The efficacy of hypnosis compared with the tell/show/do technique for the reduction of anxiety/pain in children undergoing pulpotomies: a randomized controlled trial.

Anxiety/pain is a combined experience that can hinder dental treatment in children and lead to the development of negative behaviours in any form of surgical treatment. Hypnosis is a suitable option with which to reduce anxiety and pain during dental treatment. In this study, we aimed to evaluate the efficacy of hypnosis compared to the tell/show/do technique for the reduction of anxiety and pain as measured by Face, Legs, Activity, Crying, Consolability (FLACC) scale in children undergoing pulpotomies. We performed a randomized and controlled clinical trial involving 60 children aged 5 to 7 years without previous dental experiences but with clinical and radiographic indications for pulpotomy in the primary mandibular right or left first or second molar. The children were divided into two groups: a control group (treated by conventional behaviour management techniques) and an experimental group (treated by hypnosis). The FLACC scale was used to evaluate anxiety/pain during preoperative, transoperative and postoperative pulpotomy treatment; we also analysed variations in heart rate and skin conductance. The trial was registered at ClinicalTrials.gov (NCT03739346). Statistical analysis was performed in R Studio version 1.2.1335. The FLACC scale was significantly lower in the experimental group (p = 0.022) throughout the entire treatment duration. In addition, heart rate and global skin conductance were both significantly lower in the experimental group when measured at different times (p = 0.005 and p = 0.032, respectively). When compared to conventional behavioural management techniques, the FLACC scale demonstrated that hypnosis was associated with significant reductions in heart rate, skin conductance and anxiety/pain throughout the entire duration of treatment. decreases anxiety/pain during the entire operative procedure. There was clear improvements in anxiety and pain control in patients receiving hypnotic therapy.

The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network.

OBJECTIVE: The purpose of this study was to evaluate the impact of COVID-19 pandemic public health restrictions on our drip and ship mechanical thrombectomy program in Santiago Chile. MATERIALS AND METHODS: This was a retrospective analysis of a prospectively collected database comparing two cohorts, one during a two-year period before COVID-19 and the second during the two years of the pandemic at our metropolitan stroke program. RESULTS: A total of 100 patients were included in the pre COVID-19 cohort (cohort 1) and 121 in the COVID-19 cohort (cohort 2). There was a significant difference between cohorts, with older patients, different occlusion sites and higher door to arterial puncture time during the COVID-19 period. A non-significant trend for worse 90-day outcomes and higher mortality was present in cohort 2. There were no statistical differences in safety treatment parameters. CONCLUSIONS: COVID-19 pandemic has had a measurable impact on our mechanical thrombectomy program. Results showed similarities to other reported Latin American series, where less robust health systems could adapt less efficiently compared to developed countries. After two years of public health restrictions, there were changes in the treatment population characteristics, delay in some internal management metrics and a non-significant trend to worse 90-day outcomes and higher mortality.

Mucilage extracted from Chilean papaya seeds is enriched with homogalacturonan domains.

Chilean papaya, also known as mountain papaya (Vasconcellea pubescens), is a fruit valued for its nutritional value and pleasant fragrance. The oblong fruit, featuring five ridges and a seed-filled mucilage cavity, is typically consumed cooked due to its high protease content. The mucilage and the seeds are usually discarded as byproducts. This study analyzed the biochemical composition of mountain papaya seed mucilage using methods such as HPAEC and immunolabeling. Results revealed that papaya seeds yield nearly 20% of their weight in mucilage polysaccharides, which can be separated into soluble and adherent layers. The mucilage exhibited a high proportion of acidic sugars, indicating that homogalacturonan (HG) is the predominant domain. It also contained other domains like rhamnogalacturonan-I (RG-I) and hemicelluloses, predominantly xyloglucan. The HG-rich mucilage, currently considered waste, emerges as a promising source of polysaccharides, indicating its multifaceted utility in various industrial applications.

[Outcome of renal transplantation in patients with autosomal dominant polycystic kidney disease]. / Resultados del trasplante renal en portadores de ríñones poliquísticos.

BACKGROUND: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. AIM: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. SUBJECTS AND METHODS: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. RESULTS: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. CONCLUSIONS: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients.

Rituximab in the treatment of acute cellular rejection of renal allograft with CD20-positive clusters in the infiltrate.

A 31-year-old woman with nephronophthisis received a cadaveric kidney transplant, and was immunosuppressed with cyclosporine, azathioprine and steroids. Twelve days after transplant a biopsy showed acute rejection with vascular damage. She was treated with 3 pulses of methylprednisolone and change of immunosuppression to mycophenolate mofetil and tacrolimus, without improving graft function. At day 21, a second biopsy showed accentuation of interstitial and vascular rejection. Antibody-mediated rejection was suspected and plasmapheresis and rituximab were prescribed. Graft function improved rapidly. Staining for C4d was negative and there were no circulating antibodies against the donor. In the interstitial infiltrate there were clusters of B lymphocytes that accounted for 40% of cells, which was thought to be an ominous sign, as it has been associated with poor graft outcome. Acute T-cell-mediated rejection grade III (Banff 07) was diagnosed. Thirty-nine months after transplant her kidney function is stable with no other complication. This clinical case generates the hypothesis that rituximab may have a beneficial role in the therapy of acute cellular rejection when there are clusters of B lymphocytes in the infiltrate and a good response has not been obtained to conventional anti-rejection therapy.

