Earlier detection of gestational diabetes impacts on medication requirements, neonatal and maternal outcomes.

AIM: Gestational diabetes (GD) is a global health concern with significant implications for maternal and neonatal outcomes. This study investigates the association between early GD (eGD) diagnosis (<24 weeks), pharmacotherapy requirements and adverse neonatal outcomes. MATERIALS AND METHODS: A cohort of 369 pregnant women underwent a 75-g oral glucose tolerance test. Maternal variables, pharmacotherapy prescriptions and neonatal outcomes were analysed employing t-tests, χ2 tests, and logistic regression. A p < .05 was considered significant. RESULTS: Early GD increased the odds of neonatal hypoglycaemia [odds ratio (OR): 18.57, p = .013] and respiratory distress syndrome (OR: 4.75, p = .034). Nutritional therapy prescription by an accredited nutritionist was the most common treatment in women diagnosed after 24 weeks, but those with eGD required more frequently specialized nutritional consulting + metformin to achieve glycaemic control (p = .027). eGD was associated with a higher requirement of nutritional therapy prescription + metformin (OR: 2.26, 95% confidence interval: 1.25-4.09, p = .007) and with maternal hyperglycaemia during the post-partum period at 2 h of the oral glucose tolerance test (OR: 1.03, 95% confidence interval: 1.02-1.13, p = .024). CONCLUSION: Timely diagnosis and personalized treatment of GD are desirable because an earlier presentation is related to a higher risk of adverse neonatal and maternal outcomes.

Rosmarinic Acid Present in Lepechinia floribunda and Lepechinia meyenii as a Potent Inhibitor of the Adenylyl Cyclase gNC1 from Giardia lamblia.

Giardiasis is a parasitosis caused by Giardia lamblia with significant epidemiological and clinical importance due to its high prevalence and pathogenicity. The lack of optimal therapies for treating this parasite makes the development of new effective chemical entities an urgent need. In the search for new inhibitors of the adenylyl cyclase gNC1 obtained from G. lamblia, 14 extracts from Argentinian native plants were screened. Lepechinia floribunda and L. meyenii extracts exhibited the highest gNC1 inhibitory activity, with IC50 values of 9 and 31 µg/mL, respectively. In silico studies showed rosmarinic acid, a hydroxycinnamic acid present in both mentioned species, to be a promising anti-gNC1 compound. This result was confirmed experimentally, with rosmarinic acid showing an IC50 value of 10.1 µM. Theoretical and experimental findings elucidate the molecular-level mechanism of rosmarinic acid, pinpointing the key interactions stabilizing the compound-enzyme complex and the binding site. These results strongly support that rosmarinic acid is a promising scaffold for developing novel compounds with inhibitory activity against gNC1, which could serve as potential therapeutic agents to treat giardiasis.

Sobrevida del cáncer glótico en estadio inicial en 4 centros hospitalarios de Uruguay / Survival of glottic cancer in the initial stage in 4 hospital centers in Uruguay / Sobrevivência de câncer glótico em estágio inicial em 4 hospitais uruguaios

Introducción: El cáncer de laringe es el tumor maligno de mayor prevalencia en la Otorrinolaringología. La topografía glótica es la más frecuente en Uruguay y suele detectarse en estadios tempranos dada la manifestación precoz y sostenida de disfonía. El objetivo de este estudio es describir la sobrevida libre de enfermedad (SLE) y la sobrevida global (SG) de los pacientes con cáncer de laringe glótico en estadio T1N0M0 en 4 instituciones de Montevideo. Metodología: Se analizó de forma retrospectiva la SG y SLE de 55 pacientes diagnosticados con cáncer de glotis T1 entre los años 2009 y 2019. Para el cálculo de la sobrevida se utilizó el método de Kaplan-Meier. Se estudió además el efecto de variables pronósticas de interés sobre la SG mediante análisis univariado y multivariado. Resultados: En la muestra analizada la SG de los pacientes con cáncer glótico T1N0M0 fue como media de 7.706 años (IC 95% 6.63 - 8.78). A los 5 años, la SG fue de 77.5% (± 7%) y de 62% (± 9.8%) a los 10 años. La SLE para todos los pacientes correspondió al 74.6% (± 7.5%) y 63.1% (± 9.8%), a 5 y 10 años respectivamente. No se alcanzaron las medianas de SG ni de SLE para los grupos. Conclusiones: Los valores de SG y SLE medios obtenidos en nuestro medio son comparables a los valores reportados en la bibliografía internacional. No se alcanzó la mediana de SG ni de SLE, por lo que se puede afirmar que ésta enfermedad tiene, cuando se realiza el tratamiento adecuado, un buen pronóstico vital a los 10 años. Se requiere un seguimiento más largo para determinar las medianas de SG y SLE de los grupos en estudio.

