Why do patients with urinary diversions have an increased risk of bone fracture? A systematic review on risk factors for osteoporosis and bone mineral density loss in this group of patients.

INTRODUCTION: Patients undergoing radical cystectomy with urinary diversions (UD) are at increased risk of bone fractures compared to the general population. Although a loss of bone mineral density (BMD) has been described in patients with UD, we still do not know with certainty why these patients follow this tendency. OBJECTIVE: We performed a systematic review of the available literature to analyze the prevalence of osteoporosis and bone alterations in patients with ileal UD and the possible associated risk factors. EVIDENCE ACQUISITION: We systematically searched PubMed® and Cochrane Library for original articles published before December 2022 according to PRISMA guidelines. EVIDENCE SYNTHESIS: A total of 394 publications were identified. We selected 12 studies that met the inclusion criteria with 496 patients included. Six of the twelve studies showed decreased BMD values. Prevalence of osteoporosis was specified in three articles, with values ranging ​​from 0% to 36%. Risk factors such as age, sex, body mass index, metabolic acidosis and renal function appear to have an impact on bone tissue reduction, while type of UD, follow-up, 25-hydroxyvitamin D and parathormone had less evidence or contradictory data. The heterogeneity of the studies analyzed could led to interpretation bias. CONCLUSIONS: UD are associated with multiple risk factors for osteoporosis and bone fractures. Identifying patients at highest risk and establishing diagnostic protocols in routine clinical practice are essential to reduce the risk of fractures and the resulting complications.

Prognostic factors and outcome in cats with thymic epithelial tumours: 64 cases (1999-2021).

OBJECTIVES: To describe the clinical presentation, treatment and outcomes of cats diagnosed with thymic epithelial tumours and to determine prognostic factors for survival and recurrence. MATERIALS AND METHODS: Clinical records of cats diagnosed with a thymic epithelial tumour between 1999 and 2021 at three referral institutions were retrospectively reviewed. RESULTS: Sixty-four cats were included. Paraneoplastic syndromes were present in nine cats and metastatic disease was seen in two cats, one at diagnosis and one at the time of recurrence. Median tumour diameter was 6 cm (range, 2 to 15) and a cystic appearance was described on imaging in 25 cats. Surgical excision was attempted in 54 cats with a perioperative mortality rate of 11%. Median survival time for cats surviving to hospital discharge was 897 days (range, 21 to 3322). The 1-, 2- and 5-year survival rates for surgically treated thymic epithelial tumour were 86%, 70% and 66%, respectively. Survival was longer for cats with Masaoka-Koga stage I and II tumours compared to stages III and IV (1366 days versus 454 days; P=0.002). Masaoka-Koga stage was the only significant prognostic factor detected on multi-variable analysis, with stage III and IV tumours associated with increased risk of death (hazard ratio: 5.67, 95% confidence interval: 1.29 to 24.91, P=.021). Tumour recurrence occurred in 11 cats at a median of 564 days (range, 93 to 1095); no significant prognostic factors for recurrence were identified. CLINICAL SIGNIFICANCE: Cats with thymic epithelial tumours had a good long-term prognosis following surgery. Tumour recurrence can occur late in the disease course and ongoing monitoring should therefore be considered. Masaoka-Koga stage may influence survival time and could be used to predict outcome.

Clinical characterisation and long-term survival of paediatric and juvenile lymphoma in cats: 33 cases (2008-2022).

