Application of CAD-CAM technology in the reconstruction of anterior teeth with implant restorations affected by growth changes in young adults: A clinical report.

Anterior implant-supported restorations can be challenging, but for a patient undergoing growth and development changes, clinical resolution becomes complex and demanding. To achieve successful outcomes, multidisciplinary dental therapy is required to manage esthetic consequences while maintaining a minimally invasive approach. This clinical report describes a comprehensive treatment protocol to address and treat growth and development complications for an implant-supported prosthesis. By combining computer-aided design and computer-aided manufacture technology and facially driven procedures, a predictable and favorable outcome was achieved.

Fabrication of facially guided CAD-CAM complete dentures: A dental technique.

An alternative protocol is presented to design computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures and overdentures using a facially guided digital design. The facially guided design protocol with CAD-CAM facilitated communication between the clinician and dental laboratory technician. A monolithic denture and overdenture were fabricated guided by preliminary dentures with 3-dimensionally (3D) printed denture bases and milled wax teeth.

Particle Swarm Optimisation Applied to the Direct Aperture Optimisation Problem in Radiation Therapy.

Intensity modulated radiation therapy (IMRT) is one of the most used techniques for cancer treatment. Using a linear accelerator, it delivers radiation directly at the cancerogenic cells in the tumour, reducing the impact of the radiation on the organs surrounding the tumour. The complexity of the IMRT problem forces researchers to subdivide it into three sub-problems that are addressed sequentially. Using this sequential approach, we first need to find a beam angle configuration that will be the set of irradiation points (beam angles) over which the tumour radiation is delivered. This first problem is called the Beam Angle Optimisation (BAO) problem. Then, we must optimise the radiation intensity delivered from each angle to the tumour. This second problem is called the Fluence Map Optimisation (FMO) problem. Finally, we need to generate a set of apertures for each beam angle, making the intensities computed in the previous step deliverable. This third problem is called the Sequencing problem. Solving these three sub-problems sequentially allows clinicians to obtain a treatment plan that can be delivered from a physical point of view. However, the obtained treatment plans generally have too many apertures, resulting in long delivery times. One strategy to avoid this problem is the Direct Aperture Optimisation (DAO) problem. In the DAO problem, the idea is to merge the FMO and the Sequencing problem. Hence, optimising the radiation's intensities considers the physical constraints of the delivery process. The DAO problem is usually modelled as a Mixed-Integer optimisation problem and aims to determine the aperture shapes and their corresponding radiation intensities, considering the physical constraints imposed by the Multi-Leaf Collimator device. In solving the DAO problem, generating clinically acceptable treatments without additional sequencing steps to deliver to the patients is possible. In this work, we propose to solve the DAO problem using the well-known Particle Swarm Optimisation (PSO) algorithm. Our approach integrates the use of mathematical programming to optimise the intensities and utilizes PSO to optimise the aperture shapes. Additionally, we introduce a reparation heuristic to enhance aperture shapes with minimal impact on the treatment plan. We apply our proposed algorithm to prostate cancer cases and compare our results with those obtained in the sequential approach. Results show that the PSO obtains competitive results compared to the sequential approach, receiving less radiation time (beam on time) and using the available apertures with major efficiency.

The retinoic acid response is a minor component of the cardiac phenotype in H9c2 myoblast differentiation.

The H9c2 myoblast cell line, isolated from the left ventricular tissue of rat, is currently used in vitro as a mimetic for skeletal and cardiac muscle due to its biochemical, morphological, and electrical/hormonal signaling properties. During culture, H9c2 cells acquire a myotube phenotype, where a critical component is the inclusion of retinoic acid (RA). The results from some authors on H9c2 suggested that thousands of genes respond to RA stimuli, while others report hundreds of genes responding to RA over different cell types. In this article, using a more appropriate experimental design, we first confirm the H9c2 cardiac phenotype with and without RA and report transcriptomic and physiological changes regarding calcium handling, bioenergetics, and other biological concepts. Interestingly, of the 2360 genes showing a transcriptional change, 622 genes were statistically associated with the RA response. Of these genes, only 305 were RA-specific, and the rest also showed a culture-time component. Thus, the major expression changes (from 74 to 87%) were indeed due to culture conditions over time. Unexpectedly, only a few components of the retinol pathway in KEGG responded to RA. Our results show the role of RA in the H9c2 cultures impacting the interpretation using H9c2 as an in vitro model.

