Non-tunneled catheter tip depth position in urgent hemodialysis: a randomized controlled trial.

BACKGROUND: The average accepted depth for non-tunneled catheters (NTC) insertion does not guarantee its correct position, so controversy exists. The aim of this study was to assess the effect of two NTC placement depths on the number of NTC complication episodes. METHODS: We designed a triple blind, parallel group, randomized controlled trial in a single Hemodialysis Center in Mexico (Registry: ACTRN12619000774123). We included patients in urgent need of hemodialysis via internal right jugular vein NTC. The length of the NTC tip placement depth was randomized to second intercostal space (2ICS) or fourth intercostal space (4ICS), using physical landmarks. The primary outcome was to compare the composite number of NTC dysfunction, repositioning, and relocation episodes for 48 hours post-procedure. RESULTS: One hundred and sixty-five patients were included, 86 and 79 patients to NTC placement in the 2ICS and 4ICS, respectively. All patients underwent intention-to-treat analysis. The incidence of the composite outcome was lower in the 2ICS group compared to the 4ICS group, 4 (4.6%) and 50 (63%) combined episodes, respectively (P<0.001). Compared to the 4ICS group, the 2ICS group presented a relative risk of 0.06 (CI: 0.02-0.21, P<0.001) and number needed to treat (NNT) of 2.1. No adverse events occurred, derived from the NTC placement. CONCLUSIONS: NTC tip placement in the 2ICS compared to 4ICS decreases the incidence of the combined number of dysfunctions, repositioning and relocation episodes, with a NNT of 2 for its prevention.

Batch and fed-batch production of probiotic biomass and nisin in nutrient-supplemented whey media.

The production of a highly concentrated probiotic preparation of Lactococcus lactis CECT 539 was studied in both batch and realkalized fed-batch fermentations in diluted whey (DW) media (DW25, DW50, DW75, DW100, and DW125) supplemented with MRS broth nutrients (except glucose and Tween 80) at 25, 50, 75, 100, and 125% of their standard concentrations in the complex medium. The fed-batch culture using DW100 medium provided the highest concentrations of probiotic biomass (5.98 g/L) and nisin (258.47 BU/mL), which were obtained at lower production costs than those estimated for the fed-batch culture in DW medium. The batch and fed-batch cultures reduced the initial chemical oxygen demand (COD) of the media by 29.1-41.7% and 31.2-54.2%, respectively. Graphical abstract.

Nurturing the citizens of the future: milk stations and child nutrition in Puerto Rico, 1929-60.

Between the 1930s and 1960s Puerto Rico was transformed from a marginal United States territory into an industrialised 'showcase of development'. This article investigates the organisation of milk station programmes on the island during this crucial period and how these reflected the circulation of child welfare knowledge, nutrition expertise and public health practices. During the Depression, these perspectives fostered a recast of the eugenic regeneration ideologies motivating medical assessments of and sanitary interventions with Puerto Rico's rural poor since the nineteenth century. Innovations in nutrition knowledge and an emerging rural hygiene movement highlighted the negative health effects of the island's monocrops economy. In this context, the nourishment of children's bodies assumed symbolic and instrumental significance for the reconfiguration of colonial and developmental models promoted by the new Popular Democratic Party (PPD). The experience of public health professionals in relief work during the 1930s contributed to the articulation of food and nutrition as key elements of this party's populist discourse. Programmes like milk stations became part of strategies to rear and manage the labour force needed in the industrial development model promoted by the PPD. From the perspective of poor Puerto Ricans, however, they were part of the materialisation of its promise of social justice for the poorer classes.

Hidroneumopericardio iatrogénico tras pericardiocentesis / Iatrogenic Hidropneumopericardium after Pericardiocentesis

El hidroneumopericardio se define por la presencia de líquido y aire en la cavidad pericárdica. Se trata de una afección infrecuente en los adultos, habitualmente asociada a buen pronóstico, pero que puede resultar potencialmente grave. Presentamos el caso de un paciente trasplantado renal que debutó con taponamiento cardíaco y que precisó pericardiocentesis; varios días después, presentó un cuadro de dolor torácico debido a un hidroneumopericardio iatrogénico. Las pruebas de imagen son claves en la obtención de este diagnóstico.

Hydropneumopericardium is defined by the accumulation of serous fluid and gas in the pericardial sac. It is uncommon in adults, usually associated with favorable outcomes; yet, it may be severe occasionally. We present the case of a kidney transplant patient who developed cardiac tamponade requiring pericardiocentesis. Several days after the procedure, the patient presented chest pain due to iatrogenic hydropneumopericardium. Image tests are essential to make this diagnosis.

[Kidney transplantation. Experience at the University Hospital José González, UANL in Monterrey, Mexico]. / Trasplante renal. Experiencia en el Hospital Universitario José E. González, UANL, en Monterrey, México.

BACKGROUND: In patients with end-stage renal disease, successful renal allotransplantation improves the quality of life and increases survival as compared with long-term dialysis treatment. OBJECTIVE: To show our experience, effectiveness and results of renal transplantations at the University Hospital of UANL. MATERIAL AND METHODS: A retrospective study of renal transplantation performed at University Hospital of UANL was done. The transplant cases from 1967 to July 2001 and January 2003 to June 2011 were included. RESULTS: 280 kidney transplants were performed in 264 patients, 146 men and 118 women; 201 from deceased donor and 79 from living donor. The patient survival at 1, 3, and 5 years was 98.8, 85.9 and 85.9%, respectively. The graft survival at 1, 3, and 5 years, censored for death with functioning graft, was 98.8, 85.7 and 74.9%, respectively. CONCLUSIONS: Our results, in this population with unfavorable socioeconomic conditions, are comparable to those obtained in other institutions.

