Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study.

BACKGROUND: Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. METHODS: Multicenter, prospective cross-sectional observational study conducted in three medical-surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. RESULTS: Ninety patients were included. Median age was 63 [45-71] years old, and median SOFA score was 9 [7-11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR-). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR- groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. CONCLUSIONS: Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.

Application of the Yamanaka Transcription Factors Oct4, Sox2, Klf4, and c-Myc from the Laboratory to the Clinic.

The transcription factors Oct4, Sox2, Klf4, and c-Myc enable the reprogramming of somatic cells into induced pluripotent cells. Reprogramming generates newly differentiated cells for potential therapies in cancer, neurodegenerative diseases, and rejuvenation processes. In cancer therapies, these transcription factors lead to a reduction in the size and aggressiveness of certain tumors, such as sarcomas, and in neurodegenerative diseases, they enable the production of dopaminergic cells in Parkinson's disease, the replacement of affected neuronal cells in olivopontocerebellar atrophy, and the regeneration of the optic nerve. However, there are limitations, such as an increased risk of cancer development when using Klf4 and c-Myc and the occurrence of abnormal dyskinesias in the medium term, possibly generated by the uncontrolled growth of differentiated dopaminergic cells and the impairment of the survival of the new cells. Therefore, the Yamanaka transcription factors have shown therapeutic potential through cell reprogramming for some carcinomas, neurodegenerative diseases, and rejuvenation. However, the limitations found in the studies require further investigation before the use of these transcription factors in humans.

First report of epiphytic dinoflagellate Coolia malayensis (Dinophyceae) in the southeastern Pacific Ocean.

Coolia species are epiphytic and benthic dinoflagellates with a cosmopolitan distribution in tropical and subtropical areas. In the austral summer of 2016, during a survey in Bahía Calderilla, a dinoflagellate of the genus Coolia was detected in macroalgae samples, and a clonal culture was established. Subsequently, the cultured cells were observed by scanning electron microscopy (SEM) and identified as C. malayensis based on their morphological characteristics. Phylogenetic analyses based on the LSU rDNA D1/D2 regions confirmed that strain D005-1 corresponded to C. malayensis and clustered with strains isolated from New Zealand, Mexico, and Asia Pacific countries. Although the strain D005-1 culture did not contain yessotoxin (YTX), cooliatoxin, 44-methyl gambierone, or its analogs in detectable amounts by LC-MS/MS, more research is needed to evaluate its toxicity and to determine the possible impact of C. malayensis in northern Chilean waters.

An allosteric switch ensures efficient unidirectional information transmission by the histidine kinase DesK from Bacillus subtilis.

Phosphorylation carries chemical information in biological systems. In two-component systems (TCSs), the sensor histidine kinase and the response regulator are connected through phosphoryl transfer reactions that may be uni- or bidirectional. Directionality enables the construction of complex regulatory networks that optimize signal propagation and ensure the forward flow of information. We combined x-ray crystallography, hybrid quantum mechanics/molecular mechanics (QM/MM) simulations, and systems-integrative kinetic modeling approaches to study phosphoryl flow through the Bacillus subtilis thermosensing TCS DesK-DesR. The allosteric regulation of the histidine kinase DesK was critical to avoid back transfer of phosphoryl groups and futile phosphorylation-dephosphorylation cycles by isolating phosphatase, autokinase, and phosphotransferase activities. Interactions between the kinase's ATP-binding domain and the regulator's receiver domain placed the regulator in two distinct positions in the phosphotransferase and phosphatase complexes, thereby determining whether a key glutamine residue in DesK was properly situated to assist in the dephosphorylation reaction. Moreover, an energetically unfavorable phosphotransferase conformation when DesK was not phosphorylated minimized reverse phosphoryl transfer. DesR dimerization and a dissociative phosphoryl transfer reaction also enforced the direction of phosphoryl flow. Shorter or longer distances between the phosphoryl acceptor and donor residues shifted the phosphoryl transfer equilibrium by modulating the stabilizing effect of the Mg2+ cofactor. These mechanisms control the directionality of signal transmission and show how structure-encoded allostery stores and transmits information in signaling systems.