Introduction: Laryngeal cancer is the most prevalent malignant tumor in Otorhinolaryngology. Glottic topography is the most frequent in Uruguay and is usually detected in early stages given the early and sustained manifestation of dysphonia. The objective of this study is to analyze disease-free survival (DFS) and overall survival (OS) of patients with stage T1N0M0 glottic laryngeal cancer at 4 institutions in Montevideo. Methodology: The mean OS and DFS of 55 patients diagnosed with T1 glottic cancer between 2009 and 2019 were retrospectively analyzed. Kaplan-Meier method was used to calculate survival. The prognostic effect of certain variables of interest on OS was also studied using univariate and multivariate analysis. Results: In this study, mean odds survival (OS) for T1N0M0 glottic cancer was 7.706 years (CI 95% 6.63 - 8.78). At 5 years, OS was 77.5% (± 7%) and at 10 years was 62% (± 9.8%). Disease free survival (DFS) was 74.6% ± (7.5%) at 5 years and 63.1% (± 9.8%), at 10 years. Median OS and DFS for the groups were not reached. Conclusions: OS and DFS in our medium is comparable to that reported in the international literature. The median OS and DFS were not reached, so it can be stated that this disease has, when appropriate treatment is performed, a good vital prognosis at 10 years. Longer follow-up is required to determine the median OS and DFS of the study groups.

Introdução: O câncer de laringe é o tumor maligno mais prevalente na Otorrinolaringologia. A topografia glótica é a mais frequente no Uruguai e geralmente é detectada em estágios iniciais devido à manifestação precoce e sustentada da disfonia. O objetivo deste estudo é analisar a sobrevida livre de doença (DFS) e a sobrevida global (OS) de pacientes com câncer de laringe glótico estágio T1N0M0 em 4 instituições em Montevidéu. Metodologia: Foram analisados retrospectivamente o OS e DFS de 55 pacientes diagnosticados com câncer glótico T1 entre 2009 e 2019. O método de Kaplan-Meier foi usado para calcular a sobrevida. Resultados: Na amostra, a sobrevida global (OS) do câncer glótico T1N0M0 foi em média de 7.706 anos (IC 95% 6,63 - 8,78). Aos 5 anos, a OS foi de 77,5% (± 7%) e 62% (± 9,8%) aos 10 anos. A DFS para todos os pacientes correspondeu a 74,6% (± 7,5%) e 63,1% (± 9,8%), aos 5 e 10 anos, respectivamente. As medianas de OS e DFS para os grupos não foram alcançadas. Conclusões: OS e DFS em nosso ambiente é comparável ao relatado na literatura internacional. As medianas de SG e SLD não foram alcançadas, pelo que se pode afirmar que esta doença apresenta, quando realizado tratamento adequado, um bom prognóstico vital aos 10 anos. É necessário um acompanhamento mais longo para determinar a mediana da SG e da SLD dos grupos de estudo.

A Mission Simulating the Search for Life on Mars with Automated Drilling, Sample Handling, and Life Detection Instruments Performed in the Hyperarid Core of the Atacama Desert, Chile.

We report on a field demonstration of a rover-based drilling mission to search for biomolecular evidence of life in the arid core of the Atacama Desert, Chile. The KREX2 rover carried the Honeybee Robotics 1 m depth The Regolith and Ice Drill for Exploration of New Terrains (TRIDENT) drill and a robotic arm with scoop that delivered subsurface fines to three flight prototype instruments: (1) The Signs of Life Detector (SOLID), a protein and biomolecule analyzer based on fluorescence sandwich microarray immunoassay; (2) the Planetary In Situ Capillary Electrophoresis System (PISCES), an amino acid analyzer based on subcritical water extraction coupled to microchip electrophoresis analysis; and (3) a Wet Chemistry Laboratory cell to measure soluble ions using ion selective electrodes and chronopotentiometry. A California-based science team selected and directed drilling and sampling of three sites separated by hundreds of meters that included a light-toned basin area showing evidence of aqueous activity surrounded by a rocky desert pavement. Biosignatures were detected in basin samples collected at depths ranging from 20 to 80 cm but were not detected in the surrounding area. Subsurface stratigraphy of the units drilled was interpreted from drill sensor data as fine-scale layers of sand/clay sediments interspersed with layers of harder material in the basins and a uniform subsurface composed of course-to-fine sand in the surroundings. The mission timeline and number of commands sent to accomplish each activity were tracked. The deepest sample collected (80 cm) required 55 commands, including drilling and delivery to three instruments. Elapsed time required for drilling and sample handling was less than 3 hours to collect sample from 72 cm depth, including time devoted to recovery from a jammed drill. The experiment demonstrated drilling, sample transfer technologies, and instruments that accomplished successful detection of biomolecular evidence of life in one of the most biologically sparse environments on Earth.

