantitative sudomotor axon reflex test, heart rate variability and sympathetic skin response). RESULTS: Mean age of patients was 50.9 ±â€¯10.3 years and there were 18 men. npSN patients had higher SCOPA-Aut scores than controls (26.63 ±â€¯12.72 vs. 12.66 ±â€¯9.11, p < .001). QSART was abnormal in 92% of the patients - sweat volumes in all examined sites were smaller among patients (p < .001). Cardiovascular autonomic neuropathy was more frequent in these patients as well (p < .001). CONCLUSION: Altogether our results suggest that autonomic dysfunction in distinct domains is frequent in npSN patients. These findings suggest that the clinical picture of npSN is related to a double neuronopathy: sensory and autonomic.

[Fibromyxoid sarcoma of kidney]. / Sarcoma fibromixoide renal.

OBJECTIVE: To report a case of fibromyxoid sarcoma of the kidney. CLINIC REPORT: A 28-year-old male patient attended the urological outpatient clinic for left varicocele associated with abdominal pain, fatigue, and weight loss. CONCLUSIONS: Low-grade fibromyxoid sarcoma of the kidney is an uncommon tumor. Surgery is the treatment of choice for this condition. Pathological analysis provides the final diagnosis.

[Long-term follow-up of antegrade endopyelotomy. Factors that influence the outcome]. / Seguimiento a largo plazo de la endopielotomía anterógrada. Factores que influyen en el resultado.

OBJECTIVE: To find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results. MATERIAL AND METHODS: We review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10-year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed. RESULTS: Mean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70 +/- 8.32 cm2 vs 30.19 +/- 11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0,87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively. CONCLUSION: Endopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results.

[Comparison between Valdivia position and prone position in percutaneous nephrolithotomy]. / Comparacin entre la posición de Valdivia y la posición prona en la nefrolitectomía percutánea (NLP).

INTRODUCTION: Although the supine position created by Dr. Valdivia two decades ago to perform the procedure known as percutaneous nephrolitectomy (PNL) presents advantages against the prone position in some aspects concerning anesthesia and surgical ergonomy, its use has failed to spread widely among the urology community due to certain technical difficulties, a lower rate of calculi clearing and a higher rate of complications, in spite of the fact that the scarce comparative studies do not show enough data to support this opinion. The present study compares both positions considering the technical difficulties encountered, their effectiveness and their results and complications. MATERIAL AND METHODS: A series of 50 patients that underwent PCNL by prone position is compared retrospectively with another series of 54 patients that underwent consecutively PCNL by prone position. All procedures were performed under general anesthesia, the inferior calyx approach was the one used the most over the supracostal approach, and the sole tract over the multi-tract approach was predominant. Dilatation of the nephrostomy tract was done, in most of the cases, with a high-pressure balloon catheter. The stone surface treated was 399.93+/-58.2 mm2 for the supine group, and 416.36+/-46.54 mm2 for the prone one (p=0.456). The management of the stones was carried out by ultrasonic or ballistic fragmentation, and a small group of patients underwent direct stone removal. RESULTS: As far as demographic parameters and operative variables such as number of tracts performed, calyx election, type of tract dilatation and kind of energy used for fragmentation, both groups were homogeneous. In 3 cases of each group there was a failure to access the kidney. The rate of failure was 6%, and 5.56%, for the supine and prone groups, respectively (p=0.716). Average operating time was 74.55+/-25.54 and 91.82+/-24.82 minutes, respectively, p=0.123. A postoperative x-ray showed a stone-free rate of 76% for the supine group and 74% for the prone group, p=0.308. ESWL was the supplementary treatment for 12% of the patients in the supine group, and for 12.96% of the patients in the prone group p= 0.478, and a second procedure was performed on 4 (8%) patients in the supine group and on 3 (5.56%) in the prone one, p=0.697. Hospital stay was the same for both groups (5.89+/-4.7 for the supine group, and 5.5+/-4.09 for the prone one, p=0.694). As far as analgesia required, 6.89+/-4.87 was administered for the supine against 6.18+/-4.09 for the prone, p=0.580. The complications rate was very low for both groups and also very similar; one of the patients in the supine group suffered a lesion to the colon. CONCLUSION: Valdivia position is as feasible as the prone position for PCNL. Success rates, as far as stone clearing, and complications are similar for both positions.