Characterization of patients with acutely decompensated cirrhosis who received care in different highly complex emergency services of Medellín, Colombia. / Caracterización de los pacientes con cirrosis agudamente descompensada que consultaron a diferentes servicios de urgencias de alta complejidad en Medellín, Colombia

INTRODUCTION: Cirrhosis is one of the ten leading causes of death in the Western hemisphere and entails a significant cost of health care. OBJECTIVE: To describe the sociodemographic, clinical, and laboratory characteristics of patients older than 18 years who received care for acute decompensation of cirrhosis in the emergency services of three highly complex centers in Medellín, Colombia. MATERIALS AND METHODS: This was an observational retrospective cohort study from clinical records. The results were analyzed by frequency measures and represented in tables and graphics. RESULTS: In total, 576 clinical records met the inclusion criteria; 287 were included for analysis, and 58.9% were men, with an average age of 64 (± 13.5) years. The most frequent causes of cirrhosis were alcohol intake (47.7%), cryptogenic or unspecified etiology (29.6%), and non-alcoholic fatty liver disease (9.1%). The main reasons for visiting the emergency department were the presence of edema and/or ascites (34.1%), suspicion of gastrointestinal bleeding (26.5%), abdominal pain (14.3%) and altered mental status (13.9%). The most frequent clinical manifestations of an acute decompensation of cirrhosis were ascites (45.6%), variceal hemorrhage (25.4%), hepatic encephalopathy (23.0%), and spontaneous bacterial peritonitis (5.2%). During their treatment, 56.1% of the patients received intravenous antibiotics; 24.0%, human albumin; 24.0%, vasoactive support, and 27.5%, blood products; 21.3% required management in an intensive or intermediate care unit, registering 53 deceased patients for a mortality of 18.5%. CONCLUSION: Patients who consult the emergency services due to acute decompensation of cirrhosis demand a high amount of health resources, frequently present associated complications, and a high percentage requires management in critical care units and shows a high in-hospital mortality rate.

Introducción. La cirrosis hace parte de las diez primeras causas de muerte en el hemisferio occidental y acarrea un importante costo en salud. Objetivo. Describir las características sociodemográficas, clínicas y de laboratorio, de los pacientes mayores de 18 años que recibieron atención por descompensación aguda de la cirrosis en los servicios de urgencias de tres centros de alta complejidad en Medellín, Colombia. Materiales y métodos. Se trata de un estudio observacional de cohorte. Los resultados se analizaron mediante medidas de frecuencia, y se representaron en tablas y gráficas. Resultados. En total, en 576 registros clínicos se cumplieron los criterios de inclusión; se incluyeron 287 para el análisis. El 58,9 % fueron hombres, con edad promedio de 64 (±13,5) años. Las causas más frecuentes de cirrosis fueron: ingestión de alcohol (47,7 %), criptogénica o inespecífica (29,6 %) y enfermedad por hígado graso no alcohólico (9,1 %). Los principales motivos de consulta fueron: presencia de edemas, ascitis o ambas (34,1 %), sospecha de hemorragia digestiva (26,5 %), dolor abdominal (14,3 %) y alteración del estado mental (13,9 %). Los diagnósticos de complicación aguda más frecuentes fueron ascitis (45,6 %), hemorragia digestiva por várices esofágicas (25,4 %), encefalopatía hepática (23,0 %) y peritonitis bacteriana espontánea (5,2 %). El 56,1 % de los pacientes recibió antibióticos; el 24,0 %, albúmina humana; el 24,0 % medicamentos, y el 27,5 % hemoderivados. En el 21,3 % de los casos, se requirió hospitalización en la unidad de cuidados intensivos o en la de cuidados intermedios. Se registraron 53 decesos, para una mortalidad del 18,5 %. Conclusiones. Los pacientes que consultan a los servicios de urgencias por una descompensación aguda de la cirrosis demandan una gran cantidad de recursos, frecuentemente presentan complicaciones asociadas, requieren manejo en unidades de cuidado crítico y evidencian una alta tasa de mortalidad.