Menor aerolización con bloqueo del nervio laríngeo superior comparado con lidocaína intravenosa a la extubación / Less aerolization with superior laryngeal nerve block compared to intravenous lidocaine at extubation

Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.

Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.

Efecto del confinamiento durante la pandemia de Covid-19 en los niveles séricos de lípidos y composición corporal de estudiantes universitarios.

No disponible.

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients.

BACKGROUND: The safety and efficacy data of the different types of available vaccines is still needed. The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients. METHODS: Participants were included from February to September 2021. No prioritized vaccination roll call applied for OLT patients. Controls were otherwise healthy people. Blood samples were drawn after 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer's instructions using the Liaison XL platform from DiaSorin (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (Abbott Diagnostics, IL, USA). RESULTS: A total of 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity. The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p = 0.001). A positive humoral response was found in 133 OLT individuals: 89.2% with BNT162b2 (Pfizer-BioNTech), 60% ChAdOx1 nCOV-19 (Oxford-AstraZeneca), 76.9% with CoronaVac (Sinovac, Life Sciences, China), 55.6% Ad5-nCov (Cansino, Biologics), 68.2% Gam-COVID-Vac (Sputnik V) and 100% with mRNA-1273. In controls the serological response was 100%, except for Cansino (75%). In a multivariable model, personal history of COVID-19 and BNT162b2 inoculation were associated with the serologic response, while the use of prednisone (vs. other immunosuppressants) reduced this response. CONCLUSION: The serologic response to COVID-19 vaccines in OLT patients is lower than in healthy controls. The BNT162b2 vaccine was associated with a higher serologic response.

Molecular Characterization of Embryos with Different Buoyancy Levels in the Yellowtail Kingfish (Seriola lalandi).

The buoyancy of eggs and embryos is associated with successful development in pelagic fish. Buoyancy is the result of oocyte hydration, which depends on the osmotic force exerted by free amino acids (FAA) generated by yolk proteolysis, and cathepsins are the main enzymes involved in this process. Seriola lalandi is a pelagic fish whose farming has been hampered by development failure that have been partially attributed to decreased buoyancy of embryos. Therefore, the aim of this study was to compare the mRNA expression and activity of cathepsins B, D, and L, as well as the FAA content in floating and low-floating embryos at different developmental stages. The chosen stages were eggs, morula, blastula, gastrula and 24 h embryos. Complementary assessments showed that there were no differences attributed to buoyancy status in embryo and oil droplet diameters, as well as the transcriptional status at any developmental stage. Cathepsin B did not show differences in mRNA expression or activity related to buoyancy at any stage. Cathepsin D displayed higher transcript and activity levels only in low-floating eggs compared with those floating. Cathepsin L showed higher expression in floating eggs and 24 h embryos compared with that of low-floating, but the activity of this enzyme was higher in floating eggs and morula. Total FAA content constantly decreased throughout development in floating embryos, but it was always higher than low-floating embryos until gastrula stage. In 24 h embryos floating and low-floating embryos share similar quantities of FAA. In summary, differences in the expression and activity of cathepsins between floating and low-floating embryos could be revealed at specific embryonic stages, suggesting different functions of these enzymes throughout development. Besides 24 h embryos, FAA content seems to be a decisive factor for buoyancy of embryos during early development of S. lalandi. Overall, considering the main role of cathepsins and FAA in buoyancy acquisition process and therefore in both embryo quality and viability, our study identifies good marker candidates to evaluate embryo quality in the farming of this species.

Outcomes of late open fetal surgery for intrauterine spina bifida repair after 26 weeks. Should we extend the Management of Myelomeningocele Study time window?