OBJECTIVES: The aims of this study were to describe the clinical presentation, tumour characteristics, responses to chemotherapy protocols and toxicity in a cohort of cats with lymphoma up to 18 months of age. In addition, the probability of long-term (>2 years) survival was explored. MATERIALS AND METHODS: The medical records of client-owned cats aged up to 18 months diagnosed with lymphoma between 2008 and 2022 at five UK-based veterinary referral hospitals were reviewed. RESULTS: Thirty-three cats were included. The most common anatomical forms were mediastinal (42%), disseminated disease (30%) and renal (15%), with all cats having intermediate to large cell lymphoma. Three out of 29 cats tested were positive for FeLV but none for FIV. Twenty-six cats were treated with multi-agent chemotherapy protocols with complete and partial responses seen in 46% and 50% of cats, respectively. For this group, median progression-free survival was 133 days (95% confidence interval [Cl] 67 to 199) and median survival time was 268 days (95% Cl 106 to 430). Complete response to chemotherapy was associated with a longer progression-free survival. Seven cats were considered long-term survivors (>2 years). Chemotherapy was generally well tolerated with none of the long-term survivors suffering from chronic sequelae from cytotoxic treatment. CLINICAL SIGNIFICANCE: Paediatric and juvenile cats with lymphoma showed a high response rate to multi-agent chemotherapy protocols with rare significant toxicities. The presence of long-term survivors may suggest a more favourable outcome in a subset of patients.

Bacteria associated with apical periodontitis promotes in vitro the differentiation of macrophages to osteoclasts.

OBJECTIVE: To analyze the possible in vitro effect of the cytokine RANKL and bacteria involved in apical periodontitis on the differentiation of macrophages into osteoclasts. MATERIAL AND METHODS: Bacteria were isolated (mainly E. faecium and E. faecalis) from the root canal of fifty patients with apical periodontitis, the possible effect of these bacteria on the phagocytic activity of the monocyte cell line THP-1 was analyzed by flow cytometry. Furthermore, the effect of these bacteria (alone or in combination with the cytokine RANKL) on the differentiation of THP-1 macrophages into osteoclasts was analyzed through the expression of the receptor RANK and the tartrate-resistant acid phosphatase TRAP. Finally, the release of different cytokines (IL-1ß, TNF-α, IL-6, IL-8, IL-10, and IL-12p70) by THP-1 cells induced to differentiate into osteoclasts was also analyzed. RESULTS: We observed a significant proportion of THP-1 cells were able to internalize E. faecium and E. faecalis. Furthermore, these bacteria were able to induce (alone or in combination with RANKL) a significant expression of RANK by THP-1 macrophages; accordingly, E. faecium and E. faecalis induced very significant levels of TRAP in these cells. Finally, during the differentiation of THP-1 macrophages induced by RANKL or bacteria, a significant release of the pro-inflammatory cytokines IL-6 and TNF-α was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Our data suggest that the causative agents of apical periodontitis can induce the differentiation of osteoclasts as well as the release of pro-inflammatory cytokines, phenomena that may have an important role in the bone damage observed in this condition.

Molecular pathology in the cancer clinic - where are we now and where are we headed?

Molecular pathology is a developing sub-microscopic discipline of pathology that studies the effects of molecular variations and mutations on disease processes. The ultimate goal of molecular pathology in cancer is to predict risk, facilitate diagnosis and improve prognostication based on a complete understanding of the biological impact of specific molecular variations, mutations and dysregulations. This knowledge will provide the basis for customised cancer treatment, so-called precision medicine. Rapid developments in genomics have placed this field at the forefront of clinical molecular pathology and there are already a number of well-established genetic tests available for clinical use including PCR of antigen receptor rearrangement and KIT mutational analysis. Moving beyond tests assessing a single gene, there are significant research efforts utilising genomics to predict cancer risk, forecast aggressive behaviour and identify druggable mutations and therapeutic biomarkers. Researchers are also investigating the use of circulating cells and nucleic acid for clinically useful low morbidity genomic assessments. If we are to realise the full potential of molecular pathology and precision medicine there are a number of challenges to overcome. These include developing our understanding of the underlying biology (in particular intra-tumoural heterogeneity), methodological standardisation of assays, provision of adequate infrastructure and production of novel therapeutics backed by high-quality clinical data supporting the precision medicine approach. The era of molecular pathology holds the potential to revolutionise veterinary cancer care, but its impact on clinical practice will depend upon the extent to which the inherent challenges can be overcome.