Caracterización epidemiológica, clínica y de laboratorio en pacientes positivos persistentes a COVID-19

Introducción: La COVID-19 es una preocupación mundial, requiere enfoque integral para reducir la transmisión, comenzando por la detección de casos, atención hospitalaria y seguimiento posterior. Objetivo: Caracterizar a pacientes positivos persistentes a COVID-19 en cuanto a epidemiología, clínica y datos de laboratorio. Métodos: Se realizó un estudio descriptivo transversal en 16 pacientes positivos persistentes a SARS-CoV-2 diagnosticados por RCP-TR en hisopado nasofaríngeo, en el Hospital Comandante Manuel Fajardo Rivero de Santa Clara en el período de septiembre 2020 a noviembre 2020. Resultados: Predominó el sexo femenino en un 75 %, el grupo de edad más representativo fue de 40-59 años de edad (68,75 %), el 37,50 % de los casos fueron asintomáticos y el síntoma más frecuente fue la fiebre menor de siete días 31,25 %. Existió linfopenia en el hemograma inicial con media en 27,49, índice neutrófilo leucocitario por encima de tres en cuatro pacientes con una media inicial 3,42. Estadía hospitalaria de 20,75 días de promedio. La mitad no tenía historia de enfermedad conocida, la comorbilidad más frecuente fue la hipertensión arterial 43,75 %. El índice neutrófilo leucocitario por encima de tres en pacientes con comorbilidades, evolutivo para todos menor de tres. Conclusiones: Predominó el sexo femenino, el grupo de edad más representativo fue de 40-59 años, es frecuente que se presenten asintomáticos y la fiebre fue el síntoma más usual. Existió linfopenia en el hemograma inicial. La mitad de los contagiados sin comorbilidades. El índice neutrófilo leucocitario evolutivo fue menor de tres para todos los pacientes.

Introduction: COVID-19 is a global concern, it requires a comprehensive approach to reduce transmission, starting with case detection, hospital care and subsequent follow-up. Objective: To characterize persistent COVID-19 positive patients in terms of epidemiology, clinical and laboratory data. Methods: A cross-sectional descriptive study was carried out in 16 persistent SARS-CoV-2 positive patients diagnosed by RT-CPR in nasopharyngeal swab, at Comandante Manuel Fajardo Rivero Hospital of Santa Clara in the period from September 2020 to November 2020. Results: The female sex predominated in 75%, the most representative age group was 40-59 years of age (68.75%), 37.50% of the cases were asymptomatic and the most frequent symptom was fever less than seven days 31.25%. There was lymphopenia in the initial hemogram with an average of 27.49, and a leukocyte neutrophil index above three in 4 patients with an initial average of 3.42. Hospital stay of 20.75 days on average. Half had no history of known disease, the most frequent comorbidity was arterial hypertension 43.75 %. The neutrophil leukocyte index above 3 in patients with comorbidities, evolutionary for all pariente was less than 3. Conclusions: The female sex predominates, the most representative age group is 40-59 years, it is frequent that they present asymptomatic and fever is the most usual symptom. There is lymphopenia on the initial blood count. Half of those infected without comorbidities. The evolutionary leukocyte neutrophil index was less than 3 for all patients.

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Pioderma gangrenoso / Pyoderma gangrenosum

RESUMEN El pioderma gangrenoso (PG) es una enfermedad inflamatoria rara de causa desconocida, perteneciente al grupo de las dermatosis neutrofílicas, caracterizada por ulceraciones cutáneas dolorosas y recurrentes, asociada comúnmente con enfermedades autoinmunes o neoplasias, pero también aparece de forma independiente a estos trastornos. Existen varios subtipos: ulceroso o clásico, ampollar, pustuloso y vegetante. Se presenta una paciente femenina de 68 años de edad, con lesión ulcerosa cutánea, con cultivos bacteriológicos y micológicos negativos, biopsia cutánea que informó pioderma gangrenoso y exámenes complementarios para descartar enfermedades asociadas. No se evidenció asociación con enfermedades sistémicas.

ABSTRACT Pyoderma gangrenosum (PG) is a rare inflammatory disease of unknown cause, belonging to the group of neutrophilic dermatoses, characterized by painful and recurrent skin ulcerations and commonly associated with autoimmune diseases or neoplasms, although it can also occur independently of these disorders. Ulcerative or classic, bullous, pustular and vegetating forms are the different subtypes. We present a 68-year-old female patient with an ulcerative skin lesion, negative bacteriological and mycological cultures, a skin biopsy showing pyoderma gangrenosum and complementary examinations to rule out associated diseases. No association with systemic diseases was evidenced.

Lipophilic Toxins in Chile: History, Producers and Impacts.