[Genotyping and its applications, a look to the future]. / Genotipificación y sus aplicaciones, una mirada hacia el futuro.

The detection of the most significant erythrocyte antigens present in each one of the individuals is fundamental when carrying out a transfusion or a transplant. Detection to date is performed by conventional serological methods through the antigen-antibody reaction. But several drawbacks may arise depending on the pathology under study, limiting the availability of blood components. Molecular methods such as genotyping is a tool that complements sensitivity and specificity and has come to revolutionize immunohematology in the blood bank, allowing not only the detection of erythrocyte antigens but also platelet antigens. These methodologies are applicable in patients and in large-scale donors, starting from the allelic variants present in each of the genes that code for the antigens of clinical interest, using microarray systems or systems based on particles labeled with specific probes or their variants that allow an analysis from the immunohematological point of view.

La detección de los antígenos eritrocitarios más significativos presentes en cada uno de los individuos es fundamental cuando se lleva a cabo una transfusión o un trasplante. La detección a la fecha se realiza mediante métodos serológicos convencionales a través de la reacción de antígeno-anticuerpo. Pero se pueden presentar varios inconvenientes dependiendo de la patología en estudio, lo cual limita la disponibilidad de los hemocomponentes. Los métodos moleculares, como la genotipificación, son una herramienta que complementa la sensibilidad y especificidad y que han venido a revolucionar la inmunohematología en el banco de sangre, lo cual permite no solo la detención de antígenos eritrocitarios sino también la de antígenos plaquetarios. Estas metodologías son aplicables en pacientes y en donantes a gran escala, partiendo de las variantes alélicas presentes en cada uno de los genes que codifican para los antígenos de interés clínico, utilizando los sistemas de microarreglos o los sistemas basados en partículas marcadas con sondas específicas o sus variantes que permiten un análisis desde el punto de vista inmunohematológico.

Measurement of post-transfusion red blood cell survival kinetics in sickle cell disease and ß-Thalassemia: A biotin label approach.

BACKGROUND: Red blood cell (RBC) transfusions are an important treatment modality for patients with sickle cell disease (SCD) and ß-thalassemia. A subgroup of these patients relies on a chronic RBC transfusion regimen. Little is known about RBC survival (RCS) of the transfused allogeneic RBCs. In this study, we aimed to study the RCS kinetics of transfused RBCs in SCD and ß-thalassemia and to investigate factors that determine RCS. METHODS AND MATERIALS: We performed a prospective cohort study on fourteen adults with SCD and ß-thalassemia disease receiving a chronic transfusion regimen. RCS and the influence of donor and patient characteristics on RCS were assessed by simultaneous transfusion of two allogeneic RBCs using RBC biotinylation. Phenotyping of well-known RBC markers over time was performed using flow cytometry. RESULTS: RCS of the two transfused RBC units was similar in most patients. Although intra-individual variation was small, inter-individual variation in RCS kinetics was observed. Most patients demonstrated a non-linear trend in RCS that was different from the observed linear RCS kinetics in healthy volunteers. After an initial slight increase in the proportion of biotinylated RBCs during the first 24 h, a rapid decrease within the first 10-12 days was followed by a slower clearance rate. CONCLUSION: These are the first data to demonstrate that patient-related factors largely determine post-transfusion RCS behavior of donor RBC in SCD and ß-thalassemia, while donor factors exert a negligible effect. Further assessment and modeling of RCS kinetics and its determinants in SCD and ß-thalassemia patients may ultimately improve transfusion therapy.

