Effect of Immersive Virtual Reality by a Computer Assisted Rehabilitation Environment (CAREN) in Juvenile Huntington's Disease: A Case Report.

Various studies have proven the utility of immersive virtual reality (VR) as a complementary approach to conventional neurorehabilitation therapy for improving neuromuscular and cognitive outcomes in several neurological diseases. We hereby report findings from a single-case experience of a 21-year-old woman affected by juvenile Huntington's disease (HD) who underwent a targeted rehabilitative approach using an advanced Computer Assisted Rehabilitation Environment (CAREN) with a three sessions/week schedule for six months. At the end of the program, a manifested improvement was noticed in the Falls Efficacy Scale International score, in the Tinetti Scale, in the Berg Balance score and in the lower limb strength (MRC scale). Minor although tangible improvements were also noticed in some physical performance tests (10 m walking test, time up and go test). Findings reported, although preliminary, extend for the first time the usefulness of neurorehabilitation using innovative VR technologies also to juvenile HD, a condition for which common rehabilitation strategies bring only marginal physical benefits in the majority of cases. Future, controlled studies are awaited for generalizing these observations to larger populations and for clarifying whether such benefits may persist also in the long-term.

Empowering immigrant youth in Chicago: utilizing CBPR to document the impact of a Youth Health Service Corps program.

Community-based participatory research (CBPR) is an approach that engages community residents with a goal of influencing change in community health systems, programs, or policies. As such, CBPR is particularly relevant to historically marginalized communities that often have not directly benefited from the knowledge research produces. This article analyzes a youth empowerment program, Chicago's Youth Health Service Corps, from a CBPR perspective. The purpose of this work was (1) to discuss Youth Health Service Corps as a health promotion program, (2) examine the use of CBPR within the immigrant community, and (3) discuss preliminary findings using a model on critical youth empowerment.

Effect of topical application of melatonin to the gingiva on salivary osteoprotegerin, RANKL and melatonin levels in patients with diabetes and periodontal disease.

This cross-section study was designed to assess the effect of topical application of melatonin to the gingiva on salivary RANKL, osteoprotegrin (OPG) and melatonin levels as well as plasma melatonin in 30 patients with diabetes and periodontal disease and in a control group of 30 healthy subjects. Salivary RANKL and OPG were measured by enzyme-linked immunosorbent assay and salivary and plasma melatonin by radioimmunoassay using commercial kits. Periodontograms were performed using the Florida Probe(®). Diabetic patients were treated with topical application of melatonin (1% orabase cream formula) once daily for 20 days. Patients with diabetes showed significantly higher mean levels of salivary RANKL than healthy subjects as well as significantly lower values of salivary OPG and salivary and plasma melatonin. After treatment with melatonin, there was a statistically significant decrease of the gingival index, pocket depth and salivary levels of RANKL, and a significant rise in salivary values of OPG. Changes of salivary OPG levels before and after topical melatonin treatment correlated significantly with changes in the gingival index and pocket depth. Treatment with topical melatonin was associated with an improvement in the gingival index and pocket depth, a reduction in salivary concentrations of RANKL and increase in salivary concentrations of OPG, which indicates that melatonin has a favorable effect in slowing osteoclastogenesis, improving the quality of alveolar bone and preventing the progression of periodontal disease.

Cause-Specific Mortality and Racial Differentials in Life Expectancy, Chicago 2018-2019.