A variety of microalgal species produce lipophilic toxins (LT) that are accumulated by filter-feeding bivalves. Their negative impacts on human health and shellfish exploitation are determined by toxic potential of the local strains and toxin biotransformations by exploited bivalve species. Chile has become, in a decade, the world's major exporter of mussels (Mytilus chilensis) and scallops (Argopecten purpuratus) and has implemented toxin testing according to importing countries' demands. Species of the Dinophysis acuminata complex and Protoceratium reticulatum are the most widespread and abundant LT producers in Chile. Dominant D. acuminata strains, notwithstanding, unlike most strains in Europe rich in okadaic acid (OA), produce only pectenotoxins, with no impact on human health. Dinophysis acuta, suspected to be the main cause of diarrhetic shellfish poisoning outbreaks, is found in the two southernmost regions of Chile, and has apparently shifted poleward. Mouse bioassay (MBA) is the official method to control shellfish safety for the national market. Positive results from mouse tests to mixtures of toxins and other compounds only toxic by intraperitoneal injection, including already deregulated toxins (PTXs), force unnecessary harvesting bans, and hinder progress in the identification of emerging toxins. Here, 50 years of LST events in Chile, and current knowledge of their sources, accumulation and effects, are reviewed. Improvements of monitoring practices are suggested, and strategies to face new challenges and answer the main questions are proposed.

Traducción al español de la Guía de Práctica Clínica de Nivel S3 de la Federación Europea de Periodoncia (EFP) - Tratamiento de la periodontitis en Estadios I-III / Spanish translation of the Level S3 Clinical Practice Guideline of the European Federation of Periodontology (EFP) - Treatment of periodontitis in Stages I-III

Resumen. Antecedentes: La clasificación de la periodontitis recientemente introducida en el World Workshop de 2017, que incorpora estadios y grados de la enfermedad, tiene por objeto vincular la clasificación de la enfermedad con los enfoques preventivos y terapéuticos, ya que no solo describe su gravedad y el alcance, sino también el grado de complejidad y el riesgo de un individuo. Por lo tanto, es necesario contar con directrices clínicas basadas en la evidencia que ofrezcan recomendaciones para tratar la periodontitis. Objetivo: El objetivo del presente proyecto fue desarrollar una Guía de Práctica Clínica (CPG, por sus siglas en inglés, clinical practice guideline) de nivel S3 para el tratamiento de la periodontitis en los estadios I-III. Material y métodos: Estas CPG S3 se elaboraron bajo los auspicios de la Federación Europea de Periodoncia (EFP), siguiendo la orientación metodológica de la Asociación de Sociedades Médico-Científicas de Alemania y la estructura Grading of Recommendations Assessment, Development and Evaluation (GRADE). El proceso, riguroso y transparente, incluyó la síntesis de las investigaciones relevantes en 15 revisiones sistemáticas encargadas de manera específica, la evaluación de la calidad y la solidez de la evidencia, la formulación de recomendaciones específicas, así como lograr un acuerdo, sobre esas recomendaciones, por parte de expertos destacados y una amplia base de partes interesadas. Resultados: Estas CPG S3 abordan el tratamiento de la periodontitis (estadios I, II y III) utilizando un enfoque gradual preestablecido del tratamiento que, según el estadio de la enfermedad, debe ser incremental, incluyendo en cada caso diferentes intervenciones. Se llegó a un acuerdo sobre las recomendaciones relativas a las diferentes intervenciones, dirigidas a: i) cambios de comportamiento, control de biofilm supragingival, inflamación gingival y factores de riesgo; ii) instrumentación supragingival y subgingival, con y sin tratamientos coadyuvantes; iii) diferentes tipos de intervenciones quirúrgicas periodontales; y iv) el mantenimiento periodontal necesario para extender los beneficios a lo largo del tiempo. Conclusión: Esta Guía S3 informa a los clínicos, a los sistemas de salud, a los encargados de formular políticas sanitarias e, indirectamente, al público, sobre las modalidades disponibles y más eficaces para tratar la periodontitis y mantener una dentición sana durante toda la vida, de acuerdo con la evidencia disponible en el momento de su publicación.

First Report of Domoic Acid Production from Pseudo-nitzschia multistriata in Paracas Bay (Peru).