Management of the oral hemangiomas in infants and children: Scoping review.

BACKGROUND: Pediatric oral hemangiomas are benign vascular tumors that can be seen from birth, particularly in females. Hemangiomas are most frequent located in the lips and usually regress spontaneously, thus they do not require any type of treatment in most cases. The present scoping review pretended to synthesize the most relevant and currently available information from the international dental literature published in the last 25 years, regarding the management of pediatric oral hemangiomas. MATERIAL AND METHODS: An exhaustive literature search was performed in four electronic databases (PubMed, Embase, Google Scholar, and Cochrane). Initially, 241 related titles and abstracts were found. After the duplication removal, screening, and assessment processes, 37 records were included for full-text reading. Finally, 20 articles in the English language were included in the scoping review for data extraction and assessment. RESULTS: We identified and subsequently discussed three fundamental issues associated to the management of pediatric oral hemangiomas: (i) clinical characteristics, differential diagnosis, and histopathological findings; (ii) evolution and complications; and (iii) current available treatment modalities. CONCLUSIONS: Although these like-tumor lesions are uncommon, pediatric dentistry practitioners must be familiar with the inherent clinical characteristics, diagnosis approaches, and currently available treatment options. Nowadays, surgical removal and non-invasive medical/pharmacologic therapies are the best management modalities for pediatric oral hemangiomas.

Toxicity of cytarabine constant rate infusion in dogs with high-grade non-Hodgkin lymphoma with bone marrow or central nervous system involvement.

OBJECTIVE: Cytarabine, a cell-cycle phase-specific antimetabolite, has been reported to improve outcomes in dogs with bone marrow (BM) or central nervous system (CNS) lymphoma involvement receiving combination chemotherapy. The objective of this study was to evaluate the incidence and severity of toxicity of cytarabine constant rate infusion (CRI) in dogs with high-grade non-Hodgkin lymphoma. METHODS: Medical records of canine lymphoma patients with confirmed or suspected BM (group 1) or CNS (group 2) involvement, treated with a modified cyclophosphamide, epirubicin, vincristine and prednisolone protocol, including a single dose of cytarabine given as CRI, were reviewed and adverse events graded. RESULTS: Twenty-six dogs were included. Gastrointestinal toxicity occurred in 17 dogs (65.3%), with 5 (19.2%) experiencing grade III or IV toxicity. Neutropenia occurred in nine dogs (34.6%), but was grade I or II in most cases. Three dogs (11.5%) had thrombocytopenia: one grade III and two grade IV. Four dogs (15.3%) experienced increases in alanine amino transferase: one each grade I and II and two grade III. Five dogs (19.2%) required hospitalisation to manage toxicity after completing cytarabine CRI, and haematological toxicity resulted in treatment delays in five dogs (median delay of 4 days, range: 3-7 days). CONCLUSION: Our findings suggest that gastrointestinal toxicity should be expected in lymphoma patients undergoing cytarabine CRI.

Treatment of ankyloglossia with dental laser in paediatric patients: Scoping review and a case report.

AIM: The two aims of this article were to conduct a scoping review of current knowledge regarding laser treatment of ankyloglossia in children and to report a case of a male paediatric patient with ankyloglossia treated with laser surgery. METHODS: A comprehensive literature search was carried out on the following electronic databases: PubMed; Embase; Google Scholar; The Cochrane Library, and Dentistry and Oral Science Source (EBSCO). RESULTS: The initial search identified 278 references. After the process of title/abstract screening, 61 articles received a full-text reading; finally, 17 articles were selected. According to this scoping literature review, lingual frenulectomy managed with laser surgery provides a more efficient and comfortable treatment for both the paediatric patient and the dentist compared with conventional scalpel/blades/suturing techniques. Nevertheless, further high-quality studies on the clinical efficacy of laser devices for lingual frenulectomy in paediatric populations are required. CONCLUSION: Early diagnosis and treatment of ankyloglossia are fundamental for the adequate functional oral development of paediatric patients. Laser surgery for lingual frenulectomy provides a more efficient and comfortable treatment for both the child and the paediatric dentist compared to traditional scalpel/blade methods.

