Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial.

BACKGROUND: Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness. AIM: To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device. STUDY DESIGN: Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups. RESULTS: Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%. CONCLUSION: Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement. RELEVANCE TO CLINICAL PRACTICE: Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.

COVID-19 in elderly kidney transplant recipients.

The SARS-Cov-2 infection disease (COVID-19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March 12 until April 4, 2020, we diagnosed COVID-19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti-retroviral and tocilizumab. Short-term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail, and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic, and showed higher D-dimer, C-reactive protein, and IL-6 at their first tests. COVID-19 is frequent among the elderly KT population and associates a very early and high mortality rate.

Clopidogrel-induced thrombotic microangiopathy: a case report.

Thrombotic microangiopathy is a serious condition that can be precipitated by exposure to certain medications. Although rare, it is life threatening and requires a high index of clinical suspicion, appropriate laboratory testing and immediate cessation of the offending agent. We present a case of a 75-year-old man with a history of ischaemic heart disease treated with clopidogrel and aspirin. One month after initiating the treatment he developed microangiopathic haemolytic anaemia and thrombocytopenia. Extensive clinical and laboratory investigations suggested thrombotic microangiopathy secondary to clopidogrel. The drug was immediately discontinued and treatment with intravenous corticosteroids was started. Within a week the patient's laboratory parameters normalised, indicating successful recovery. This case highlights the role of early detection and immediate discontinuation of suspected medication in the effective management of clopidogrel-induced thrombotic microangiopathy. Healthcare professionals should consider drug-induced thrombotic microangiopathy as a possible diagnosis in patients receiving clopidogrel who present with thrombocytopenia and microangiopathic haemolytic anaemia.

Benznidazole-induced drug reaction with eosinophilia and systemic symptoms syndrome in a patient with human leucocyte antigen (HLA)-A*68.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe drug hypersensitivity reaction with potentially life-threatening consequences. It is characterised by fever, extensive maculopapular exanthema, lymph node enlargement, abnormal blood cell counts, and organ-related complications. Diagnosis can be challenging due to incomplete or non-specific symptoms, and it can sometimes manifest as a purely systemic disease. Discontinuation of the causative drug is essential. Treatment may involve corticosteroids and supportive care. Genetic screening for specific markers, such as human leucocyte antigen (HLA)-A*68, A11:01, and A29:02, can help identify individuals at risk for severe reactions to benznidazole, a drug used to treat Chagas disease. This case report describes the rarity and severity of DRESS syndrome, underscoring the potential benefit of genetic screening to prevent adverse reactions in patients with Chagas disease.

Plastic matters: an analytical procedure to evaluate the degradability of contemporary works of art.

The most significant results concerning a chemical study to evaluate the degradability of polymeric components in four contemporary works of art, partially or completely realized in plastics, are presented and discussed in this paper. The procedure applied is mainly based on the use of Fourier transform IR and UV-vis spectroscopies and pyrolysis-gas chromatography/mass spectrometry, and consists of the following steps: (1) compositional analysis of the artworks, with particular attention to components which may have a negative effect on the overall ageing; (2) evaluation of the actual state of conservation; (3) investigation of the accelerated ageing of reference polymer samples; and (4) monitoring of the natural ageing of the artworks. On such a basis, the following could be concluded. Stage Evidence by Loris Cecchini is made of poly(ether urethane) elastomer which contains a high amount of phthalates. Their exudation gives a sticky appearance to the artwork and their removal during ageing is the main cause of the loss of flexibility. The latex used by Andrés Pinal for tailoring Traxe de Home is a natural polyisoprene, whose oxidative degradation accounts for the extensive deterioration and yellowing of the artwork. The plaster sculptures of 3D Bodyscans 1:9 by Karin Sander are coated with an aliphatic epoxy resin. Its oxidation with formation of amides is the cause of the surface yellowing. The adhesive used by Dario Villalba for Tierra, Ladrillo y Agua is a commercial poly(vinyl acetate). Simulated photoageing suggests a fast deterioration due to deacetylation and cross-linking, which possibly is the main reason for the actual detachment of debris from the support.

National survey of the incidence of missing anterior teeth: potential use in bite mark analysis in the Brazilian context.