The Peruvian sea is one of the most productive ecosystems in the world. Phytoplankton production provides food for fish, mammals, mollusks and birds. This trophic network is affected by the presence of toxic phytoplankton species. In July 2017, samples of phytoplankton were obtained from Paracas Bay, an important zone for scallop (Argopecten purpuratus) aquaculture in Peru. Morphological analysis revealed the presence of the genus Pseudo-nitzschia, which was isolated and cultivated in laboratory conditions. Subsequently, the monoclonal cultures were observed by scanning electron microscopy (SEM), and identified as P. multistriata, based on both the morphological characteristics, and internal transcribed spacers region (ITS2) sequence phylogenetic analysis. Toxin analysis using liquid chromatography (LC) with high-resolution mass spectrometry (HRMS) revealed the presence of domoic acid (DA) with an estimated amount of 0.004 to 0.010 pg cell-1. This is the first report of DA from the coastal waters of Peru and its detection in P. multistriata indicates that it is a potential risk. Based on our results, routine monitoring of this genus should be considered in order to ensure public health.

Técnicas alternativas del manejo de la conducta en odontopediatría / Técnicas alternativas para a gestão comportamental em odontologia pediátrica / Alternative behavioral management techniques in pediatric dentistry

Diversas técnicas convencionales han sido utilizadas con gran eficacia; sin embargo, la no aceptación de algunas de ellas por los padres, ciertos condicionamientos éticos y legales así como cambios en la educación actual y el avance en nuevas tecnologías, obligan al odontólogo a un replanteamiento de actitudes. Objetivo: El objetivo del presente trabajo es identificar qué técnicas alternativas son empleadas en la clínica dental por los profesionales para el manejo de la conducta de pacientes infantiles. Material y métodos: Se realizó un cuestionario en la plataforma de Google, remitido vía email a 190 odonto/estomatólogos que tratasen pacientes infantiles, obteniendo una participación de 132 encuestas adecuadas para el análisis de 6 técnicas alternativas de manejo de la conducta. El estudio estadístico se realizó en el programa SPSS aplicando el test de ANOVA para una significación de p= 0,05. Resultados: Un 35,1% de los encuestados utilizaban medios audiovisuales para el tratamiento dental, siendo la televisión el más frecuentemente empleado. La musicoterapia fue la técnica más utilizada (70,5% de los participantes) con mayor frecuencia del sexo femenino, aunque sin diferencias significativas, siendo la música moderna la de mayor aceptación. Un 32,8% utilizaron la ludoterapia como técnica de manejo seguida del empleo de técnicas de relajación con un 25%, ambas con mayor porcentaje femenino. Las dos técnicas menos utilizadas fueron la aromaterapia (6,8%) y la hipnosis (2,3%). Conclusiones: A pesar del incremento en la utilización de técnicas alternativas en el manejo de la conducta, todavía su empleo es escaso por los odonto/estomatólogos.

Várias técnicas convencionais têm sido usadas com grande eficácia; contudo, a não aceitação de algumas delas pelos pais, certas condições éticas e legais, assim como as mudanças na educação atual e o avanço das novas tecnologias, forçam o dentista a repensar as atitudes. Objetivo: O objetivo do presente estudo é identificar quais técnicas alternativas são utilizadas na clínica odontológica por profissionais para gerenciar o comportamento de pacientes infantis. Material e métodos: Foi realizado um questionário na plataforma Google, enviado por e-mail a 190 dentistas/stomatologistas que trataram crianças, obtendo 132 pesquisas adequadas para a análise de 6 técnicas alternativas de gestão comportamental. O estudo estatístico foi realizado no programa SPSS aplicando o teste ANOVA para uma significância de p= 0,05. Resultados: 35,1% dos inquiridos utilizaram meios audiovisuais para tratamento dentário, sendo a televisão a mais frequentemente utilizada. A musicoterapia foi a técnica mais utilizada (70,5% dos participantes) pelo sexo feminino, embora sem diferenças significativas, sendo a música moderna a mais amplamente aceita. 32,8% utilizaram a terapia lúdica como técnica de gestão seguida do uso de técnicas de relaxamento com 25%, ambas com uma percentagem maior de mulheres. As duas técnicas menos utilizadas foram a aromaterapia (6,8%) e a hipnose (2,3%). Conclusões: Apesar do aumento do uso de técnicas alternativas na gestão do comportamento, o seu uso ainda é escasso pelos odontologistas/estomatologistas.