Causas de muerte en pacientes infectados con VIH en el año 2017. Hospital Vargas de Caracas

Objetivo: Describir las causas de muerte en pacientes con virus de inmunodeficiencia humana (VIH), ingresados en el Hospital Vargas de Caracas (HVC) durante el período enero a diciembre de 2017. Materiales y Métodos: Se realizó un estudio retrospectivo, que incluyó a todos los pacientes fallecidos infectados por VIH en el HVC. Se calcularon frecuencias relativas y absolutas, medidas de tendencia central utilizando el programa SPSS Statistics. Resultados: Durante el período estudiado, fallecieron 32 pacientes con VIH, de estos últimos solo se obtuvo acceso a través del departamento de archivos médicos a 23 historias ya que las 9 restantes no pudieron ser localizadas para su revisión. El 73,9 % de la muestra estuvo representado por el sexo masculino con una edad media de 36,78 años, el 73,9 % no tenían antecedente de comorbilidades asociadas; el 73,9 % tenía menos de un año de diagnóstico y 60,9 % no recibían terapia antiretroviral. El 95,7 % de las muertes estuvieron asociadas a síndrome de inmunodeficiencia humana (SIDA). Las causas de muerte más frecuentes fueron tuberculosis pulmonar y extrapulmonar (40,9 % de la muestra) seguida de encefalitis por Toxoplasma gondii e histoplasmosis diseminada. Conclusiones: Los pacientes fallecidos tenían una edad media de 36 años, con estadio de SIDA avanzado y tuberculosis como causa principal de muerte.

Objective: To describe the causes of death in patients with human immunodeficiency virus (HIV), admitted to the Vargas Hospital of Caracas (VHC) during the period January to December 2017. Materials and Methods: A retrospective study was carried out, which included all deceased patients infected with HIV in the VHC. Relative and absolute frequencies, measures of central tendency were calculated and the statistical program SPSS Statistics was applied. Results: During the period studied, 32 patients with HIV died, we only had access to 23 medical records since the remaining 9 could not be located for review. 73.9 % of the sample was represented by the male sex with an average age of 36.78 years, 73.9 % had no history of associated comorbidities; 73.9 % had less than one year of diagnosis and 60.9 % did not receive antiretroviral therapy. 95.7 % of the deaths were associated with Human Immunodeficiency Syndrome (AIDS). Pulmonary and extrapulmonary tuberculosis was the most representative sample with 40.9 % followed by toxoplasmic encephalitis and disseminated histoplasmosis.Conclusions: The deceased patients had an average age of 36 years, with stage of advanced AIDS and tuberculosis as their main cause of death.

Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case.

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Oral mucositis in paediatric acute lymphoblastic leukemia patients receiving methotrexate-based chemotherapy: case series.

AIM: Oral mucositis (OM) is a painful and inflammatory ulcerative lesion occurring as an adverse effect during chemotherapy in children with acute lymphoblastic leukemia (ALL). This condition may cause significant systemic anomalies such as malnutrition, opportunistic infections, and delay in the chemotherapy course. This report aims to describe a case series of 11 ALL patients treated with methotrexate as chemotherapy agent. CASE SERIES: Each patient was carefully followed-up and orally examined for 14 days after their chemotherapy session. OM occurred in all children. Then, the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) management protocol for OM was applied to them. The mean time of the lesion total resolution was 3.7 days. CONCLUSIONS: It is necessary to emphasise the importance of early detection of OM through a close clinical oral examination of children and adolescents with ALL undergoing methotrexate chemotherapy. Pain/infection control and the maintenance of good levels of oral hygiene are fundamental during the management of OM. Therefore, paediatric dentists need to be part of the oncology care team, and thus contributing and helping with ALL treatment.