BACKGROUND: In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death are increasingly recognized products of structural racism, in urban areas, such causes may have potential for reducing racial inequities through public health intervention. Our purpose is to allocate racial inequities in ALE in Chicago to differentials in cause-specific mortality. METHODS: Using multiple decrement processes and decomposition analysis, we examine cause-specific mortality in Chicago to determine the causes of death that contribute to the gap in life expectancy between NH Blacks and NH Whites. RESULTS: Among females, the racial difference in ALE was 8.21 years; for males, it was 10.53 years. We find that cancer and heart disease mortality account for 3.03 years or 36% of the racial gap in average life expectancy among females. Differences in homicide and heart disease mortality rates comprised over 45% of the disparity among males. CONCLUSIONS: Strategies for improving inequities in life expectancy should account for differences between males and females in cause-specific mortality rates. In urban areas with high levels of segregation, reducing inequities in ALE may be possible by dramatically reducing mortality rates from some causes. CONTRIBUTION: This paper illustrates the state of inequities in ALE between NH Blacks and NH Whites in Chicago for the period just prior to the onset of the COVID-19 pandemic, using a well-established method of decomposing mortality differentials for sub-populations.

The effect of Computer Assisted Rehabilitation Environment (CAREN) in cognitive impairment and coping strategies in Parkinson's disease: a preliminary study.

Parkinson's disease is a neurodegenerative disorder characterized by different motor, vegetative, behavioral, and cognitive impairments, with worsening quality of life. Virtual reality devices have given promising results in neurorehabilitation as they can provide multisensory stimulation in a realistic environment. This study aims to test the efficacy of virtual reality training by using Computer Assisted Rehabilitation Environment in cognitive impairment in a sample of PD. 31 patients affected by PD were enrolled. All PD patients underwent 24 sessions of Computer Assisted Rehabilitation Environment training. The participants were assessed at baseline (T0) and after two months (T1). Our results suggested that Computer Assisted Rehabilitation Environment training may be effective in the cognitive and emotional domains, particularly by improving executive function, anxiety, and depressive symptoms. These changes have helped to improve self-efficacy and coping strategies. These results indicate greater cognitive and physical effort to overcome stressors. Our results show that Computer Assisted Rehabilitation Environment training was beneficial in improving cognitive functions. Longer duration training may be especially beneficial for patients with mild cognitive impairment. Our findings open the door to tailored personalized treatments based on the patient's motor and cognitive profiles.

What Should Count as Best Practices of Forensic Medical and Psychological Evaluations for Children Seeking Asylum?

The process of being granted asylum is complex, often taking months and years. Asylum seekers face high risk of being denied asylum in the United States. As medical and psychological evaluations assist in achieving successful asylum outcomes, human rights asylum clinics are being established throughout the country to facilitate these types of evaluations. The Midwest Human Rights Consortium, a multi-institutional, interdisciplinary initiative, is working to streamline the referral process and increase the evaluator workforce through training and mentorship of practitioners. More work is needed to establish evidence-based, child-centered, and trauma-informed best practices in training evaluators and performing evaluations.

El proceso para recibir asilo es complejo y normalmente lleva meses o años. Quienes solicitan asilo enfrentan un alto riesgo de ser rechazados en los Estados Unidos. Debido a que las evaluaciones médicas y psicológicas ayudan a obtener resultados exitosos en cuanto al asilo, se han estado estableciendo clínicas de derechos humanos de asilo en todo el país para facilitar este tipo de evaluaciones. El Consorcio de Derechos Humanos del Centro de EE.UU., una iniciativa multiinstitucional e interdisciplinaria, trabaja para agilizar el proceso de derivaciones y aumentar la cantidad de evaluadores mediante la capacitación y mentoría de los profesionales. Se necesita más información para establecer mejores prácticas con base en evidencia, centradas en los niños y con datos sobre traumas en las capacitaciones de los evaluadores y las evaluaciones.

Cognitive rehabilitation using immersive virtual reality at young age: A case report on traumatic brain injury.