Bite mark analysis in forensic dentistry presupposes that the human dentition is unique and that its characteristics can be transferred precisely to several materials. The aim of the present study was to register the frequency of missing anterior teeth in the Brazilian adult population, discussing its potential importance in bite mark analysis. Data from the Brazilian Oral Health Survey were used; 13,431 male and female individuals aged 35 to 44 were examined according to the criteria of the World Health Organization. The analysis of Poisson regression was performed in order to calculate the rating ratios and the respective confidence interval at 95%. A total of 13,431 adults participated in the study. Among male individuals, 2063 (47.00%) were dentate and 2036 (46.40%) had at least one missing tooth. Only 254 (5.83%) were totally edentulous. A significant number of males and females presented 6 missing teeth in the same dental arch, revealing the poor state of oral health of adult Brazilians. Missing teeth were more frequent in the upper dental arch than in the lower arch. In the upper dental arch, the incisor group (central and lateral) was missing the most. In the lower dental arch, however, a certain lack of homogeneity was observed among the different dental groups as regards missing teeth. White individuals presented a smaller proportion of missing teeth compared to the other ethnic groups. Females were 1.61 (CI 1.50-1.73) times more likely than males to present missing teeth. The absence of upper teeth and the presence of lower teeth were observed in 16.10% of the individuals. Further research should also include an analysis of different age groups. This would increase the potential of applying this kind of information to bite mark analysis.

Accuracy of mandibular measurements of sexual dimorphism using stabilizer equipment.

The objective of this investigation was to compare the accuracy of mandibular measurements using a stabilizer (MS) with gold standard computed tomography (GS) images. Sixty mandibles were studied. Werth TomoScope HV Compact® was used to obtain CT images (GS), and the MS was also used. Analysis of the CT scans was performed using the VG Studio Max software® (Volume Graphics GmbH, Heidelberg, Germany), and MS was used after the proper positioning of the mandible. Descriptive and paired t test measures were used, and a ROC curve was calculated, as well as sensibility and specificity. MedCalc and STATA 13.0® were used (95% level of significance). Bicondylar breadth, bicoronoid breadth and minimum ramus breadth reached the highest concordance correlation coefficients at 0.99 (0.99-1.00), 0.99 (0.99-1.00) and 1.00 (0.99-1.00), respectively. Comparing observers with GS, the lowest accuracy was noted for the maximum mandibular length [0.59 (0.45-0.69), 0.64 (0.51-0.74)], the breadth of the right (0.14 (0.04-0.23), 0.14 (0.004-0.24)) and left mandibular body [0.14 (0.03-0.24), 0.16 (0.05-0.26)], and the right [0.58 (0.45-0.69), 0.63 (0.51-0.73) and left (0.59 (0.45-0.70), 0.59 (0.46-0.69)] mandibular angle. Various measurements exhibited good sensibility for males using MS: maximum mandibular length (78.12), bicondylar breadth (78.12), left mandibular notch breadth (84.37), and the left height of the mandibular body at the mental foramen (75.00). High specificity in discriminating females was observed for the left maximal ramus height (85.19), mandibular length (85.71), bicoronoid breadth (96.43), right height of the mandibular body at the mental foramen (82.19), bimental breadth (78.57), breadth right (92.86) and left (96.43) mandibular body, minimum ramus breadth (89.29), and left mandibular angle (85.71). MS was able to discriminate sexual dimorphism.

Utilidad de la Ozonoterapia en el tratamiento de la enfermedad de Sever / Effectiveness of ozone therapy in the treatment of Sever's disease

Introducción: la enfermedad de Sever es causa frecuente de talalgia en niños. Objetivo: evaluar la utilidad de la Ozonoterapia en el tratamiento de la enfermedad de Sever en niños de 7-18 años atendidos en el Hospital Provincial Pediátrico Docente "Pepe Portilla" de Pinar del Río, de julio 2017 a julio 2018. Métodos: se ha realizado investigación descriptiva longitudinal y prospectiva, a 46 niños, que asistieron a consulta de Medicina Natural y Tradicional con enfermedad de Sever recidivante. Se les aplicó Ozono terapéutico, por la vía rectal, mediante el equipo OZOMED mini. En el procesamiento se utilizaron herramientas descriptivas como tablas de frecuencias y cálculo porcentual. Resultados: el grupo de edad de 7 a 12 años fue el más representado y el sexo masculino sobre el femenino, el calcáneo valgo fue la deformidad podálica que más se presentó. Se encontró actividad física alta en el 73.9 % de los niños y la mitad eran sobrepesos u obesos. Para la cuarta semana total de casos se encontraban aliviados, no hubo recaídas. No se presentaron efectos indeseables durante la aplicación de la Ozonoterapia. Conclusiones: la Ozonoterapia es una modalidad terapéutica útil en el tratamiento de la enfermedad de Sever.