Diferenciação morfométrica entre larvas de Amblyomma sculptum Berlese, 1888 e Amblyomma dubitatum Neumann, 1899 / Morphometric differentiation between larvae of Amblyomma sculptum Berlese, 1888 and Amblyomma dubitatum Neumann, 1899

Os carrapatos estão envolvidos em processos biológicos de uma grande variedade de organismos patogênicos. O gênero Amblyomma é o de maior importância médica, com a espécie Amblyomma sculptum Berlese, 1888 envolvida no ciclo de transmissão da febre maculosa brasileira (FMB). Neste estudo, objetivou-se a validação molecular para uma diferenciação na característica morfométrica e no tamanho de idiossoma de larvas de duas espécies de carrapatos, Amblyomma dubitatum Neumann, 1899 e A. sculptum. Larvas não alimentadas foram coletadas em duas áreas de transmissão para FMB, por meio da técnica de armadilha atrativa de CO2. Foram identificadas em nível de espécie por morfometria comparativa, análise molecular por PCR e sequenciamento genômico, com validação pela análise de concordância pelo teste Kappa. As larvas de A. dubitatum apresentaram um comprimento significativamente maior que as larvas de A. sculptum. Embora nenhuma outra espécie do gênero Amblyomma tenha sido testada neste estudo, essa técnica poderá ser utilizada nos locais onde levantamentos acarológicos prévios, baseados nos estádios de ninfa e adultos, indicaram a presença de apenas A. sculptum e A. dubitatum, geralmente mantidos por capivaras. Digno de nota, essa condição é muito comum ao longo das áreas endêmicas para FMB na região Sudeste do Brasil.(AU)

Ticks are involved in biological processes of a wide variety of pathogenic organisms. The genus Amblyomma presents the greatest medical importance, with the species Amblyomma sculptum Berlese, 1888 involved in the transmission cycle of Brazilian Spotted Fever (BSF). In this study, we performed a molecular validation of the morphometric differentiation based on the idiosomal length of the larvae of A. dubitatum and A. sculptum. Unfed larvae were collected in two BSF-transmission areas, using the attractive CO2 trap technique. Larvae were identified at the species level by comparative morphometry, molecular analysis by PCR and genomic sequencing, with validation through agreement analysis by the Kappa test. The larvae of A. dubitatum showed a significantly longer idiosomal length than A. sculptum larvae. Although no other species of the genus Amblyomma has been tested in this study, this technique can be applied to places where previous acarological surveillances based on adult and nymphal ticks stages have indicated the presence of only A. sculptum and A. dubitatum, usually sustained by capybaras. Noteworthy, this condition is very common among many BSF-endemic areas in southeastern Brazil.(AU)

Dental approach for Apert syndrome in children: a systematic review.

BACKGROUND: Apert Syndrome (AS), or type I acrocephalosyndactyly, is a rare, congenital craniosynostosis condition resulting from missense mutations in the gene encoding fibroblast growth factor receptor 2. It is characterized by three specific clinical features: brachycephalic skull; midface hypoplasia, and limb abnormalities (syndactyly of hands and feet). The disorder exhibits variable presentations in bones, brain, skin, internal organs, and in the oral/maxillofacial region. The aim of the present paper was to show the main results from a systematic review of AS. MATERIAL AND METHODS: A search of the literature was performed from April to June 2016 in five electronic databases. Clinical interventional or observational studies, reviews, and case reports were included. The present systematic review was carried out strictly following PRISMA and Cochrane Collaboration criteria. RESULTS: A total of 129 potential references were identified. After reviewing titles and abstracts, 77 of these did not meet the desired criteria and were discarded. The full text of the remaining 52 manuscripts was critically screened. Finally, 35 relevant papers were identified for inclusion in the present systematic review and classified according to topic type. CONCLUSIONS: According to the information gathered, dentistry practitioners must be able to supply an early diagnosis through the recognition of AS clinical features and provide correct oral management. Additionally, they should be integrated in a multidisciplinary medical care team in order to improve the quality of life of the affected patients.

Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial.

BACKGROUND: Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. MATERIAL AND METHODS: A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. RESULTS: Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. CONCLUSIONS: According to the VAS and UAC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery.

Results of induction chemotherapy in children older than 18 months with stage-4 neuroblastoma treated with an adaptive-to-response modified N7 protocol (mN7).

PURPOSE: We report the response rate in children older than 18 months with stage 4 Neuroblastoma, using a modified dose-intensive, response-adaptive, induction mN7 protocol. METHODS: From 2005 to 2012, 24 patients were treated with the mN7 protocol. Phase 1 included five MSKCC N7 cycles and surgery and two high-dose cyclophosphamide-topotecan (HD-CT) cycles for those who did not achieve complete remission (CR) and negative bone marrow (BM) minimal residual disease (MRD) status (CR+MRD-). Phase 2 consisted of myeloablative doses of topotecan, thiotepa and carboplatin plus hyperfractionated RT. Phase 3 included isotretinoin and 3F8 immunotherapy plus GM-CSF. BM MRD was monitored using GD2 synthase, PHOX2B and cyclin D1 mRNAs. RESULTS: After 3 cycles, all patients showed BM complete histological clearance and 6 (25 %) were MRD-. Twenty of 21 s-look surgeries achieved macroscopic complete resection. After 5 cycles and surgery, (123)I-MIBG scan was negative in 15 (62.5 %) cases, BM disease by histology was negative in 23 (96 %) and 10 (42 %) patients were MRD-. Twelve (50 %) pts were in CR, 2 in very good partial response (VGPR), 9 partial response (PR) and one had progressive disease. With 2 HD-CT extra cycles, 17 (71 %) pts achieved CR+MRD- status moving to phase 2. Overall and event-free survival at 3 years for the 17 patients who achieved CR+MRD- is 65 and 53 %, respectively, median follow-up 47 months. Seven (29 %) patients never achieved CR+MRD-. Univariate Cox regression analysis shows CR+MRD- status after mN7 induction as the only statistically significant prognostic factor to predict overall survival. CONCLUSIONS: mN7 induction regimen produced a CR+MRD- rate of 71 %. CR+MRD- status following induction was the only predictive marker of long-term survival.

Analgesic efficacy of lysine clonixinate plus tramadol versus tramadol in multiple doses following impacted third molar surgery.

This study compared the analgesic and anti-inflammatory efficacy, trismus control, and tolerability of the combination of lysine clonixinate and tramadol (LCT) versus tramadol (T) alone after surgical removal of impacted mandibular third molars. This study was a double-blind, randomized clinical trial, including two study groups of 20 patients each, who exhibited acute pain subsequent to surgical extraction of two mandibular third molars. Pain intensity was quantified over a 96-h period using a visual analogue scale and a 5-point verbal rating scale. Secondary indicators of analgesic and anti-inflammatory efficacy, trismus control, and tolerability were determined. Patients administered LCT exhibited better therapeutic effects that those administered T. Fifty percent of patients in the LCT group rated this therapy as 'excellent analgesia' compared with only 10% in the T group. The onset of the analgesic effect of LCT was significantly faster, without any therapeutic failures. There were no significant differences between the groups with regard to anti-inflammatory effect or trismus. The results of this study suggest that the postsurgical analgesic efficacy of LCT in combination (LC 125 mg + T 25 mg) is superior to that obtained with T alone, administered at the standard dose of 50 mg, for up to 96 h after the extraction of both impacted mandibular third molars.

Actin, RhoA, and Rab11 participation during encystment in Entamoeba invadens.

