Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial.

BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

The central oxytocinergic system of the prairie vole.

Oxytocin (OXT) is a peptide hormone and a neuropeptide that regulates various peripheral physiological processes and modulates behavioral responses in the central nervous system. While the humoral release occurs from the axons arriving at the median eminence, the neuropeptide is also released from oxytocinergic cell axons in various brain structures that contain its receptor, and from their dendrites in hypothalamic nuclei and potentially into the cerebrospinal fluid (CSF). Understanding oxytocin's complex functions requires the knowledge on patterns of oxytocinergic projections in relationship to its receptor (OXTR). This study provides the first comprehensive examination of the oxytocinergic system in the prairie vole (Microtus ochrogaster), an animal exhibiting social behaviors that mirror human social behaviors linked to oxytocinergic functioning. Using light and electron microscopy, we characterized the neuroanatomy of the oxytocinergic system in this species. OXT+ cell bodies were found primarily in the hypothalamus, and axons were densest in subcortical regions. Examination of the OXT+ fibers and their relationship to oxytocin receptor transcripts (Oxtr) revealed that except for some subcortical structures, the presence of axons was not correlated with the amount of Oxtr across the brain. Of particular interest, the cerebral cortex that had high expression of Oxtr transcripts contained little to no fibers. Electron microscopy is used to quantify dense cored vesicles (DCV) in OXT+ axons and to identify potential axonal release sites. The ependymal cells that line the ventricles were frequently permissive of DCV-containing OXT+ dendrites reaching the third ventricle. Our results highlight a mechanism in which oxytocin is released directly into the ventricles and circulates throughout the ventricular system, may serve as the primary source for oxytocin that binds to OXTR in the cerebral cortex.

Monkeypox: What the Dermatologist Needs to Know.

Monkeypox, an endemic disease in some African countries, has provoked public health activeness on a global scale that even the World Health Organization (WHO), invoking international health regulations, declared it a public health emergency of international concern (PHEIC). The WHO called attention of member states to exert maximum surveillance over the disease, its patients, and contact persons in order to standardize control measures. A need was directed to provide complete knowledge about the disease, allowing the administration of prior diagnoses as well as isolation and more effective epidemiologic control measures. An updated review on monkeypox emphasized upon having the fundamental aspects of the lesions caused by the disease, and appropriate management of patients upon clinical and epidemiologic evaluation.

Rationale and Guidelines for the Use of Hyaluronidase: A Practical Guide for Complications Caused by Hyaluronic Acid.

The use of enzyme hyaluronidase to treat the complications of different brands of hyaluronic acid (HA) dermal fillers is increasing in the same proportion as the number of nonsurgical cosmetic procedures. Guidelines for diagnosing and treating complications remain controversial and are primarily based on anecdotal reports and small case series. We proposed approaching HA-related complications based on our clinical research and observations of treating more than 200 patients and providing a practical guide for the thoughtful use of hyaluronidase according to adverse events. Standardization of hyaluronidase dose and concentration is beneficial for better outcomes and future comparative analyses of the results of this treatment worldwide. The use of hyaluronidase is increasing for the reversal of the clinical manifestations of complications caused by HA fillers, although a consensus is lacking. We propose using different doses and concentrations of hyaluronidase to focus on selected anatomic areas considering properties of the product and pathogenesis of each complication.

Recalcitrant Sterile Abscesses by Volux®: A New Therapeutic Approach.

The number of patients developing sterile abscesses because of hyaluronic acid (HA) filler procedures has increased for unknown reasons. We described this adverse reaction after filling with Juvederm Volux®, the latest innovative product in the Vycross range of technology. We presented five patients with recalcitrant sterile abscesses after filling with Juvederm Volux® who did not respond to the traditional therapy but whose lesions were resolved with the "Munhoz-Cavallieri lavage protocol" developed and recently published by the present authors. (SKINmed. 2023;21:27-33).

Brooke-Spiegler Syndrome with Parotid Gland Involvement.

A 60-year-old black man, working in construction sector, was referred to dermatology clinic for having multiple hardened and asymptomatic tumors on the scalp, face, and trunk for more than 40 years. There was a progressive increase in the number and size of lesions, causing significant aesthetic and functional impairment. In his family history, a son had numerous normochromic papules on the centrofacial region with a diagnosis of multiple trichoepithelioma. The deceased mother of our patient presented lesions similar to those of her grandson but without a confirmatory diagnosis. (SKINmed. 2023;21:47-50).

Carbonate system in the Cabo Frio upwelling.