Modelo de gestión de riesgo del programa de recuperación precoz de la cirugía colorectal electiva / Risk management model of the early recovery program of the elective colorectal surgery

Introducción: La gestión de riesgo perioperatorio sustentado en los programas o protocolos de recuperación precoz o mejorada después de la cirugía valida la calidad en los cuidados perioperatorios con disminución de la incidencia de morbilidad y mortalidad basado en la evidencia de un conjunto de acciones que cubren todo el período perioperatorio. Objetivo: Validar el programa de recuperación precoz después de la cirugía colorectal en los pacientes quirúrgicos electivos en los hospitales Provincial Docente de Oncología María Curie, Universitario Manuel Ascunce Domenech de la provincia de Camagüey y General Universitario Carlos Manuel de Céspedes y del Castillo en la provincia de Granma. Métodos: La investigación se ejecutó en dos fases. En la Fase I se realizó validación externa e interna del programa de recuperación precoz de la cirugía colorectal electiva por consulta de expertos mediante escala Likert. En la Fase II se realizó un estudio piloto experimental con dos grupos de 119 pacientes cada uno. Resultados: La mayor parte de los pacientes del grupo de estudio, 97,5 por ciento tuvieron una recuperación precoz óptima basada en no dolor, no íleo paralítico, no complicaciones cardiovasculares, ni respiratorias perioperatorias. El 94,1 por ciento de grupo de estudio egresó en condición de vivo, con una estadía de cinco días en promedio, inferior a los nueve del grupo control. Conclusiones: El programa de recuperación precoz muestra disminución de la incidencia de morbilidad y mortalidad así como reducción de estadía hospitalaria. Con beneficios tanto para el paciente como para los servicios de salud(AU)

Introduction: Perioperative risk management supported by programs or protocols for early or improved recovery after surgery validates the quality of perioperative care, with a decrease in the incidence of morbidity and mortality based on the evidence of a set of actions covering the entire perioperative period. Objective: To validate the program for early recovery after colorectal surgery in elective surgical patients at María Curie Provincial Teaching Oncological Hospital and Manuel Ascunce Domenech University Hospital, both in Camagüey Province, as well as at Carlos Manuel de Céspedes General University Hospital in Granma Province. Methods: The research was carried out in two phases. In phase I, external and internal validation of the early recovery program for elective colorectal surgery was carried out by means of expert consultation using a Likert scale. In phase II, an experimental pilot study was carried out with two groups of 119 patients each. Results: Most of the patients in the study group (97.5 percent) had optimal early recovery, based on the fact that they did not present pain, paralytic ileus, either cardiovascular or respiratory complications perioperatively. 94.1 percent of the patients in the study group were discharged in the condition of living, with an average hospital stay of five days, lower than the nine days of the control group. Conclusions: The early recovery program shows a decrease in the incidence of morbidity and mortality, as well as a reduction in hospital stay, with benefits for both the patient and the health services(AU)

Ayuno preoperatorio / Preoperative fasting

La broncoaspiración es una de las complicaciones más temidas por parte de los anestesiólogos durante todo el periodo perioperatorio. Desde hace más de un siglo, con el propósito de evitar esta complicación, se ha implementado el ayuno preoperatorio, periodo en el cual el paciente no ingiere alimentos para disminuir el contenido gástrico. El objetivo de este artículo es realizar una revisión de los aspectos más destacados y actuales sobre el ayuno preoperatorio. Para lo cual se realizó una búsqueda manual y digital en diferentes bases de datos como MEDLINE, Scielo, IBECS y Cochrane, con los descriptores siguientes: ayuno preoperatorio, efectos del ayuno. Cuando surge el concepto de ayuno preoperatorio el paciente debía estar más de 8 horas sin alimentarse, provocando esto no solo sensación de hambre, sed, irritabilidad, sino que también provocaba serias alteraciones endocrinometabólicas. Según las últimas recomendaciones, basadas en la evidencia científica, se aconseja seguir los siguientes tiempos de ayuno quirúrgico: 2 h para líquidos claros, 4 h para leche materna, 6 h para la leche de vaca, 8 h para sólidos. En conclusión, se considera que un periodo prolongado sin ingerir alimentos antes de la intervención quirúrgica lejos de ser beneficioso es deletéreo para el buen pronóstico del paciente(AU)