Various conventional techniques have been used with great efficiency; nevertheless, the non-acceptance of some of them by the parents, certain ethical and legal conditions as well as changes in the current education and the advance in new technologies, force the dentist to a rethinking of attitudes. Aim: The aim of this paper is to identify what alternative techniques are used by professionals for the behavior's management of pediatric patients in the dental clinic. Material and methods: A questionnaire was carried out on the Google platform, sent via email to 190 odonto / stomatologists who treated pediatric patients, obtaining a participation of 132 appropriate surveys for the analysis of 6 alternative behavior management techniques. The statistical study was carried out in the SPSS program, applying the ANOVA test for a significance of p = 0.05. Results: 35.1% of respondents used audiovisual media for dental treatment, being television the most frequently used. Music therapy was the most applied technique (70.5% of the participants) with the highest frequency of female sex, without significant differences though, being modern music the most widely accepted. 32.8% used play therapy as a management technique followed by the use of relaxation techniques with 25%, both with a higher female percentage. The two least used techniques were aromatherapy (6.8%) and hypnosis (2.3%). Conclusions: Despite the increase in the use of alternative techniques in behavior management, their use is still scarce by dentists / stomatologists.

Rapid Domoic Acid Depuration in the Scallop Argopecten purpuratus and Its Transfer from the Digestive Gland to Other Organs.

Domoic acid (DA), the main toxin responsible for Amnesic Shellfish Poisoning, frequently affects the marine resources of Chile and other countries across the South Pacific, thus becoming a risk for human health. One of the affected resources is the scallop Argopecten purpuratus. Even though this species has a high commercial importance in Northern Chile and Peru, the characteristics of its DA depuration are not known. In this work, the DA depuration was studied by means of two experiments: one in controlled (laboratory) and another in natural conditions. All organs of A. purpuratus depurated the toxin very quickly in both experiments. In some organs, an increase or a very small decrease of toxin was detected in the early depuration steps. Several models were used to describe this kinetics. The one that included toxin transfer between organs and independent depuration from each organ was the model that best fit the data. It seems, therefore, that the DA in this species is quickly transferred from the digestive gland to all other organs, which release it into the environment. Physiological differences in the two experiments have been shown to have some effect on the depuration from each organ but the actual reasons are still unknown.

Factores asociados a placa blanda en pacientes con score de calcio igual a cero / Factors Associated with Non-calcified Plaques in Patients with Coronary Artery Calcium Score of Zero

RESUMEN Introducción: El score de calcio es una prueba utilizada en la estratificación de riesgo de pacientes asintomáticos. Aunque la enfermedad coronaria puede producirse en ausencia de calcificaciones, no se han descripto afecciones asociadas a la presencia de placa blanda en este contexto, más allá de la presencia de síntomas. Objetivos: Determinar asociaciones entre la presencia de placa blanda y variables independientes en pacientes con un score de calcio de cero. Material y métodos: Se incluyeron pacientes consecutivos con un score de calcio de 0 unidades Agatston que se hubieran realizado, además, una angiotomografía coronaria. Se determinaron asociaciones a partir de análisis univariado. Se calculó la sensibilidad, especificidad, VPN, VPP, +LR y -LR. Resultados: Se incluyeron en el estudio 93 pacientes. El 10% (n = 9) presentaron placa blanda. La ergometría positiva se asoció a placas de cualquier gravedad (OR 6,5; IC del 95%: 1,3-33, p = 0,02). Esta asociación persistió para placas no graves cuando se combinó la ergometría positiva con perfusión miocárdica SPECT o ecocardiograma estrés negativos para isquemia (OR 12,4 IC 95% 1,5-101, p = 0,02). La sensibilidad y la especificidad del infradesnivel del ST para placa blanda de cualquier nivel de gravedad fue del 44,4% y del 86%, respectivamente. El VPN fue del 94% y el VPP del 25%, LR+ fue de 3,11 y LR- fue de 0,65. Conclusiones: El infradesnivel del ST se asociaría a la presencia de placa blanda en pacientes sin calcificaciones coronarias, incluso en contexto de perfusión miocárdica o motilidad parietal en esfuerzo normales (enfermedad no obstructiva).