Vasoespasmo coronario asintomático y arritmias ventriculares graves / Asymptomatic Coronary Artery Spasm and Severe Ventricular Arrhythmias

El vasoespasmo coronario generalmente evoluciona con episodios de dolor torácico y elevación del ST. No obstante, existen casos de vasoespasmo sin dolor torácico con taquiarritmias ventriculares documentadas. Su incidencia se desconoce y debe incluirse en el diagnóstico diferencial de taquicardia o fibrilación ventricular idiopática. En esta presentación se describe el caso de un paciente con historia de dos cuadros sincopales sin cardiopatía estructural aparente. La monitorización electrocardiográfica continua objetivó episodios de elevación del ST que conducían a taquicardia ventricular polimorfa. Con el diagnóstico de vasoespasmo coronario asintomático se inició tratamiento con calcioantagonistas y se implantó un cardiodesfibrilador automático.

Coronary artery spasm usually results in episodes of chest pain and ST-segment elevation. However, it may occasionally occur in the absence of angina with documented severe ventricular arrhythmias. The incidence of this condition is unknown and should be included in the differential diagnosis of idiopathic ventricular tachycardia or fibrillation. We describe the case of a patient with a history of two episodes of syncope without apparent structural heart disease. Continuous ECG monitoring revealed the presence of episodes of ST-segment elevation leading to polymorphic ventricular tachycardia. Asymptomatic coronary artery spasm was diagnosed and treatment with calcium channel blockers was initiated; an implantable cardioverter defibrillator device was implanted.

Estudio del apéndice del frenillo vestibular: ¿Alteración del desarrollo o lesión neoplásica? / Tissue tag of the labial frenum: Development anomaly or neoplastic lesion?

El apéndice del frenillo vestibular (AFV) es un fragmento de tejido mucoso que se desprende desde el frenillo labial del maxilar superior. Aunque su formación y función aún son desconocidas  se reconoce como una alteración del desarrollo. Sin embargo, muchos odontólogos y médicos confunden a menudo esta entidad  con  hiperplasias fibrosas producto de trauma. El objetivo de la siguiente investigación fue determinar la frecuencia de AFV en una población y su posible asociación con factores traumáticos locales. Se realizó un examen estomatológico completo a 185 individuos luego de llenar una historia clínica y consentimiento informado. Cerca del 20% de la población estudiada presentaron AFV (36 individuos), sin embargo el uso de prótesis o aparatología ortodóncica/ortopédica no pudo asociarse estadísticamente. El AFV es una anomalía del desarrollo que se presenta con relativa frecuencia y no se relaciona con factores traumáticos, por lo cual no representa una lesión reactiva y mucho menos neoplásica.

Tissue tag of the labial frenum (TTLF) is a fragment of oral mucosa that arises from the labial superior frenum. Its cause and function are still unknown, however, it is considered an alteration of the normal oral anatomy. Although its nature, many dentists and medics confuse this entity with fibrous hyperplasias produced by trauma. The aims of this study were to determine the frequency of TTLF and the association to traumatic local factors. 185 people were examined after filling an oral medicine history and signed an informed consent. About 20% of the study population showed TTLF (36 people), however, the use of prostheses or orthodontic treatment could not be statistically associated. TTLF is a relatively frequent development anomaly that it is not cause by trauma, and it does not represent a reactional lesion or a neoplasia.

O apêndice do frenillo a vestibular (AFV) é um fragmento do tecido mucoso que seja vindo fora de maxilar superior labial do frenillo. Embora suas formação e função não sejam sabidas ainda sejam reconhecidas como uma alteração do desenvolvimento. Não obstante, muitos dentistas e doutores confundem frequentemente esta organização com o produto do trauma das hiperplasias fibrosas. O objetivo da seguinte investigação era determinar a freqüência de AFV em uma população e de sua associação possível com fatores traumáticos locais. Uma examinação completa estomatologica a 185 indivíduos após o enchimento a uma historia clínica e a um consentimento informado foi feita. Perto de 20% da população estudada eles pressentem AFV (36 indivíduos), não obstante o uso do prótesis ou do aparatología ortodôntica o ortopédica não podia ser associado estatísticamente. O AFV é uma anomalia do desenvolvimento que aparece com freqüência relativa e não se relaciona aos fatores traumáticos, assim não representa uma lesão reativa e muito menos neoplásica.

Quiste odontogénico ortoqueratinizado: una nueva entidad derivada del queratoquiste odontogénico. Revisión de la literatura / Orthokeratinized odontogenic cyst: a new entity from the odontogenic keratocyst: a review of the literature

Son múltiples los recientes estudios e investigaciones que soportan claramente las diferencias clínicas, histopatológicas e inmunohistoquímicas entre las variantes paraqueratinizada y ortoqueratinizada del Queratoquiste Odontogénico, suscitándose de esta manera controversias entre los diferentes autores con respecto a este tema. Sin embargo, son muchos los que ya han fijado su posición y afirman, en base a diferentes hallazgos, que el Queratoquiste odontogénico y su variante ortoqueratinizada, son dos lesiones diferentes e independientes una de la otra. Desde 1981 se introdujo el término de Quiste Odontogénico Ortoqueratinizado, para describir esta entidad patológica que posee unas características bien definidas y cuyas alternativas de tratamiento son conservadoras debido a su baja recurrencia. La presente revisión de la literatura pretende establecer las diferencias entre el Queratoquiste Odontogénico, ya hoy considerado un tumor odontogénico, y el Quiste Odontogénico Ortoqueratinizado como dos entidades independientes