OBJECTIVE: To evaluate maternal and perinatal outcomes of late open fetal repair for open spina bifida (OSB) between 26+0 -27+6  weeks. METHODS: A cohort of fetuses with OSB who underwent open surgery in two fetal surgery centers (Argentina and Mexico). Two groups were defined based on the gestational age (GA) at intervention: Management of Myelomeningocele Study (MOMS) time window group: GA 19+0 -25+6 , and late intervention group: GA 26+0 -27+6 . RESULTS: Intrauterine OSB repair was successfully performed in 140 cases, either before (n = 57) or after (n = 83) 26 weeks, at on average 25+0 (22+6 -25+6 ) and 26+5 (26+0 -27+6 ) weeks + days, respectively. There were no significant differences in the rate of premature rupture of membranes, chorioamnionitis, oligohydramnios, preterm delivery, perinatal death and maternal complications. The late intervention group showed a significantly lower surgical times (112.6 vs. 124.2 min, p = 0.01), lower interval between fetal surgery and delivery (7.9 vs. 9.2 weeks, p < 0.01) and similar rate of hydrocephalus requiring treatment (30.6% vs. 23.3%, p = 0.44) than the MOMS time window group. CONCLUSION: Late fetal surgery for OSB repair between 26+0 -27+6  weeks is feasible and was associated with similar outcomes than that performed before 26 weeks. These findings may allow an extension of the proposed time window for cases with late diagnosis or referral.

Structure activity relationships and the binding mode of quinolinone-pyrimidine hybrids as reversal agents of multidrug resistance mediated by P-gp.

P-gp-associated multidrug resistance is a major impediment to the success of chemotherapy. With the aim of finding non-toxic and effective P-gp inhibitors, we investigated a panel of quinolin-2-one-pyrimidine hybrids. Among the active compounds, two of them significantly increased intracellular doxorubicin and rhodamine 123 accumulation by inhibiting the efflux mediated by P-gp and restored doxorubicin toxicity at nanomolar range. Structure-activity relationships showed that the number of methoxy groups, an optimal length of the molecule in its extended conformation, and at least one flexible methylene group bridging the quinolinone to the moiety bearing the pyrimidine favored the inhibitory potency of P-gp. The best compounds showed a similar binding pattern and interactions to those of doxorubicin and tariquidar, as revealed by MD and hybrid QM/MM simulations performed with the recent experimental structure of P-gp co-crystallized with paclitaxel. Analysis of the molecular interactions stabilizing the different molecular complexes determined by MD and QTAIM showed that binding to key residues from TMH 4-7 and 12 is required for inhibition.

Pediatric KT in children up to 15 kg: A single-center experience.

BACKGROUND: KT is the preferred treatment for ESRD in pediatrics. However, it may be challenging in those weighing ≤15 kg with potential complications that impact on morbidity and graft loss. METHODS: This retrospective review reports our experience in KT in children, weighing ≤15 kg, and the strategies to reduce morbidity and mortality. RESULTS: All patients were on RRT prior to KT. Patients reached ESRD mainly due to urologic malformations (54.54%). LD was performed in 82% of patients. The recipient's median age was 2.83 years, and median weight 12.280 kg. Male sex was predominant (73%). All patients required transfusions of PRBCs. There was a high requirement for ventilated support in patients post-KT with no relation to weight, amount of resuscitation used intra-operatively or ml/kg of PRBCs. One patient presented with stenosis of the native renal artery. No patients presented DGF, graft thrombosis, or surgical complications. No association was found between cold ischemia and eGFR at 1 year (p = .12). In univariate analysis, eGFR at 1 year is related to AR. eGFR at 3 years is related to the number of UTI. Median follow-up was 1363 days. Patient and graft survival were 100%. CONCLUSIONS: KT in children ≤15 kg can be challenging and requires a meticulous perioperative management and surgical expertise. Patient and graft survival are excellent with low rate of complications.

Colestasis intrahepática del embarazo Un reto más para la obstetricia / Intrahepatic Cholestasis of Pregnancy. One More Challenge for Obstetrics