[Laparoscopic treatment of ovarian vein syndrome]. / Tratamiento laparoscópico del síndrome de la vena ovárica.

OBJECTIVE: We report a case of Ovarian Vein Syndrome, describe its clinical symptoms and discuss its diagnosis and management including laparoscopic surgery treatment. MATERIALS AND METHODS: A 36-year-old female with right kidney recurring pain was studied by means of abdominal RX, urography, CT, MRI and ultrasonography and finally diagnosed from Ovarian Vein Syndrome. The case was resolved with laparoscopic surgery. CONCLUSIONS: Ovarian Vein Syndrome is an uncommon disorder. Differential diagnosis must be done with external processes that cause ureteral obstruction. Surgery is the first line treatment when clinical symptoms are present and, in our opinion,laparoscopic surgery is the best approach to treat this pathology.

[TRUS-guided biopsy: comparison of two anesthetic methods]. / Biopsia prostática ecodirigida: comparación de dos métodos anestésicos.

PURPOSE: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine. PATIENTS AND METHODS: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. RESULTS: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p < or = 0.05). There were no significant differences in major complications. CONCLUSIONS: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.

[Ureteroscopy in the follow-up protocol for upper urinary tract urothelial tumors treated endoscopically]. / La ureteroscopia en el protocolo del seguimiento del tumor del urotelio superior tratado por via endoscópica.

OBJECTIVES: To evaluate the role of ureteroscopy (rigid and flexible) in the follow-up protocol for transitional cell tumors treated conservatively in our department by endourological procedures, and to review the articles on this topic available in the literature. METHODS: From February 1997 to June 2003, 10 patients (12 renal units) with upper urinary tract urothelial tumor treated conservatively by endourological procedures were followed by cytology, cystoscopy, retrograde ureteropyelography, and ureteroscopy (rigid and flexible), quarterly during the first year, semi-annually during the second year, and yearly thereafter in order to detect tumor recurrence. RESULTS: Mean follow-up was 31.9 months (R 14-65). Two patients died: one because of a previous metacronous bladder tumor and the other after distant progression. One patient was lost to followup. A total of 42 ureteroscopies were performed (31 flexible and 11 rigid). Flexible ureteroscopy was performed in 6 patients and rigid ureteroscopy in three; neither was feasible in one patient so that follow-up was done by cytology, cystoscopy and urography. Tumor recurrence was detected in 2 patients but ureteroscopy did not inform about tumor stage. Flexible ureteroscopy failed in another patient in which rigid ureteroscopy was feasible. Although this latter was technically easier to perform, procedure discomfort was worse. CONCLUSIONS: The follow-up of transitional cell tumors of the upper urinary tract should be very strict because of the high risk of tumor relapse. Ureteroscopy, mainly flexible, is standing out as the most effective procedure to watch these tumors.

Enfermedad de Kikuchi-Fujimoto: Reporte de un caso / Kikuchi-Fujimori's disease: A case report

Se presenta el caso de una paciente de 21 años de edad con cuadro adénico febril de tres meses de evolución que simuló inicialmente el diagnóstico de una infección por el virus de inmunodeficiencia humana (VIH) o de una adenitis en el curso de enfermedad infecciosa, lo cual motivó el uso de antibioticoterapia por vía endovenosa. Se confirma mediante estudio histológico por punción aspirativa de ganglio cervical el diagnóstico de enfermedad de Kikuchi - Fujimoto. Se destacó la evolución favorable de manera espontánea, lo cual apoya el carácter autolimitado de la entidad. Se hizo hincapié en la necesidad e importancia de un juicio diagnóstico y pensamiento médico en busca de esta afección con el objetivo de evitar procederes diagnósticos y terapéuticos innecesarios.