In the genus Entamoeba, actin reorganization is necessary for cyst differentiation; however, its role is still unknown. The aim of this work was to investigate the role of actin and encystation-related proteins during Entamoeba invadens encystation. Studied proteins were actin, RhoA, a small GTPase involved through its effectors in the rearrangement of the actin cytoskeleton; Rab11, a protein involved in the transport of encystation vesicles; and enolase, as an encystment vesicles marker. Results showed a high level of polymerized actin accompanied by increased levels of RhoA-GTP during cell rounding and loss of vacuoles. Cytochalasin D, an actin polymerization inhibitor, and Y27632, an inhibitor of RhoA activity, reduced encystment in 80%. These inhibitors also blocked cell rounding, disposal of vacuoles, and the proper formation of the cysts wall. At later times, F-actin and Rab11 colocalized with enolase, suggesting that Rab11 could participate in the transport of the cyst wall components through the F-actin cytoskeleton. These results suggest that actin cytoskeleton rearrangement is playing a decisive role in determining cell morphology changes and helping with the transport of cell wall components to the cell surface during encystment of E. invadens.

Mortalidad durante la primera hospitalización en una población que inicia diálisis crónica en un hospital general / Mortality during first hospital admission in a population that begins chronic dialysis in a general hospital

Introducción: El Ministerio de Salud del Perú atiende a población que no cuenta con seguro social y carece de un programa nacional de diálisis, por lo que la atención es limitada a hospitales que cuentan con centros de diálisis. Objetivos: Determinar la mortalidad en la primera hospitalización de pacientes incidentes de diálisis en una población sin seguro social. Diseño: Estudio descriptivo. Lugar: Hospital Nacional 2 de Mayo, Lima, Perú. Participantes: Pacientes con enfermedad renal crónica. Intervenciones: Se estudió a los pacientes que iniciaron diálisis desde enero hasta diciembre del 2012. Para describir se utilizó promedios, porcentajes, desviaciones estándar. Principales medidas de resultados: Características clínicas de los pacientes que iniciaron diálisis. Resultados: Se estudió 105 pacientes con edad promedio de 55,5 años; el 62,9% fue hombre. La etiología más frecuente fue la etiología no filiada (39,1%), seguido de la nefropatía diabética (31,4%). El 71,7% no se atendió previamente en este hospital. El 46,7% conoció su diagnóstico de enfermedad renal crónica durante su hospitalización y 75,2% supo que requería diálisis durante su hospitalización. El 80% no había tenido evaluación nefrológica previa, 89% ingresó por emergencia, con una estancia hospitalaria promedio de 16 días. El catéter venoso central transitorio fue el acceso vascular más usado (96,2%). Las principales indicaciones de diálisis fueron: encefalopatía urémica (59,1%) y acidosis metabólica severa (39,1%). El 23,3% falleció durante su primera hospitalización. Conclusiones: El control prediálisis de los pacientes es deficiente. Cerca de un cuarto de ellos muere durante su primera hospitalización.

Introduction: The Health Ministry attends Peruvian population without social security and without a national dialysis program. Attention is limited to a few hospitals with dialysis centers. objectives: To determine mortality in the first hospitalization for dialysis in a population without social security. design: Descriptive study. Setting: Hospital Nacional Dos de Mayo, Lima, Peru. Patients: Patients with chronic renal disease. Interventions: We studied patients who started dialysis from January to December, 2012. We described averages, percentages, standard deviations. Main outcome measures: Clinical characteristics of patients starting dialysis. results: In 105 patients studied mean age was 55.5 years, 62.9% were men. Most common etiology was not determined (39.1%) followed by diabetic nephropathy (31.4%); 71.7% were not previously attended at our hospital; 46.7% knew their diagnosis of chronic kidney disease, 75.2% learned he required dialysis during hospitalization; 80% had no previous nephrology evaluation, 89% was admitted by emergency, with a mean hospital stay of 16 days. Transient central venous catheter was the most used vascular access (96.2%). Main indications for dialysis were uremic encephalopathy (59.1%) and severe metabolic acidosis (39.1%); 23.3% died during their first hospitalization. Conclusions: Patients’ pre dialysis control was poor. About a quarter of them died during their first hospitalization.