Adolescents having moderate to severe traumatic brain injury (TBI) often experience long-lasting cognitive, emotional, and behavioral problems. In current clinical practice, rehabilitation techniques to treat cognitive abnormalities may be classified in two main categories, i.e. conventional or advanced. Aim of this case study was to evaluate the safety and efficacy of an immersive virtual environment (Computer Assisted Rehabilitation Environment [CAREN]), in a young boy affected by severe TBI. A 15-year-old boy with TBI involving the right parietal-temporal region underwent two different rehabilitation trainings, including standard cognitive rehabilitation alone in a usual clinical setting (face-to-face intervention with a paper and pencil approach) or the same cognitive program using virtual scenarios by means of CAREN. We evaluated the patient's cognitive status, before and after the two different trainings, by using a specific psychometric battery to evaluate the cognitive and behavioral functioning, such as attention abilities, visuo-spatial and executive functions. Only at the end of the CAREN training, we observed a significant improvement in specific cognitive and motor domains, such as attention abilities, visuo-executive processes, emotional awareness, and balance. Cognitive training, using immersive Virtual Reality, may be a useful tool to facilitate cognitive recovery in TBI patients.

The Growing Use of Virtual Reality in Cognitive Rehabilitation: Fact, Fake or Vision? A Scoping Review.

OBJECTIVE: This review aims to evaluate the role of Virtual Reality (VR) in cognitive rehabilitation of different neurological diseases, and the accessibility to healthcare systems providing this type of treatment. METHOD OF RESEARCH: Studies performed between 2003 and 2017 and fulfilling the selected criteria were found on PubMed, Scopus, Cochrane and Web of Sciences databases. The search combined the terms VR rehabilitation with different neurological disease. RESULTS: Our findings showed that neurological patients performed significant improvement in many cognitive domains (executive and visual-spatial abilities; speech, attention and memory skills) following the use of VR training. CONCLUSIONS: This review supports the idea that rehabilitation through new VR tools could positively affect neurological patients' outcomes, by boosting motivation and participation so to get a better response to treatment. In particular, VR can be used to enhance the effects of conventional therapies, promoting longer training sessions and a reduction in overall hospitalization time.

Local application of melatonin into alveolar sockets of beagle dogs reduces tooth removal-induced oxidative stress.

BACKGROUND: The antioxidant and anti-inflammatory hormone melatonin is secreted by saliva into the oral cavity, where it may protect the mucosal and gingival tissues from radical damage. To date, no studies have addressed the potential beneficial role of melatonin in the acute inflammatory response that follows oral surgical interventions, especially tooth extractions. The aim of this study was to determine whether tooth extraction induces changes in plasma oxidative stress levels, and whether melatonin treatment may counteract these changes. METHODS: Maxillary and mandibular premolars and molars of 16 adult Beagle dogs were extracted under general anesthesia. Eight dogs were treated with 2 mg melatonin placed into the alveolar sockets, whereas the other eight dogs received only vehicle. Lipid peroxidation (LPO) and nitrite plus nitrate (NOx) levels were determined in plasma, whereas glutathione (GSH) and glutathione disulfide (GSSG) levels and glutathione peroxidase (GPx) and reductase (GRd) activities were measured in red blood cells before and 24 hours after tooth extraction. RESULTS: Removal of the premolars and molars caused a significant rise in plasma LPO and NOx levels and in the erythrocyte GSSG/GSH ratio, whereas melatonin treatment restored the normal values of these parameters. Also, melatonin slightly increased erythrocyte GRd activity without changing GPx activity. CONCLUSION: For the first time to our knowledge, the results show that during the immediate postoperative period following tooth extraction, there is a significant increase of oxidative stress, which is counteracted by the administration of melatonin into the alveolar sockets.

Changes in crevicular cytokines after application of melatonin in patients with periodontal disease.