Resumen: La colestasis intrahepática del embarazo es el trastorno hepático específico más común durante la gestación; es una condición multifactorial que aparece en mujeres genéticamente susceptibles. Se caracteriza principalmente por prurito palmo-plantar de predominio nocturno, su importancia radica en su considerable morbimortalidad fetal y aunque su tratamiento es sencillo, se debe diagnosticar. Objetivo: Realizar una revisión actualizada y a detalle de la bibliografía nacional e internacional de la etiología, las pruebas diagnósticas, tratamiento, resultados perinatales y su asociación con otras patologías del embarazo. Metodología: Se realizó una búsqueda de la literatura publicada en inglés y en español en bases de datos como PubMed / MEDLINE, Ovid, MD Consult, entre otras, utilizando las palabras clave: colestasis intrahepática del embarazo, etiología, diagnóstico, tratamiento, efectos adversos perinatales, preeclampsia, embarazo múltiple. De la información obtenida se seleccionaron 64 artículos, los cuales fueron clasificados y utilizados como soporte para realizar esta revisión. Resultados: Se aporta una actualización en cuanto al diagnóstico y tratamiento de esta enfermedad para actuar como guía clínica a los profesionales de la salud. Conclusión: Esta enfermedad es una entidad importante de diagnosticar para evitar los efectos adversos fetales que implica, la principal limitación es la carencia de determinación de niveles de ácidos biliares séricos en nuestro país, por lo tanto, la sospecha clínica se convierte en la herramienta más factible para su diagnóstico e inicio oportuno de tratamiento.

Abstract: Intrahepatic cholestasis of pregnancy is the most common specific liver disorder during pregnancy, it is a multifactorial condition that appears in genetically susceptible women and it is mainly characterized by palmoplantar itching predominantly at night. Its importance lies in the considerable fetal morbidity and mortality. Although the treatment is simple, we must know how to make the diagnosis. Objective: To carry out an updated and detailed review of the national and international bibliography of etiology, diagnostic tests, treatment, perinatal results, and their association with other pregnancy pathologies. Methodology: A search of the literature published in English and Spanish was conducted in databases such as PubMed / MEDLINE, Ovid, MD Consult, and others, using the keywords: intrahepatic cholestasis of pregnancy, etiology, diagnosis, treatment, perinatal adverse effects, preeclampsia, tween pregnancy. 64 articles were selected from the obtained, which were classified and used as support to carry out this review. Results: An update regarding the diagnosis and treatment of this disease is provided, to act as a clinical guide for healthcare professionals. Conclusion: This disease is an important entity to diagnose in order to avoid the fetal adverse effects that implies. The main limitation is the lack of determination of serum bile acid levels in our country, therefore, clinical suspicion becomes the most useful tool for diagnosis and early treatment.

Panoramic Dental Radiography Image Enhancement Using Multiscale Mathematical Morphology.

Panoramic dental radiography is one of the most used images of the different dental specialties. This radiography provides information about the anatomical structures of the teeth. The correct evaluation of these radiographs is associated with a good quality of the image obtained. In this study, 598 patients were consecutively selected to undergo dental panoramic radiography at the Department of Radiology of the Faculty of Dentistry, Universidad Nacional de Asunción. Contrast enhancement techniques are used to enhance the visual quality of panoramic dental radiographs. Specifically, this article presents a new algorithm for contrast, detail and edge enhancement of panoramic dental radiographs. The proposed algorithm is called Multi-Scale Top-Hat transform powered by Geodesic Reconstruction for panoramic dental radiography enhancement (MSTHGR). This algorithm is based on multi-scale mathematical morphology techniques. The proposal extracts multiple features of brightness and darkness, through the reconstruction of the marker (obtained by the Top-Hat transformation by reconstruction) starting from the mask (obtained by the classic Top-Hat transformation). The maximum characteristics of brightness and darkness are added to the dental panoramic radiography. In this way, the contrast, details and edges of the panoramic radiographs of teeth are improved. For the tests, MSTHGR was compared with the following algorithms: Geodesic Reconstruction Multiscale Morphology Contrast Enhancement (GRMMCE), Histogram Equalization (HE), Brightness Preserving Bi-Histogram Equalization (BBHE), Dual Sub-Image Histogram Equalization (DSIHE), Minimum Mean Brightness Error Bi-Histogram Equalization (MMBEBHE), Quadri-Histogram Equalization with Limited Contrast (QHELC), Contrast-Limited Adaptive Histogram Equalization (CLAHE) and Gamma Correction (GC). Experimentally, the numerical results show that the MSTHGR obtained the best results with respect to the Contrast Improvement Ratio (CIR), Entropy (E) and Spatial Frequency (SF) metrics. This indicates that the algorithm performs better local enhancements on panoramic radiographs, improving their details and edges.