The quantitative assessment of the carbonate system represents one of the biggest challenges toward the "Sustainable Development Goals" defined by the United Nations in 2015. In this sense, the present study investigated the Spatio-temporal dynamics of the carbonate system and the effects of the El Niño and La Niña phenomena over the Cabo Frio upwelling area. The physical characterization of the site was carried out through data on wind speed and sea surface temperature. Water samples were also collected during the oceanographic cruise onboard the Diadorim R/V (Research Vessel). From these samples, the parameters of absolute and practical salinity, density, pH, total alkalinity, carbonate, calcite, aragonite, bicarbonate dissolved inorganic carbon, carbon dioxide, partial pressure of carbon, calcium, and total boron were obtained. The highest average concentration of bicarbonate in S1 (2018 µmol/kg) seems to contribute to the dissolved inorganic carbon values (2203 µmol/kg). The values of calcite saturation state, aragonite saturation state, and carbonate were higher on the surface of each station (calcite saturation state = 4.80-5.48; aragonite saturation state = 3.10-3.63, and carbonate = 189-216 µmol/kg). The mean values of pH were similar in the day/night samples (7.96/7.97). The whole carbonate system was calculated through thermodynamic modeling with the Marine Chemical Analysis (AQM) program loaded with the results of the following parameters: temperature, salinity, total alkalinity, and pH parameters. This manuscript presents original data on the carbonate system and the "acidification" process influenced by the Cabo Frio upwelling, which directly depends on the El Niño and La Niña phenomena oscillations in the sea surface temperature.

Implications of COVID-19 and mitigation measures on gender and the Zimbabwean economy.

This paper provides a macro-micro modeling analysis of the ex-ante effects of COVID-19 mitigation and recovery policies on macroeconomic and distributional effects, particularly on female and male workers, income distribution, and poverty in Zimbabwe. With an emphasis on modeling gender-disaggregated labor markets and COVID-19 policy responses, the paper presents and combines the most recent data on poverty, gender, and the economy at the national level. The study finds that i) without any government mitigation measures, the gross domestic product will remain below business-as-usual levels; ii) poorer women are hardest hit because they are employed in sectors that are exposed and vulnerable to COVID-19 response measures; and iii) mitigation measures to counteract the negative effects of increases in poverty are effective only in the short term, and additional measures to sustain poverty reduction for the long term to sustain the poverty reductions are required. These results highlight the short-term versus long-term dilemma the government faces when contemplating responses to COVID-19.

Technical Aspects of Using a Second Magnetic Grasper to Improve the Surgical Field in Single Port Revisional Bariatric Surgery.

BACKGROUND: The future of minimally invasive surgery in revisional surgery is experiencing changes with new equipment such as the magnetic assistance that can be used with single port devices in order to perform an incisionless surgery (Luengas R, Galindo J, Castro M, et al. Surg Obes Relat Dis. 2021;17(1):147-152). Magnetic assistance through an auxiliary grasper with two internal magnets serves beyond liver retraction in different steps of the surgery improving the surgical field by obtaining a better visualization and triangulation. PURPOSE: Expose the feasibility of using two internal magnetic graspers by single port performing a conversion surgery of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). METHODS: A 36-year-old female patient underwent a SG in 2015 and consults in 2021 because of severe GERD with a 33-point GERD-HRQL score. She has preoperative evaluation for a conversion surgery from SG to RYGB. Using a single port device through the umbilicus, an additional 5 mm trocar was placed in the left side of the abdomen. Two internal magnets were introduced through the umbilicus, and they were controlled by two external magnets placed over the abdomen with an articulated arm. The first magnet was used for liver retraction and the second one to perform both anastomoses, close the intermesenteric and Petersen defect, acting as an auxiliary grasper. The ethical committee approval was obtained through an informed consent from the participant included in the study.

Assessment of the structures contribution (crystalline and mesophases) and mechanical properties of polycaprolactone/pluronic blends.

Films of biodegradable blends of polycaprolactone (PCL) and Pluronics F68 and F127 were manufactured by an industrial thermo-mechanical process to be applied as potential delivery systems. The effects of Pluronics on the structure (mesophase organization), and thermal and mechanical properties of polycaprolactone were investigated using differential scanning calorimetry (DSC), small-angle X-ray scattering (SAXS), X-ray diffraction (XRD), polarized optical microscopy (POM) and tensile mechanical tests. The addition of Pluronics affected the crystallization process by changing the relative amounts of crystalline, amorphous, and meso- (condis + plastic) phases. The melting transition and XRD profiles were deconvoluted to assess the individual contribution of the different crystal morphologies. Furthermore, it was found that the mechanical properties of the blends depended on the ratio and type of Pluronic. Thus, Pluronic F127 showed a larger mesophase content than its F68 counterpart with PCL and blends with enhanced ductility.

Keloids and Hypertrophic Scars.