Introduction: Sever's disease is a common cause of thalalgia in children. Objective: to evaluate the effectiveness of the Ozone Therapy in the treatment of Sever's disease in children from 7-18 years old attended at Pepe Portilla Pediatric Provincial Teaching Hospital, Pinar del Rio province, during July 2017 to July 2018. Methods: longitudinal and prospective descriptive research was conducted to 46 children, who attended Natural and Traditional Medicine service with relapsed of Sever's disease. Therapeutic ozone was applied to them through the rectal route, and by means of the OZOMED mini-equipment. Descriptive tools such as frequency tables and percentage calculation were used throughout the process. Results: the age group from 7 to 12 years old was the most represented and male sex prevailed over the female, the calcaneus valgus was the most frequent foot deformity. High physical activity prevailed in the 73.9% of children and half of them were overweight or obese. By the fourth week of treatment, the total of cases were relieved, without relapses. No undesirable effects during the application of ozone therapy were observed. Conclusions: ozone therapy is a useful therapeutic modality in the treatment of Sever's disease.

Safety and efficacy of sevelamer in the treatment of uncontrolled hyperphosphataemia of haemodialysis patients.

BACKGROUND/AIM: The treatment of hyperphosphataemia is of major importance in the management of patients on dialysis. Traditional phosphate binders can be associated with undesirable effects. Recently, a new non-absorbable phosphate-binding polymer, sevelamer hydrochloride, has been available. Clinical information is scarce, and its cost could be a limiting factor for its wider use. No studies have evaluated its usefulness in uncontrolled hyperphosphataemic patients. METHODS: We identified 34 patients with a maintained serum phosphorus concentration >6.5 mg/dl and/or toxicity related to standard phosphorus-binding treatment (aluminium or calcium based). Sevelamer was added and titrated up fortnightly to achieve phosphorus control. Previous phosphate binders were decreased, whenever possible. The period of the study was 6 months. RESULTS: Thirteen patients (38%) dropped out because of side effects, mainly related to the gastro-intestinal tract. The efficacy analysis disclosed that the phosphorus concentration decreased from 2.39 +/- 0.48 to 1.84 +/- 0.48 mmol/l (p < 0.001). The mean dose of sevelamer was stabilised at 3.4 +/- 1.8 g/day. The amount of calcium- and aluminium-based phosphate binders could be decreased from 5.1 +/- 3.5 to 3.1 +/- 2.7 g/day (38% decrease) and from 2.4 +/- 1.5 to 1.5 +/- 1.7 g/day (36% decrease), respectively. The Ca x P product was significantly decreased from 5.83 +/- 1.19 to 4.36 +/- 1.12 mmol/l2 (p < 0.001). The total cholesterol concentration decreased from 4.34 +/- 0.9 to 3.98 +/- 0.9 mmol/l (p < 0.01) and the low-density lipoprotein cholesterol level from 2.61 +/- 0.98 to 2.20 +/- 0.77 mmol/l (p < 0.03). CONCLUSIONS: Sevelamer is an effective phosphate binder that allows a better serum phosphorus control, while allowing a decrease in the dose of calcium- and aluminium-based phosphate binders in these difficult patients. The drawbacks are the high intolerance rate and the price of the product.

Distribution of peri-implant stresses with a countertorque device.