Primeiros socorros: investigação do treinamento de professores de uma escola da rede pública de Campo Grande / First aid: investigating the training of teachers at a public school in Campo Grande / Primeros auxilios: estudiar la capacitacion de los profesores en una escuela pública en Campo Grande

Introdução: Qualquer pessoa pode passar por situações de urgência e emergência, em qualquer lugar. Dessa forma, a primeira pessoa a se deparar com a cena deve ser o primeiro a prestar socorros. Objetivo: identificar o conhecimento em primeiros socorros de professores de uma escola municipal. Método: Estudo de caráter exploratório, quantitativo realizado com professores de uma escola municipal de Campo Grande. A amostra foi composta por 43% (n=30) dos professores. Foi realizado a aplicação de um questionário após treinamento de primeiros socorros. Resultados e discussão: Quando questionados sobre os números de emergência, 43,4% (n=13) conheciam. Em relação a abertura de vias aéreas, 46,6% (n=14) responderam corretamente. Posicionamento da vítima para compressão cardíaca foi assinalado assertivamente por 53,4% (n=16). Conclusão: Mesmo após receberem treinamentos, grande parte dos professores ainda não se demonstraram preparados a prestar assistência de urgência ou emergência. O profissional capacitado para responder esta demanda seria o enfermeiro (AU).

Introduction: Anyone can go through urgent and emergency situations, anywhere. Thus, the first person to come across the scene must be the first to provide assistance. Objective: to identify first aid knowledge of teachers at a municipal school. Method: An exploratory, quantitative study carried out with teachers from a municipal school in Campo Grande - MS. The sample was composed of 43% (n = 30) of teachers. A questionnaire was administered after first aid training. Results and discussion: When asked about the emergency numbers, 43.4% (n = 13) knew about it. Regarding the opening of the airways, 46.6% (n = 14) responded correctly. Positioning the victim for cardiac compression was assertively reported by 53.4% (n = 16). Conclusion: Even after receiving training, most teachers have not yet shown themselves prepared to provide urgent or emergency assistance. The professional trained to answer this demand would be the nurse (AU).

Introducción: Cualquiera puede pasar por situaciones urgentes y de emergencia, en cualquier lugar. Por lo tanto, la primera persona que se encuentre con la escena debe ser la primera en brindar asistencia. Objetivo: Identificar el conocimiento de primeros auxilios que tienen los maestros de una escuela municipal. Método: Estudio exploratorio cuantitativo realizado con docentes de una escuela municipal de Campo Grande, MS. La muestra estuvo compuesta por el 43% (n=30) de los docentes. Se administró un cuestionario después del entrenamiento de primeros auxilios. Resultados y discusión: Cuando se les preguntó los números de emergencia, el 43,4% (n = 13) los sabía. En cuanto a la apertura de las vías aéreas, el 46,6% (n=14) respondió correctamente. La posición de la víctima para la compresión cardíaca fue marcada asertivamente por el 53,4% (n=16). Conclusión: Incluso después de recibir la capacitación, la mayoría de los docentes aún no está preparado para brindar asistencia de urgencia o de emergencia. El profesional capacitado para responder a esta demanda sería el enfermero (AU).

Impact of needle positioning on ablation success of irreversible electroporation: a unicentric retrospective analysis.

Irreversible electroporation (IRE) is an ablation procedure in which cell death is induced by ultrashort electrical pulses. In this unicentric retrospective study we investigated the influence of needle positioning on ablation success. 15 IREs with residual tumor after ablation, detected in the first follow-up MRI, were included, and compared with 30 successful ablations. Evaluation of needle geometry revealed significantly higher values for needle divergence (NDiv, 7.0° vs. 3.7°, p = 0.02), tumor-center-to-ablation-center distance (TACD, 11.6 vs. 3.2 mm, p < 0.001), tumor-to-needle distance (4.7 vs. 1.9 mm, p = 0.04), and tumor diameter per needle (7.5 vs. 5.9 mm/needle, p = 0.01) in patients with residual tumor. The average number of needles used was higher in the group without residual tumor after ablation (3.1 vs. 2.4, p = 0.04). In many cases with residual tumor, needle depth was too short (2.1 vs. 6.8 mm tumor overlap beyond the most proximal needle tip, p < 0.01). The use of a stereotactic navigation system in 10 cases resulted in a lower NDiv value (2.1° vs. 5.6°, p < 0.01). Thus, correct needle placement seems to be a crucial factor for success and the assistance of a stereotactic navigation system might be helpful. As most important geometrical parameter TACD could be identified. Main reasons for high TACD were insufficient needle depth and a lesion location out of the needle plane.

[Hemophagocytic syndrome associated with Hodgkin lymphoma and Epstein-Barr virus infection. A case report]. / Síndrome hemofagocítico asociado a linfoma de Hodgkin e infección por virus Epstein-Barr. Reporte de caso.