Prevention of accidental exposure in radiotherapy: the risk matrix approach.

Knowledge and lessons from past accidental exposures in radiotherapy are very helpful in finding safety provisions to prevent recurrence. Disseminating lessons is necessary but not sufficient. There may be additional latent risks for other accidental exposures, which have not been reported or have not occurred, but are possible and may occur in the future if not identified, analyzed, and prevented by safety provisions. Proactive methods are available for anticipating and quantifying risk from potential event sequences. In this work, proactive methods, successfully used in industry, have been adapted and used in radiotherapy. Risk matrix is a tool that can be used in individual hospitals to classify event sequences in levels of risk. As with any anticipative method, the risk matrix involves a systematic search for potential risks; that is, any situation that can cause an accidental exposure. The method contributes new insights: The application of the risk matrix approach has identified that another group of less catastrophic but still severe single-patient events may have a higher probability, resulting in higher risk. The use of the risk matrix approach for safety assessment in individual hospitals would provide an opportunity for self-evaluation and managing the safety measures that are most suitable to the hospital's own conditions.

[Mortality following cardiac surgery in the National Health Service Hospitals of the Community of Valencia in 2007: a descriptive analysis]. / Análisis descriptivo de mortalidad en cirugía cardiaca en los hospitales públicos de la Comunidad Valenciana en el año 2007.

OBJECTIVE: To analyze clinical records of cardiac surgery patients in an attempt to identify factors associated with mortality in the postoperative critical care units of the public health service hospitals in the Community of Valencia, Spain, in 2007. METHODS: Retrospective study of cases from January 1, 2007 to December 31, 2007. The charts of all patients who underwent cardiac surgery with or without extracorporeal circulation were reviewed. A data collection protocol was followed to obtain information on age, sex, body mass index (BMI), presurgical risk factors, type of surgery, duration of extracorporeal circulation, duration of ischemia, cause of death, and length of stay in the postoperative critical care unit. RESULTS: The study population consisted of 2113 patients at 5 public hospitals; 124 patients (70 men, 54 women) died. The mean (SD) age was 70 (9.43) years (range, 36-91 years). The mean BMI was 28.19 kg/m2 (maximum, 42 kg/m2). The mean Euroscore was 21.92 (maximum, 94.29). Hypertension was present as a preoperative risk factor in most patients (74.2%); dyslipidemia was present in 51.6%, diabetes mellitus in 38.7%, stroke in 73%, and renal failure in 2.4%. It was noteworthy was that the group who underwent coronary revascularization had the highest mortality rate (nearly 35% of the 124 patients). The next highest mortality rate (19.4%) was in patients who had combined procedures (valve repair or substitution plus coronary revascularization). Mortality was 18.5% in the group undergoing aortic valve surgery and 11.3% in those undergoing mitral valve surgery. The mean duration of extracorporeal circulation was 148.63 minutes. The mean duration of myocardial ischemia was 94.91 minutes. The most frequent cause of death was cardiogenic shock (54.8%). This was followed by distributive shock (29.8%) and hemorrhagic shock (8.9%). The mean length of stay in the postoperative critical care unit was 13.6 days. Overall mortality was 5.87%. CONCLUSIONS: The highest mortality rate among cardiac surgery patients in postoperative critical care units in hospitals in the Community of Valencia in 2007 was in patients who underwent coronary revascularization. The most prevalent preoperative risk factor was hypertension. Cardiogenic shock and distributive shock were the most frequent causes of death in these patients. A system for classifying risk is needed in order to predict mortality in critical care units and improve perioperative care.