The case of a 21-year-old female patient with adenic febrile picture of 3 months of evolution that simulated initially the diagnosis of an HIV infection or of an adenitis in the course of infectious disease that motivated the use of antibiotic therapy by endovenous route, was presented. The diagnosis of Kikuchi Fujimoto's disease was confirmed by histological study with aspiration puncture of the cervical ganglion.The spontaneous favorable evolution , which supports the self-limited character of the entity, was underlined. Emphasis was made on the need and importance of a diagnostic judgement and medical thinking in the search of this affection aimed at avoiding unncessary diagnostic and therapeutic procedures.

[Laparoscopic pyeloplasty. Our experience]. / Pieloplastia laparoscópica. Nuestra experiencia.

OBJECTIVES: To report our experience with laparoscopic pyeloplasty in the treatment of pyeloureteral junction obstruction. METHODS: Between August 2001 and August 2004 14 patients with the diagnosis of pyeloureteral junction obstruction underwent laparoscopic repair. Seven cases had the obstruction on the left side and the other seven on the right side. We describe the technique of laparoscopic dismembered Anderson-Hynes type pyeloplasty, performed to 12 patients in our series. The remainder 2 patients underwent Foley's Y-V plasty and the Fenger's technique. RESULTS: Mean operative time was 199.7 minutes (r: 126-290). There were not intraoperative complications. Mean hospital stay was 4.63 days (r: 3-9). One case of double J catheter obstruction can be cited as late postoperative complication. Only one of the 14 cases suffered a recurrence of the stenosis after double J catheter retrieval. CONCLUSIONS: Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy.

Daño vascular en el hipertenso esencial / Vascular damage in the essential hypertensive

Se estudió una muestra de 140 sujetos (70 hipertensos y 70 trabajadores normotensos) para verificar si el daño vascular determinado por el engrosamiento del complejo íntima media (C.I/M) y evidencia de placa de ateroma en arteria carótida y femoral era mayor en los primeros y evaluar las relaciones de estos cambios estructurales entre ambas arterias. A todos los pacientes se les realizó Eco Doppler Modo B de arteria carótida y femoral para demostrar el engrosamiento del C.I/M y evidencia de placa de ateroma. Se incluyeron sujetos de ambos sexos entre 25 y 70 años de edad. Para la comparación de los grupos (estudio y control) se utilizaron pruebas para comparar proporciones y promedios para las variables cuantitativas (grosor íntima media y número de placas), estas comparaciones se realizaron de forma simple (univariadas). Se encontró que el grosor del C.I/M de arteria carótida se presentó fundamentalmente en el grupo de pacientes hipertensos (48,6 por ciento), Se observó una asociación estadísticamente significativa entre el incremento de PAS/ PAD y engrosamiento del C.I/M en el grupo de hipertensos (p= 0,000). La PAS alcanzó en el grupo de pacientes hipertensos una mayor preponderancia en la influencia del engrosamiento del C.I/M que la PAD (p = 0,005 vs 0,01). Se concluyó que los mayores promedios de engrosamiento del C.I/M se encontraron en el grupo de pacientes hipertensos y que tanto la PAS como la PAD fueron determinantes en su aparición aunque fue la PAS la que alcanzó mayor significación estadística (p = 0,005). La presencia de placa en ambas arterias fue mayor en el grupo de hipertensos. Se demostró una asociación significativa entre grosor del C.I/M y evidencia de placa de ateroma

Infección por el virus de la inmunodeficiencia humana tipo2: presentación de 1 caso / Type 2 HIV infection: a case presentation