BACKGROUND: A clinical trial was designed to evaluate the effects of topical application of melatonin on the crevicular fluid levels of interleukins and prostaglandins and to evaluate changes in clinical parameters. MATERIAL AND METHODS: A consecutive sample of 90 patients were recruited from the Health Centre of Pinos Puente in Granada, Spain and divided into 3 groups: 30 patients with diabetes and periodontal disease, who were given melatonin; 30 patients with diabetes and periodontal disease, who were given a placebo, and 30 healthy individuals with no history of systemic disease or clinical signs of periodontal disease, who were also given a placebo. The 30 patients with diabetes and periodontitis were treated with topical application of melatonin (1% orabase cream formula) for 20 days by. The rest of the patients with diabetes and periodontitis and healthy subjects were treated with a placebo of orabase cream. We measured the gingival index by exploring the percentage of standing teeth bleeding on probing. The periodontogram was performed with a Florida Probe. RESULTS: In the diabetic patients who were given topical melatonin, there was a statistically significant decrease in the two clinical parameters. By contrast, in diabetic patients who were given the topical placebo, there was no statistically significant variation. CONCLUSIONS: In patients with diabetes and periodontal disease, treatment with topical melatonin was associated with a significant improvement in the gingival index and in pocket depth, and a statistically significant reduction in concentrations of interleukin-1ß, interleukin-6 and prostaglandin E2 in gingival crevicular fluid. Key words:Melatonin, periodontal disease, diabetes mellitus, interleukin-1ß, interleukin-6, prostaglandin E2.

Effect of topical application of melatonin on serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in patients with type 1 or type 2 diabetes and periodontal disease.

BACKGROUND: The present clinical trial study was designed to assess the effect of topical application of melatonin on serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with diabetes and periodontal disease in comparison with healthy controls. MATERIAL AND METHODS: Serum levels of TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay and CRP by nephelometry by using the proper commercial kits in 30 patients with diabetes and periodontal disease, and also in a control group of 30 healthy subjects. Periodontograms were performed using the Florida Probe®. Patients with diabetes were treated with a topical application of melatonin (1% orabase cream formula) once daily for 20 days. Healthy subjects were treated with a placebo orabase cream. RESULTS: Patients with diabetes and periodontal disease had significantly higher mean levels of serum TNF-α, IL-6 and CRP than healthy subjects (P < 0.001). Following topical melatonin application, there was a statistically significant decrease in the gingival index and pocket depth (P < 0.001) as well as a significant decrease in IL-6 and CRP serum levels (P < 0.001). Local melatonin application in patients with diabetes and periodontal disease resulted in a significant decrease in CRP and IL-6 serum levels as well as an improvement in the gingival index and pocket depth. Patients with periodontal disease had significantly higher serum CRP, IL-6 and TNF-α values by comparison with healthy subjects. CONCLUSIONS: We conclude that melatonin can modulate the inflammatory action of these molecules in periodontal patients. KEY WORDS: Melatonin, periodontal disease, diabetes mellitus, interleukin-6, tumor necrosis factor-alpha, C-reactive protein, inflammatory markers.

Evaluation of effects of topic melatonin on implant surface at 5 and 8 weeks in Beagle dogs.

PURPOSE: The aim of this study was to evaluate the effect of the topical application of melatonin on osteointegration of dental implants in Beagle dogs 5 and 8 weeks after their insertion. MATERIALS AND METHODS: For subsequent insertion of dental implants, upper and lower premolars and molars were extracted from 12 Beagle dogs. Each mandible received cylindrical screw implants of 3.25 mm in diameter and 10 mm in length. The implants were randomly assigned to the mesial and distal sites on each side of the mandible. Prior to implanting, 1.2 mg lyophylized powder melatonin was applied to one bone hole at each side of the mandible. None was applied at the control sites. Eight histological sections per implant were obtained for histomorphometric studies. RESULTS: After 5- and 8-week treatment periods, melatonin significantly increased the inter-thread bone (p < 0.05) and new bone formation (p < 0.05) in comparison to control implants in both weeks. There were no significant increases in the bone-to-implant contact and peri-implant bone (p > 0.05). CONCLUSION: Topical application of melatonin may act as a biomimetic agent in the placement of endo-osseous dental implants at 5 and 8 weeks after the implantation.