Bronchoa aspiration is one of the most feared complications by anesthesiologists throughout the perioperative period. For more than a century, in order to avoid this complication, preoperative fasting has been implemented, a period in which the patient does not eat food to decrease the gastric content. The purpose of this article is to review the highlights and current aspects of preoperative fasting. For which a manual and digital search was carried out in different databases such as MEDLINE, Scielo, IBECS and Cochrane, with the following descriptors: preoperative fasting, fasting effects. When the concept of preoperative fasting arises the patient had to spend more than 8 hours without feeding, causing this not only feeling hungry, thirsty, irritating, but also causing serious endocrine-metabolic alterations. According to the latest recommendations, based on scientific evidence, it is advised to follow the following times of surgical fasting: 2 h for clear liquids, 4 h for breast milk, 6 h for cow's milk, 8 h for solids. In conclusion, it is considered that an extended period without ingesting food before surgery far from being beneficial is deterreal for the patient's good prognosis(EU)

Ayuno preoperatorio / Preoperative fasting / Jejum pré-operatório

RESUMEN La broncoaspiración es una de las complicaciones más temidas por parte de los anestesiólogos durante todo el periodo perioperatorio. Desde hace más de un siglo, con el propósito de evitar esta complicación, se ha implementado el ayuno preoperatorio, periodo en el cual el paciente no ingiere alimentos para disminuir el contenido gástrico. El objetivo de este artículo es realizar una revisión de los aspectos más destacados y actuales sobre el ayuno preoperatorio. Para lo cual se realizó una búsqueda manual y digital en diferentes bases de datos como MEDLINE, Scielo, IBECS y Cochrane, con los descriptores siguientes: ayuno preoperatorio, efectos del ayuno. Cuando surge el concepto de ayuno preoperatorio el paciente debía estar más de 8 horas sin alimentarse, provocando esto no solo sensación de hambre, sed, irritabilidad, sino que también provocaba serias alteraciones endocrinometabólicas. Según las últimas recomendaciones, basadas en la evidencia científica, se aconseja seguir los siguientes tiempos de ayuno quirúrgico: 2 h para líquidos claros, 4 h para leche materna, 6 h para la leche de vaca, 8 h para sólidos. En conclusión, se considera que un periodo prolongado sin ingerir alimentos antes de la intervención quirúrgica lejos de ser beneficioso es deletéreo para el buen pronóstico del paciente.

ABSTRACT Bronchoa aspiration is one of the most feared complications by anesthesiologists throughout the perioperative period. For more than a century, in order to avoid this complication, preoperative fasting has been implemented, a period in which the patient does not eat food to decrease the gastric content. The purpose of this article is to review the highlights and current aspects of preoperative fasting. For which a manual and digital search was carried out in different databases such as MEDLINE, Scielo, IBECS and Cochrane, with the following descriptors: preoperative fasting, fasting effects. When the concept of preoperative fasting arises the patient had to spend more than 8 hours without feeding, causing this not only feeling hungry, thirsty, irritating, but also causing serious endocrine-metabolic alterations. According to the latest recommendations, based on scientific evidence, it is advised to follow the following times of surgical fasting: 2 h for clear liquids, 4 h for breast milk, 6 h for cow's milk, 8 h for solids. In conclusion, it is considered that an extended period without ingesting food before surgery far from being beneficial is deterreal for the patient's good prognosis.