Se presentó el caso de un paciente de 69 años de edad, residente del municipio de Centro Habana, que ingresó en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras" por presentar un cuadro clínico de fiebre, diarreas de tipo alto y pérdida de peso. Al realizar el examen físico se comprobó la presencia de lesiones sugestivas de candidiasis oral y en los estudios complementarios se halló eritrosedimentación acelerada, aumento de la deshidrogenasa de ácido láctico y severa disminución del conteo total de linfocitos CD4+. Se confirmó, mediante el estudio serológico, la presencia de anticuerpos contra el virus de la inmunodeficiencia humana tipo 2 en 2 muestras de sangre tomadas en fechas diferentes. Este caso corresponde al décimo diagnóstico de infección por VIH tipo 2 realizado en Cuba y resulta de interés que, a pesar del largo período de incubación del diagnóstico se realizó en un estadio avanzado de la infección ante la sospecha clínica de inmunodeficiencia y no como resultado de estudios previos de pesquisaje

[Laparoscopic radical prostatectomy. Preliminary experience]. / Prostatectomía radical laparoscópica: experiencia preliminar.

OBJECTIVE: Laparoscopic technique has been developed with the aim to decrease the morbidity of the open radical prostatectomy. MATERIAL AND METHODS: From january 2002 to may 2002, 8 patients were treated for prostate cancer with laparoscopic radical prostatectomy. Unilateral linfadenectomy has been carried out in only one patient. We usually employ the transperitoneal technique published by the Montsouris Institute, with some modifications. RESULTS: The main surgical time was 356 minutes (540-240). Transfusion wasn't needed in any case. Intraoperative complications were: 2 bladder injuries, 1 bleeding of the epigastric artery. Postoperative complications were: 1 ileus, 2 compressive neurapraxia, 4 anastomotic fistutas. All complications were treated conservatively. No patient were converted to open surgery. Surgical limits were negatifs in all cases, and the PSA rate was less than 0.1 ng/ml in the first month follow up. CONCLUSION: Laparoscopic radical prostatectomy is a difficult technique, but we think that, the learning curve is getting lower and lower than in the first series. Oncologic results with this technique is similar to the open one. However, laparoscopic approach shows us some benefits such as less bleeding, less time catheterisation, less hospital stay, better continence, better sexual function, better stetic result, less postoperative pain, and finally an earlier back to work.

Síndrome de linfohistiocitosis hemofagocítica: a propósito de un caso / Hemophagocytic lymphohistiocytosis syndrome: apropos of a case

El síndrome de linfohistiocitosis hemofagocítica (LHH), aunque infrecuente en la práctica clínica, resulta de extraordinario interés dado su comportamiento agresivo y mal pronóstico. El objetivo de esta publicación fue exponer, a partir de la experiencia derivada de la observación de un caso, las características clínicas fundamentales: anemia, trombocitopenia y neutropenia unido a fiebre y esplenomegalia. Se discutieron las causas que pueden producir dicho síndrome y entre ellas los linfomas, como sucedió en este caso. Se concluyó que el síndrome de LHH constituye una entidad en específico y que se necesita una búsqueda minuciosa desde el punto de vista etiológico para determinar su causa. Se destacó que este caso fue secundario a un linfoma no Hodking extranodal de células T de alto grado de malignidad con toma renal que llevó a la muerte a la enferma en breve período

Hipertensión Paroxística y Síncope Miccional como forma de presentación de Paraganglioma Vesical / Paroxysmal hypertension and micturition syncope as the form of presentation of bladder paraganglioma

Se presenta un paciente masculino de raza negra de 42 años de edad, que fue admitido en nuestro hospital por presentar cuadros sincopales en relación con el esfuerzo miccional desde 3 meses antes. Su estado clínico se caracterizó por cefaleas, palpitaciones, ansiedad, estado presincopal y síncope verdadero ocasional. Se detectaron durante los episodios fluctuaciones de la presión arterial que incluían paroxismos hipertensivos e hipotensión ocasional. Las catecolaminas urinarias y plasmáticas se encontraron elevadas. Los estudios imagenológicos (US y TAC) demostraron la presencia de un tumor de pared vesical. Tras la resección quirúrgica desaparecieron las manifestaciones clínicas. El estudio histológico fue compatible con el diagnóstico de paranganglioma de pared vesical