PURPOSE: To verify the effectiveness of a countertorque device in dental implants in redistributing stress to the bone-implant interface during tightening of the abutment screw. MATERIALS AND METHODS: Two prismatic photoelastic samples containing implants were made, one with a 3.75-mm-diameter implant and the other with a 5.0-mm-diameter implant (both implants had an external-hexagon interface) and the respective abutments were attached (CeraOne). The samples were placed in a support and submitted to torques of 10, 20, 32, and 45 Ncm with an electronic torque meter. The torque application was repeated 10 times on each sample (n = 10) with and without a countertorque device. Photoelastic patterns were detected; thus, a photographic register of each test was selected. The fringe patterns were analyzed at discrete points near the implants' external arch. RESULTS: In both implants analyzed, a stress gradient reduction was observed through the implant with the countertorque device. CONCLUSIONS: The countertorque device used in this study proved to be effective in reducing the stresses generated in the peri-implant bone tissue during torque application.

Estimating ages by third molars: stages of development in Brazilian young adults.

The purpose of this study was to estimate age through the analysis of third molar stages of development in Brazilian young adults. A cross-sectional study was conducted by analyzing 659 panoramic X-rays. Two techniques were used to establish the stages: Modified Scoring (MST) and Demirjian (DT). Regression formulas were calculated. Statistical analyses were conducted by t, Kappa tests, and simple and multiple linear regressions (5% level of significance). Out of the participants, 40.7% were female and 59.3% were male, with ages from 15-22 years. The Kappa test showed good results for intra-observer (0.84 for MST and 0.95 for DT) and inter-observer examination (0.81 for MST and 0.92 for DT). Differences were found in the stages of tooth formation between male and female, but differences were not observed between the left and right sides. We found that both DT and MST underestimated the ages in about 6 months, depending on the used classification and number of teeth. These methods are appropriate for assessing the ages of young Brazilians, although the DT showed better reproducibility.

Accuracy of mandibular measurements of sexual dimorphism using stabilizer equipment

Abstract The objective of this investigation was to compare the accuracy of mandibular measurements using a stabilizer (MS) with gold standard computed tomography (GS) images. Sixty mandibles were studied. Werth TomoScope HV Compact® was used to obtain CT images (GS), and the MS was also used. Analysis of the CT scans was performed using the VG Studio Max software® (Volume Graphics GmbH, Heidelberg, Germany), and MS was used after the proper positioning of the mandible. Descriptive and paired t test measures were used, and a ROC curve was calculated, as well as sensibility and specificity. MedCalc and STATA 13.0® were used (95% level of significance). Bicondylar breadth, bicoronoid breadth and minimum ramus breadth reached the highest concordance correlation coefficients at 0.99 (0.99-1.00), 0.99 (0.99–1.00) and 1.00 (0.99–1.00), respectively. Comparing observers with GS, the lowest accuracy was noted for the maximum mandibular length [0.59 (0.45–0.69), 0.64 (0.51–0.74)], the breadth of the right (0.14 (0.04–0.23), 0.14 (0.004–0.24)) and left mandibular body [0.14 (0.03–0.24), 0.16 (0.05-0.26)], and the right [0.58 (0.45–0.69), 0.63 (0.51–0.73) and left (0.59 (0.45–0.70), 0.59 (0.46–0.69)] mandibular angle. Various measurements exhibited good sensibility for males using MS: maximum mandibular length (78.12), bicondylar breadth (78.12), left mandibular notch breadth (84.37), and the left height of the mandibular body at the mental foramen (75.00). High specificity in discriminating females was observed for the left maximal ramus height (85.19), mandibular length (85.71), bicoronoid breadth (96.43), right height of the mandibular body at the mental foramen (82.19), bimental breadth (78.57), breadth right (92.86) and left (96.43) mandibular body, minimum ramus breadth (89.29), and left mandibular angle (85.71). MS was able to discriminate sexual dimorphism.

La sexualidad en los adolescentes: intervención educativa / Sexuality in adolescents: educative intervention