RESUMO A aspiração de broncoa é uma das complicações mais temidas pelos anestesiologistas durante todo o período perioperatório. Há mais de um século, para evitar essa complicação, o jejum pré-operatório vem sendo implementado, período em que o paciente não come alimentos para diminuir o teor gástrico. O objetivo deste artigo é rever os destaques e os aspectos atuais do jejum pré-operatório. Para o qual foi realizada uma pesquisa manual e digital em diferentes bancos de dados como MEDLINE, Scielo, IBECS e Cochrane, com os seguintes descritores: jejum pré-operatório, efeitos de jejum. Quando surge o conceito de jejum pré-operatório, o paciente teve que passar mais de 8 horas sem se alimentar, fazendo com que isso não só se sentisse com fome, sede, irritando, mas também causando graves alterações endócrinas-metabólicas. De acordo com as últimas recomendações, com base em evidências científicas, é aconselhável seguir os seguintes tempos de jejum cirúrgico: 2h para líquidos claros, 4h para leite materno, 6h para leite de vaca, 8h para sólidos. Em conclusão, considera-se que um longo período sem ingerir alimentos antes da cirurgia longe de ser benéfico é distensão para o bom prognóstico do paciente.

Factores que al ingreso influyen en la evolución de pacientes con diagnóstico de pancreatitis aguda / Factor that, upon Hospitalization, Influence the Evolution of Patients with a Diagnosis of Acute Pancreatitis

RESUMEN Introducción: La pancreatitis aguda es un proceso inflamatorio que daña reversiblemente el parénquima pancreático. Es una enfermedad engañosa y variable en el tiempo; una identificación oportuna de los signos de gravedad mejora el pronóstico y reduce la mortalidad. Objetivos: Establecer los factores que al ingreso influyen en la evolución de pacientes con diagnóstico de pancreatitis aguda e identificar la relación de los hallazgos tomográficos y ecográficos al ingreso, con la evolución de estos pacientes. Métodos: Se realizó un estudio cuantitativo, observacional y descriptivo en pacientes con diagnóstico de pancreatitis aguda, en el Hospital General Docente Provincial "Carlos Manuel de Céspedes". Resultados: La edad media fue 51,l7 años y el 60,49 por ciento de los pacientes eran del sexo masculino. La supervivencia fue 93,83 por ciento. El síndrome de respuesta inflamatoria sistémica, la disfunción de uno o más órganos, la realización de la intervención quirúrgica, la frecuencia cardiaca mayor de 90 latidos/minutos, la taquipnea, el valor de la glucemia mayor de 6,5 mmol/L y el valor del conteo de leucocitos mayor de 11,0 x 109/L, resultaron en factores de riesgo que, al ingreso, influyeron en la evolución de los pacientes hacia la muerte. Conclusiones: El síndrome de respuesta inflamatoria sistémica fue el principal factor de riesgo y la variable que mayor influencia tuvo en la evolución hacia la muerte de los pacientes estudiados, seguido de la disfunción de órganos y la realización de la intervención quirúrgica. El resto de las variables estudiadas no influyeron en la evolución de pacientes con diagnóstico de pancreatitis aguda(AU)

ABSTRACT Introduction: Acute pancreatitis is an inflammatory process that reversibly damages the pancreatic parenchyma. It is, through time, a deceitful and variable disease; timely identification of the signs of severity improves the prognosis and reduces mortality. Objective: To establish the factors that, upon hospitalization, influence the evolution of patients diagnosed with acute pancreatitis. Methods: A quantitative, observational and descriptive study with analytical phases was carried out in patients diagnosed with acute pancreatitis, at Carlos Manuel de Céspedes Provincial General Hospital. Results: The mean age was 51,17 years, while 60.49 percent of the patients were male. Survival was 93.83 percent. Systemic inflammatory response syndrome, dysfunction of one or more organs, performance of surgical intervention, heart rate higher than 90 beats per minute, tachypnea, glycemic value over 6.5 mmol/L, and white blood cell count value greater than 11.0x109/L, resulted in risk factors that, upon admission, influenced the evolution of patients towards death. Conclusions: Systemic inflammatory response syndrome was the main risk factor and the variable that had the greatest influence on the evolution towards death of the patients studied, followed by organ dysfunction and the performance of surgical intervention. The rest of the variables studied did not influence the evolution of patients diagnosed with acute pancreatitis(AU)