ABSTRACT Background: The coronary artery calcium score is used for risk stratification in asymptomatic patients. Although coronary artery disease can occur in the absence of coronary artery calcifications, no conditions associated with the presence of soft non-calcified plaques have been described in this scenario, beyond the presence of symptoms. Objectives: The aim of this study was to determine the associations between non-calcified plaques and independent variables in patients with coronary artery calcium score of zero. Methods: Consecutive patients with coronary artery score of zero Agatston units who also underwent computed tomography coronary angiography were included in the study. Univariate logistic regression analysis was used to find associations. (15) Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LH+) and negative likelihood ratio (LH-) were calculated. Results: Among a total of 93 patients, 10% (n=9) presented non-calcified plaque. A positive exercise stress test was associated with plaques of any degree of severity (OR 6.5; 95% CI, 1.3-33, p=0.02). This association persisted for non-severe plaques when the positive exercise stress test was combined with a negative myocardial perfusion SPECT or stress echocardiography for ischemia (OR, 12.4; 95% CI 1.5-101, p=0.02). Sensitivity and specificity of ST-segment depression for non-calcified plaque of any degree of severity was 44.4% and 86%, respectively, with NPV of 94%, PPV of 25%, LR+ of 3.11 and LR- of 0.65. Conclusions: ST-segment depression could be associated with non-calcified plaques in patients without coronary artery calcifications, even with normal exercise stress myocardial perfusion or wall motion (non-obstructive disease).

Paralytic Shellfish Toxins in Surf Clams Mesodesma donacium during a Large Bloom of Alexandrium catenella Dinoflagellates Associated to an Intense Shellfish Mass Mortality.

In late February 2016, a harmful algal bloom (HAB) of Alexandrium catenella was detected in southern Chiloé, leading to the banning of shellfish harvesting in an extended geographical area (~500 km). On April 24, 2016, this bloom produced a massive beaching (an accumulation on the beach surface of dead or impaired organisms which were drifted ashore) of surf clams Mesodesma donacium in Cucao Bay, Chiloé. To determine the effect of paralytic shellfish poisoning (PSP) toxins in M. donacium, samples were taken from Cucao during the third massive beaching detected on May 3, 2016. Whole tissue toxicity evidence a high interindividual variability with values which ranged from 1008 to 8763 µg STX eq 100 g-1 and with a toxin profile dominated by GTX3, GTX1, GTX2, GTX4, and neoSTX. Individuals were dissected into digestive gland (DG), foot (FT), adductor muscle (MU), and other body fractions (OBF), and histopathological and toxin analyses were carried out on the obtained fractions. Some pathological conditions were observed in gill and digestive gland of 40⁻50% of the individuals that correspond to hemocyte aggregation and haemocytic infiltration, respectively. The most toxic tissue was DG (2221 µg STX eq 100 g-1), followed by OBF (710 µg STX eq 100 g-1), FT (297 µg STX eq 100 g-1), and MU (314 µg STX eq 100 g-1). The observed surf clam mortality seems to have been mainly due to the desiccation caused by the incapability of the clams to burrow. Considering the available information of the monitoring program and taking into account that this episode was the first detected along the open coast of the Pacific Ocean in southern Chiloé, it is very likely that the M. donacium population from Cucao Bay has not had a recurrent exposition to A. catenella and, consequently, that it has not been subjected to high selective pressure for PSP resistance. However, more research is needed to determine the effects of PSP toxins on behavioral and physiological responses, nerve sensitivity, and genetic/molecular basis for the resistance or sensitivity of M. donacium.

Toxin production, growth kinetics and molecular characterization of Ostreopsis cf. ovata isolated from Todos os Santos Bay, tropical southwestern Atlantic.

The toxin profile and hemolytic activity of a strain of Ostreopsis cf. ovata (UFBA013) isolated from Todos os Santos Bay (northeastern Brazil) were evaluated under different levels of N and P. Phylogenetic analyses based on ITS rDNA region (ITS1-5.8S-ITS2) placed UFBA013 within the Atlantic/Mediterranean/Pacific clade of O. cf. ovata. Growth experiments were conducted in f/2 medium modified by adding N and P (P: 0-36 µM; N: 0-882 µM). The growth kinetics was adequately described by logistic equations. The best growth (highest Gm) was recorded under levels of N/P = 0/18, 129/5 and 441/36, while one of the lowest Gm was obtained under P-depletion. The maximum and specific maximum growth rates (as vm; cells mL-1 d-1 and µm; d-1) were achieved with N limitation (N/P = 441/36) and P-limitation/depletion (753/5.3 and 441/0) and are the highest values reported in the literature, most similar to isolates from Pacific and Mediterranean areas. The control experiment (N/P = 441/18) also yielded similar values to those from some Mediterranean isolates, but higher than formerly reported for Brazilian isolates. In all conditions assayed, no palytoxin (PLTX) was detected. The ovatoxins (OVTXs) a, b, c, d and e did not show significant differences in cell quota between exponential and stationary phases. A significant relationship was detected between OVTXs concentration and hemolytic activity.