En la actualidad, un tercio de los jóvenes se inician en la vida sexual sin protección.Se realizó un estudio de intervención en el Consultorio No.2 del Policlínico Luís A. Turcios Lima del municipio de Pinar del Río, desde del 1ro. de octubre al 30 de diciembre de 2008, con el propósito de determinar la influencia de la intervención educativa sobre educación sexual en los adolescentes. Se trabajó con una muestra de 53 adolescentes, se aplicó una encuesta y un cuestionario, donde se exploraron los conocimientos, las actitudes o percepciones y las experiencias en la vida sexual. Posteriormente se realizó una capacitación por los investigadores sobre educación sexual, con una acción participativa de este grupo poblacional; finalmente se repitió el cuestionario para evaluar modificaciones en sus percepciones, reflexiones y conocimientos alcanzados. Dentro de los principales resultados se encontró que la proporción de adolescentes entre las edades comprendidas para la etapa, fue similar en ambos sexos, mientras que predominó la adolescencia temprana (10 a 13 años), encontrándose la mayoría con una escolaridad de primaria concluida. Prácticamente la mitad de los adolescentes tenían escasa información sobre educación sexual, siendo los medios de difusión la principal vía de información en general. La mayoría opinaron que el inicio de las relaciones sexuales debe ser entre 17 y 19 años, casi la totalidad de los adolescentes tenían deficientes conocimientos sobre sexualidad, consiguiéndose elevar estos con la intervención educativa realizada...(AU)

Nowadays, a third of the young population starts sexual life without protection. A study of intervention was conducted in Doctors Office No-2 belonging to the health area of “Luis A. Turcios Lima” outpatient clinic, Pinar del Rio, from October 1st to December 30th, 2008. The study was aimed at determining the effects of an educative intervention about sexual education in adolescents; 53 adolescents were included in the sample where a survey and a questionnaire were applied, knowledge, attitudes or perceptions of sexual-life experiences were explored. Subsequently a training course for researchers of sexual education with an active participation of this group of people was prepared; at the end the questionnaire was repeated to assess the changes of their perceptions, reflections and knowledge acquired. The main results showed that the proportion of adolescents among the ages of this period of life was similar in both sexes, meanwhile early adolescence (10-13 years old) prevailed, and the majority of the adolescents were graduated from elementary studies. Mostly half of the adolescents had lack of information about sexual education. Mass media was the main source of obtaining general information. The majority of the adolescents started sexual intercourse between 17 and 19 years old, almost the total of them had insufficient knowledge regarding sexuality, and with the application of the educative intervention it was possible to increase knowledge...(AU)

Usefulness of non-invasive tests for diagnosing Helicobacter pylori infection in patients undergoing dialysis for chronic renal failure.

BACKGROUND: Helicobacter pylori infection in chronic renal failure patients has been linked to peptic ulcer and gastric neoplasia after kidney transplantation. It may also contribute to the accelerated arteriosclerosis that is usual in this population. Few data are available on the usefulness of noninvasive diagnostic tests for H. pylori infection in dialyzed patients, especially regarding the new fecal antigen detection tests. The objective of this study was to determine the efficacy of a noninvasive test for H. pylori infection in patients with chronic renal failure. METHODS: Eighty-six patients were included in a cross-sectional study. Urea breath test, serology and three fecal tests--FemtoLab H. pylori (Connex, Germany), Premier Platinum HpSA (Meridian, USA) and Simple H. pylori (Operon SA, Spain) were performed. Helicobacter pylori status was determined by concordance of the tests. Sensitivity, specificity and positive and negative predictive values were calculated for each test. RESULTS: Sensitivity, specificity, positive and negative predictive values were 94%, 96%, 94% and 96% for the urea breath test; 97%, 64%, 66% and 97% for serology; 86%, 100%, 100% and 91%, for FemtoLab H. pylori; 58%, 96%, 91% and 76% for Premier Platinum HpSA and 61%, 78%, 74% and 67% for Simple H. pylori. CONCLUSIONS: The urea breath test seems to be the most reliable diagnostic method for H. pylori infection in patients with chronic renal failure. Serology has a low specificity, and the results of the fecal tests vary widely.

A utilização de radiografias do seio frontal na identificação humana: uma revisão de literatura / Using of frontal sinus x ray in human identification: a review of literarure

A Radiologia é uma especialidade extremamente empregada na Odontologia Forense, pois permite análise comparativa de radiografias ante e post-mortem do complexo bucomaxilofacial. A identificação humana a partir do seio frontal tem se tornado cada vez mais frequente devido ao fato de apresentar-se como um padrão único na espécie humana, o que torna um instrumento de grande valia na individualização. Entretanto, para a prática comparativa deve-se levar em consideração os mesmos métodos utilizados nas tomadas radiográficas em vida, evitando distorções e erros. O presente trabalho é um artigo de revisão histórica, no qual são citados diversos autores que utilizam o seio frontal como meio para identificação humana