Keloids and hypertrophic scars are abnormal responses to wound-healing. While hypertrophic scars remain limited to the areas of trauma, keloids most often develop over several years, growing out from the limits of the initial wound area. Both lesions may cause itching, burning, and pain, and they may lead to significant impairment of self-esteem, socialization, and quality of life. Although they might be observed in all races, they are far more common in Africans and African descendants than in Caucasians.We extensively reviewed their treatment, including compression with pressure garments, occlusion with siliconized and non-siliconized gel sheets, gels, corticosteroid and antineoplastic injections, and the use of lasers and intense pulsed light (IPL) therapy. We also reviewed new therapies, including botulinum toxin injection, and addressed outcomes of various studies. (SKINmed. 2022;20:432-443).

Sporothrix brasiliensis as a Causative Agent of Disseminated Sporotrichosis in AIDS.

A 47-year-old woman who lived in the metropolitan area of Rio de Janeiro and had abandoned her Acquired Immune Deficiency Syndrome (AIDS) therapy 3 years prior, was admitted to our hospital due to weight loss, cough, and fever for 2 weeks. The dermatologic examination established normochromic papules with molluscum-like central umbilication on the face (Figure 1) and hands, erythema and infiltration in the oral cavity (Figure 2), desquamative patches on the legs, and ulceration on right calcaneus (Figure 3). Her CD4 (T-cells) count was 47 cells/ mm.3 Direct mycology examination and cultures for several agents were performed. The mycology culture done from her skin and sputum grew Sporothrix 1 week after admission (Figure 4).

What to expect when AGEP is induced by terbinafine? Case report and critical review of the literature.

BACKGROUND: Acute Generalised Exanthematous Pustulosis (AGEP) is a rash with multiple sterile intraepidermal or subcorneal non-follicular pustules on edematous papules, with a sudden development and rapid evolution, triggered by drugs, vaccination, insect bites, exposure to mercury, and allergens. OBJECTIVES AND METHODS: We describe a female patient who developed extensive and abnormally prolonged AGEP following exposure to terbinafine and SARS-CoV vaccine. A detailed review of terbinafine-induced-AGEP cases was performed, with the aim of evaluating if the AGEP criteria would follow a different pattern when the disease is triggered by this drug. A PubMed search helped retrieve all terbinafine-induced AGEP case reports. AGEP-specific Sideroff criteria were analysed in terbinafine-induced cases and compared to other trigger causes. CONCLUSIONS: When the AGEP causative drug was terbinafine, a delay in recovery was observed, compared to the existing AGEP criteria when other causes are considered. Terbinafine frequently leads to delayed resolution AGEP probably due to the presence of the drug in the skin for several weeks after exposure, even after discontinuation, and the disease severity may be potentialised by additional factors such as concomitant viral infections or vaccination.

Inventory of water masses and carbonate system from Brazilian's northeast coast: Monitoring ocean acidification.

This manuscript presents an inventory of the carbonate system from the main water masses comprising the marine current system on Brazil's northeast coast (South Atlantic Ocean). For this purpose, four transects were conducted with an approximate length of 357 km (each one) through the platform and continental slope of the Sergipe-Alagoas sedimentary basin. Water samples were then collected in vertical profiles measuring from 5 to 1,799 meters depth, totaling 34 stations. Total alkalinity, calcium, and total boron were obtained analytically from these samples and by relationships with salinity. Speciation and concentration of the carbonate system were obtained by means of thermodynamic modeling. The results revealed that the empirical models used to calculate the concentrations of TA, calcium and total boron showed relevant variation when compared to the analytical values (TA: 5.0-6.5%; Ca: 0.4-4.8%; BT: 7.0-18.9%). However, the speciation and concentration of the carbonate system (CA, DIC, [Formula: see text], CO2(aq), ΩCalc, and ΩArag) obtained from the empirical values of TA, calcium and total boron did not differ significantly from those obtained analytically (0.0-6.1%). On the other hand, the parameters of pH, [Formula: see text], [Formula: see text], CO2(aq), ρCO2, ΩCalc, and ΩArag varied significantly within the different water masses (p < 0.05). This study supports and encourages acidification monitoring projects in the South Atlantic Ocean, based on modeling the carbonate system parameters generated in real-time.

NOT SO "HAPPY BUMP": A complication due to hyaluronic acid.

INTRODUCTION: The use of hyaluronic acid (HA) as a dermal filler is considered safe. However, as new brands come to the market, reports of adverse events are becoming more and more common. OBJECTIVE: To describe a particular type of adverse effect that, unlike the erythematous, indurated, and painful nodules described in the literature as "angry red bumps," is characterized by noninflammatory, stony-like nodules that appear in sites previously treated with HA. METHODS: The report of four patients who presented this complication, and the occurrence of two HA syringes from the same batch that had hardened the product inside at the time of filling. CONCLUSION: The authors propose the nomenclature "happy bump" to group adverse reactions to HA that translate into noninflammatory nodules, with a stony consistency, appearing up to 4 weeks (recent) or after one month (late) in sites previously treated with AH.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition.

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.