[Hyponatremia on admission to the emergency room as a risk factor for hospital mortality]. / La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria.

BACKGROUND: Patients who develop hyponatremia during their hospitalization have higher hospital mortality. AIM: To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. PATIENTS AND METHODS: Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. RESULTS: Hyponatremia at admission occurred in 30 and 17% of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95% confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. CONCLUSIONS: Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Capability and clinical success.

Better outcomes for chronic diseases remain elusive because success depends on events outside the control of the health care system: patients' ability to mange their health behaviors and chronic diseases. Among the most powerful influences on self-management are the social and environmental constraints on healthy living, yet the clinical response to these environmental determinants is poorly developed. A potential approach for addressing social determinants in practice, as well as planning and evaluating community responses, is the capability framework. Defined as the real opportunity to achieve a desired lifestyle, capability focuses attention on the material conditions that constrain real opportunity and how opportunity emerges from the interaction between personal resources and the social environment. Using examples relevant to chronic disease and behavior change, we discuss the clinical application of the capability framework.

The influence of microplastics pollution on the feeding behavior of a prominent sandy beach amphipod, Orchestoidea tuberculata (Nicolet, 1849).

Pollution by microplastics has become a global threat affecting coastal habitats such as sandy beaches and their resident macrofauna. The goal of this study was to assess the influence of microplastics on the feeding behavior and growth rate of a widespread sandy beach amphipod, Orchestoidea tuberculata. These organisms were exposed to artificial food prepared with Poly(styrene-co-divinylbenzene) microspheres (8 µm particle size) at 3 different concentrations (0%, 5% and 10%). The amphipods consumed significantly more food when the concentration of microplastics was 0% and significantly less when the concentration was 10%, both in trials in which they had a choice (preference experiments) and those in which they did not have a food choice. In contrast to this, the amphipod's absorption efficiency and estimated growth rates were not significantly affected by the concentration of microplastics. Combined, these results indicate that high microplastics concentrations (e.g. 10%) cause a reduction in the amphipod's consumption rates and, indirectly, may affect the role of this species as a main consumer of stranded seaweeds in sandy beaches ecosystems.

[Hyponatremia associated to pituitary adenomas. Report of three patients]. / Hiponatremia sintomática como forma de presentación clínica de un macroadenoma hipofisiario. Comunicación de tres casos.

Severe hyponatremia occurring as the presenting feature of hypopituitarism secondary to pituitary adenomas is rare. We report three patients with this condition: Two elderly males (74 and 78 year-old) presenting with impaired consciousness and low plasma sodium after an episode of diarrhea and a 56-year-old male presenting with impaired consciousness after an episode of vomiting. All had clinical features of hypopituitarism and pituitary adenomas were found on imaging studies. Two were subjected to a trans sphenoidal resection of the adenoma.

Resultados del trasplante renal en portadores de ríñones poliquísticos / Outcome of renal transplantation in patients with autosomal dominant polycystic kidney disease

Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. Aim: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. Subjects and Methods: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. Results: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. Conclusions: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients.

La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria / Hyponatremia on admission to the emergency room as a risk factor for hospital mortality

Background: Patients who develop hyponatremia during their hospitalization have higher hospital mortality. Aim: To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. Patients and Methods: Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. Results: Hyponatremia at admission occurred in 30 and 17 percent of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95 percent confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. Conclusions: Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Late onset of familial nephrotic syndrome associated with a compound heterozygous mutation of the podocin-encoding gene.

A case of two young adult brothers with nephrotic syndrome secondary to focal segmental glomerulosclerosis is reported. Steroid resistance prompted us to perform genetic studies. These showed a compound heterozygous mutation of NPHS2, the gene encoding podocin. It was composed of a missense mutation in exon 7 (A284V) and the non-neutral polymorphism R229Q in exon 5. We review literature supporting the genetic basis of the disease.

Hiponatremia sintomática como forma de presentación clínica de un macroadenoma hipofisiario: Comunicación de tres casos / Hyponatremia associated to pituitary adenomas: Report of three patients

Severe hyponatremia occurring as the presenting feature of hypopituitarism secondary to pituitary adenomas is rare. We report three patients with this condition: Two elderly males (74 and 78 year-old) presenting with impaired consciousness and low plasma sodium after an episode of diarrhea and a 56-year-old male presenting with impaired consciousness after an episode of vomiting. All had clinical features of hypopituitarism and pituitary adenomas were found on imaging studies. Two were subjected to a trans sphenoidal resection of the adenoma.