BACKGROUND: Hodgkin lymphoma is a malignant neoplasm of B lymphoid cells whose histologic characteristic is the presence of Reed-Sternberg cells in an inflammatory environment. CASE REPORT: A 37-year-old woman with a history of up to 40°C fever for four months, progressive and bilateral decrease in hearing acuity, weight loss of up to 6 kg, cervical lymphadenopathy, hepatosplenomegaly, and pancytopenia. Auditory sensory neuropathy was confirmed. The patient developed hemophagocytic syndrome, therefore, infectious and autoimmune etiologies were ruled out. The CT scan revealed hepatosplenomegaly with thoracic and abdominal cervical nodes, with loss of fatty hilum. The laboratory tests showed evidence that suggested the reactivation of the Epstein-Barr virus. Through a submandibular node biopsy, the diagnostic conclusion was that lymphocyte-rich classical Hodgkin's lymphoma was present. CONCLUSION: This is the first report in Latin American literature about a patient with hemophagocytic syndrome that is secondary to classic Hodgkin lymphoma and associated with Epstein-Barr infection.

Antecedentes: El linfoma de Hodgkin es una neoplasia maligna de células linfoides tipo B cuya característica histológica es la presencia de células de Reed-Sternberg en un medio inflamatorio. Caso clínico: Mujer de 37 años, con fiebre de hasta 40 °C desde cuatro meses atrás, disminución bilateral y progresiva de la agudeza auditiva, pérdida ponderal de 6 kg, linfadenopatía cervical, hepatoesplenomegalia y pancitopenia. Se corroboró neuropatía sensorial auditiva. La paciente desarrolló síndrome hemofagocítico, por lo que se descartaron procesos infecciosos o autoinmunes. La tomografía reveló hepatoesplenomegalia, ganglios cervicales torácicos y abdominales con pérdida del hilio graso; en los estudios de laboratorio se evidenciaron datos sugerentes de reactivación del virus de Epstein-Barr. Mediante biopsia de ganglio submandibular se concluyó que se trataba de linfoma de Hodgkin tipo clásico rico en linfocitos. Conclusión: La paciente descrita con síndrome hemofagocítico secundario a linfoma de Hodgkin clásico asociado a infección por Epstein-Barr constituye el primero caso reportado en la literatura latinoamericana.

Dextrose Prolotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial.

Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).

Good practices to reduce unfinished nursing care: An integrative review.

AIM: To identify evidence of good practice interventions aimed at reducing unfinished nursing care in the hospital context. BACKGROUND: Unfinished nursing care is a common problem related to nursing practice, essentially due to time scarcity. There is not much research on how to deal with it and on how to develop good practices that can mitigate the unfinished nursing care. EVALUATION: This study is an integrative review of the literature. After searching databases, we selected seven articles that met the inclusion criteria. KEY ISSUES: To mitigate unfinished nursing care, the following good practices were identified: adequacy of human resources, nurse-to-patient ratio and workload distribution; improvement of the working environment with increased teamwork; and effective communication among all health professionals. CONCLUSION: An adequate number of nurses can ensure the timely provision of care and mitigate unfinished nursing care. Efficient communication between the multi-professional team, as well as recognition of professional merit, personal and organisational accountability, also contributes to mitigate unfinished nursing care. IMPLICATIONS FOR NURSING MANAGEMENT: Health organisations should staff their units adequately and ensure a well-balanced workload distribution, and promote healthy work environments that foster personal accountability, adequate communication between all professionals and recognition of professional merit.

Small Cationic Peptides: Influence of Charge on Their Antimicrobial Activity.

The first stage of the action mechanism of small cationic peptides with antimicrobial activity is ruled by electrostatic interactions between the peptide and the pathogen cell membrane. Thus, an increase in its activity could be expected with an increase in the positive charge on the peptide. By contrast, the opposite behavior has been observed when the charge increases to reach a critical value, beyond which the activity falls. This work studies the perturbation effects in a cell membrane model for two small cationic peptides with similar length and morphology but with different cationic charges. The synthesis and antibacterial activity of the two peptides used in this study are described. The thermodynamic study associated with the insertion of these peptides into the membrane and the perturbing effects on the bilayer structure provide valuable insights into the molecular action mechanism associated with the charge of these small cationic peptides.