Klebsiella pneumoniae pulmonary infection with thyroid abscess: report of a case.

Thyroid abscess is a rare clinical entity, usually associated with a pyriform sinus fistula. A prompt diagnosis is important because it may progress rapidly into a life-threatening condition. We report a very unusual case of thyroid abscess associated with a lung infection, both caused by Klebsiella pneumoniae. The patient was treated successfully with a culture-appropriate antibiotic and an uneventful thyroid lobectomy. A delay in diagnosis of morbidities associated with a thyroid abscess may result in rapid exacerbation of this condition; therefore, prompt and appropriate treatment is mandatory for a successful outcome.

Parameters of oxidative stress in saliva from diabetic and parenteral drug addict patients.

BACKGROUND: Oxidative stress constitutes the basis for many diseases and it may account for the severity of systemic and oral disease complications. The aim of this study was to assess whether saliva may be used to detect the body's oxidative stress level. METHODS: Oxidative stress was determined in saliva from 14 diabetic patients and 10 heroin addicts; two different pathologic conditions related to free radical damage, and 21 healthy control subjects were included in the study. Glutathione peroxidase (GPx) and reductase (GRd) activities, and glutathione (GSH) and glutathione disulfide (GSSG) levels were analyzed in the saliva of all individuals. Other variables including salivary volume and the oral status were also analyzed. RESULTS: Diabetic patients had GPx and GRd activities of 39.98 +/- 1.61 and 6.19 +/- 0.61 nmol/min/mg prot, respectively. These values were significantly higher (P < 0.001) than those obtained in control saliva (27.51 +/- 0.86 and 3.44 +/- 0.25 nmol/min/mg prot, respectively). Drug addicts showed significantly (P < 0.001) lower salivary GPx and GRd activities than controls. Both group of patients had significantly lower levels of GSH and higher of GSSG than controls (P < 0.001). CONCLUSIONS: Changes in the antioxidant enzymes and glutathione levels in saliva from two different pathologic situations as those here studied suggest that this biologic fluid may be suitable for determining the prognosis and evolution of these diseases and its oral manifestations.

Relationship between salivary melatonin levels and periodontal status in diabetic patients.

Among other functions, melatonin exerts both antioxidative and immunoregulatory roles. The indoleamine is secreted in the saliva, although its role into the mouth is not known. Diabetic patients frequently display oral cavity pathologies such as periodontal disease (PD), an inflammatory disease coursing with an increase in free radical production. Thus, we compared the degree of PD and interleukin-2 (IL-2) levels with melatonin concentrations in plasma and saliva of diabetic patients. A total of 43 diabetic patients (20 with type I and 23 with type II diabetes) and 20 age- and sex-matched controls were studied. Dental and medical history of all patients was in accordance with the criteria of the WHO. The periodontal status was evaluated by the Community Periodontal Index (CPI). Plasma and salivary melatonin levels were determined by specific commercial radioimmunoassays, and plasma IL-2 was measured using a commercial enzyme-linked immunosorbent assay kit. Diabetic patients had plasma and saliva melatonin levels of 8.98 +/- 7.14 and 2.70 +/- 2.04 pg/mL, respectively. These values were significantly lower (P < 0.001) than those obtained in plasma and saliva of controls (14.91 +/- 4.75 and 4.35 +/- 0.98 pg/mL, respectively). Plasma and salivary melatonin concentrations show a biphasic response in diabetic patients. Melatonin decreased in patients with a CPI index of 2, and then increased reaching highest levels in patients with a CPI index of 4. By contrast, IL-2 levels decreased from CPI index 1 to 4. The results indicate that, in diabetic patients, the presence of a marked impairment of the oral status, as assessed by the CPI index, is accompanied by an increase in plasma and salivary melatonin. The increase in salivary melatonin excretion may have a periodontal protective role.