Cirugía fetal de Mielomeningocele: evolución obstétrica y resultados perinatales a corto plazo de una cohorte de 21 casos / Fetal surgery for myelomeningocele: obstetric evolution and short-term perinatal results of a cohort of 21 cases

Objetivo: Describir la técnica quirúrgica, evolución obstétrica y resultados perinatales de una cohorte de pacientes sometidas a cirugía intrauterina para reparación de una disrafia fetal abierta (DFA). Métodos: Análisis prospectivo de 21 casos consecutivos de DFA con diagnóstico y tratamiento quirúrgico prenatal en nuestra institución entre 2015 y 2017. La técnica de la cirugía fetal (QF) fue similar a la descripta en el estudio MOMS, excepto que se utilizó histerotomía con asa bipolar. Los cuidados postoperatorios, nacimiento y cuidados neonatales se realizaron en la misma institución. Se analizaron complicaciones perioperatorias de la QF, la evolución obstétrica y los resultados perinatales. Resultados: La QF se realizó a una edad gestacional media de 25.8 semanas (24.1-27.6). La edad gestacional media al nacer fue 34.2 semanas (29.2-37.1). El tiempo quirúrgico medio fue 138 min (101-187) con tendencia descendente y el tiempo de internación medio, 7.1 días (4-32). El 52% (11/21) de las pacientes experimentó rotura prematura de membranas (RPM). Ninguna paciente requirió transfusiones postcesárea. No hubo casos de desprendimiento placentario, rotura uterina ni muertes maternas. La cicatrización de la histerorafia fue normal en 95% de las pacientes. La sobrevida perinatal fue del 95% (20/21, una muerte intrauterina secundaria a banda amniótica). La necesidad de cierre cutáneo postnatal (CCP) fue del 5%. Ninguno de los casos (20) reparados con tejidos fetales requirió CCP. El 70% (14/20) de los pacientes no requirió ningún tratamiento para hidrocefalia. Cuatro pacientes (20%) requirieron una derivación ventriculoperitoneal (DVP) y dos más fueron sometidos adicionalmente, a una tercer ventriculostomía endoscópica (ETV) (10%). El nivel funcional motor neonatal (NFN) fue mejor que el nivel anatómico prenatal (NAP) en 45% (9/20), igual en 50% (10/20) y peor en 5% (1/20). Conclusiones: El presente estudio confirma que la cirugía fetal de disrafias abiertas se asocia a un mayor riesgo de parto prematuro y rotura prematura de membranas, pero reduce significativamente la necesidad de tratamiento postnatal de hidrocefalia y mejora la función motora a corto plazo. Nuestros resultados son similares a los publicados en el ensayo aleatorizado MOMS.

Objective: To describe the surgical technique, obstetrical evolution and perinatal outcomes of a cohort of fetuses undergoing intrauterine surgery to repair open spina bifida (OSB). Methods: We performed a prospective analysis of 21 consecutive fetuses with OSB at our institution between 2015 and 2017. The surgical technique was similar to that described in the MOMS trial, except that the hysterotomy was performed using a bipolar dissector. Post-operative maternal and infant care both were provided at the same institution. There were no losses to follow-up. Surgical and obstetrical complications and perinatal outcomes were analyzed. Results: Fetal surgery was performed at a mean gestation of 25.8 weeks (24.1-27.6). The mean gestational age at birth was 34.2 weeks (29.2-37.1). The mean surgical time was 138 min (101-187), the duration of surgery trending downward over time; while the average admission length was 7.1 days (4-32). Fifty two percent (11/21) of the patients experienced pre-term premature rupture of membranes (pPROM). No patient required any post-cesarean transfusions. There were no instances of placental abruption, uterine rupture, or maternal death. Uterine scar healing was normal in 95% of the patients. All but one of the 21 fetuses (95%) survived, the one fetal death due to an amniotic band. The need for postnatal skin closure (PSC) was 5%, with one of 20 repaired prenatally with a synthetic skin patch. No case (19) repaired with fetal tissues required PSC. Seventy percent (14/20) of the infants required no further treatment for hydrocephalus over their first year of life; four patients (20%) required a ventriculoperitoneal shunt (VPS), while two others underwent an endoscopic third ventriculostomy (ETV) (10%). Neonatal motor function (NMF) was better than the prenatal anatomical level (PAL) in 45% (9/20), equal in 50% (10/20), and worse in 5% (1/20). Conclusions: Our data confirm that fetal surgery for OSB is associated with an increased risk of preterm delivery and PROM, but significantly reduces the need for postnatal treatment of hydrocephalus and improves short-term motor outcomes. Our results are similar to those published for the randomized MOMS trial.