Utilidad de la aplicación tópica de Lidocaína-Prilocaína (EMAL) previo a la venopunción / Value of the topic use of Lidocaine-Priclocaine mixture (EMAL) prior venopuncture

Se realizó el presente estudio prospectivo, comparativo y aleatorio en el Departamento de Anestesiología del Centro Médico ABC, incluyendo 31 pacientes ASA I-II, de 20 a 60 años de edad, sin medicación preanestésica, sometidos a cualquier tipo de cirugía. Material y Métodos: El universo del estudio se dividió en dos grupos, en forma aleatoria: Grupo Control con 12 pacientes canalizados sin Lidocaína-Prilocaína tópica; y el Grupo Problema con 19 pacientes a los cuales 30 minutos previos a la canalización se les aplicó la crema de Lidocaína-Prilocaína en el sitio de punción. Se evaluaron ambos grupos sobre la base de una escala nominal de: 0 = sin dolor; 1= dolor leve; 2 = dolor moderado y 3 = dolor severo, contrastándose las variables mediante la Prueba exacta de Fisher, y considerándose como valores significativos p<0.05. Resultados: En nuestro estudio no encontramos ninguna molestia al momento de canalizar los pacientes en el Grupo Problema que recibió la aplicación de Lidocaína-Prilocaína, siempre que la crema se aplicó con 30 minutos previos, así como también 7 pacientes refirieron dolor leve y 5 dolor moderado en el Grupo Control con una p=0.001, siendo estadísticamente significativo. Conclusión: En nuestro estudio se confirmó la utilidad de la asociación de Lidocaína-Prilocaína tópica como anestésico local para evitar dolor en la venopunción, encontrando ausencia de molestia al momento de canalizar los pacientes, lo cual sería de mayor utilidad en la colocación de catéteres centrales periféricos cuya aguja introductora es de mayor diámetro.

Reporte de un caso: Relajación nuromuscular prolongada con la administración de mivacurio en infusión continua / Case report: prolonged neuromuscular blockade with coninous infusion of mivacurium

Se presenta el caso clínico de una paciente femenina, 63 años, sometida a laparatomía exploradora, sin antecedentes quirúrgicos-patológicos importantes, la cual recibió inducción anestésica con Propofol, fentanilo y mivacurio. Mantenimiento anestésico con O2/Sevoflurano, además de infusión de fentanil y mivacurio. Después de 1hr y habiendo disminuido la concentración de la infusión del relajante, no se percibe respuesta en el neuroestimulador (TOF), suspendiendo la infusión, pero permanece de la misma forma al terminar la cirugía 4hrs después. Se traslada a la Unidad de terapia Intensiva para asistencia mecánica ventilatoria, en espera de recuperación neuromuscular. Se extuba a las 20 hrs, después de haber suspendido la infusión de mivacurio. Se tomaron exámenes de laboratorio encontrando una colinesterasa plasmática y un por ciento de inhibición de dibucaína disminuidos. La paciente egresó a los 12 días de su cirugía sin problemas, dándose las recomendaciones pertinentes para futuros procedimientos anestésicos.

Edema pulmonar no cardiogénico secundario a laringoespasmo posterior a anestesia general / Laryngospasm induced pulmonary edema following general anesthesia. A case report

Se presenta el caso clínico de un paciente joven, sano, que desarrolló edema pulmonar no cardiogénico secundario a laringoespasmo posterior a la extubación, no detectándose el problema en forma inmediata, sino hasta 24 hrs después cuando se manifestó con taquicardia y desaturación por oximetría de pulso. La radiografía de tórax, mostró infiltrados alveolares bilaterales difusos y zona de confluencia en el lóbulo superior del pulmón derecho. No requirió reintubación. La terapia consistió en oxígeno suplementario por puntas nasales, restricción de líquidos, diuréticos, esteroides, broncodilatadores y antibióticos. Después del tratamiento establecido, hubo franca mejoría 24 hrs después, confirmado clínica y radiológicamente