Analgesia preventiva con microdosis de ketamina en pacientes operados con anestesia general / Preemtive analgesia with micro doses of ketamine in patients under general anesthesia

INTRODUCTION: Acute postoperative pain is a complex physiological reaction to tissue injury or disease. Ketamine, an NMDA receptor antagonist, is the only intravenous anesthetic with hypnotic, analgesic and amnesic properties. OBJECTIVE: To evaluate the effectiveness of the administration of ketamine microdosis in patients operated with general anesthesia. METHODS: A prospective, quasi-experimental, controlled, double-blind study was conducted in patients operated under general anesthesia by the General Surgery service at the University Carlos Carlos de Céspedes University Hospital in Bayamo, in the period from January 2016 to December 2018. RESULTS: Age was homogeneous in both groups. The female sex prevailed in both groups without significant differences. There is a similarity in the mean ENV scores in the study group throughout the entire follow-up, never reaching 2 points. On the contrary, the patients in the control group, obtained throughout the follow-up an average score around 3 points. A lower opioid demand is observed in the group to which the ketamine microdose was administered. Hemodynamic parameters (heart rate, systolic and diastolic blood pressure) remained stable throughout the study period without statistically significant differences between the two. CONCLUSIONS: The administration of ketamine microdosis, as preventive analgesia in patients operated with general anesthesia, has proven effective in the control of acute postoperative pain.

INTRODUCCIÓN: El dolor postoperatorio agudo es una reacción fisiológica compleja a la lesión tisular o enfermedad. La ketamina, antagonista del receptor NMDA, es el único anestésico intravenoso con propiedades hipnóticas, analgésicas y amnésicas. OBJETIVO: Evaluar la efectividad de la administración de microdosis de ketamina en pacientes operados con anestesia general. MÉTODOS: Se realizó un estudio prospectivo, cuasi experimental, controlado, doble ciego en pacientes operados con anestesia general por el Servicio de Cirugía General en el Hospital Provincial Universitario "Carlos Manuel de Céspedes" de Bayamo, en el período comprendido desde enero de 2016 hasta diciembre de 2018. RESULTADOS: La edad fue homogénea en ambos grupos. El sexo femenino predominó en ambos grupos sin diferencias significativas. Hay una similitud en las puntuaciones medias de la ENV en el grupo estudio a lo largo de todo el seguimiento, nunca llegando a los 2 puntos. Por el contrario, los pacientes del grupo control, obtuvieron a lo largo de todo el seguimiento una puntuación media en torno a los 3 puntos. Se observa una demanda de opioide inferior en el grupo al que se le administró la microdosis de ketamina. Los parámetros hemodinámicos (frecuencia cardíaca, presión arterial sistólica y diastólica) permanecieron estables durante todo el periodo de estudio sin diferencias estadísticamente significativas entre ambos. CONCLUSIONES: La administración de microdosis de ketamina, como analgesia preventiva en pacientes operados con anestesia general, ha demostrado ser efectiva en el control del dolor agudo postoperatorio.

Anestesia y ventilación unipulmonar para bullectomía mínimamente invasiva. A propósito de un caso / Case report: Anesthesia and single lung ventilation for minimally invasive bullectomy

Introduction: Chronic obstructive pulmonary disease is an underdiagnosed disease; it is one of the pulmonary diseases with the greatest impact on health worldwide. Objective: To describe the anesthetic conduct carried out in a patient who undergoes surgical intervention to practice bullectomy of the right lung. Clinical case: We present the case of a 42-year-old smoker who was admitted a month ago with bilateral pneumothorax due to emphysematous bullae. He underwent anesthesia and multimodal analgesia to undergo bullectomy, achieving a good recovery and without complications. Conclusions: The use of controlled ventilation strategies in volume control mode regulated by pressure. Combined anesthesia and multimodal analgesia as well as respiratory physiotherapy in patients who will undergo surgery to perform bullectomy is a good anesthetic strategy that guarantees an adequate recovery of the patient.

Introducción: La enfermedad pulmonar obstructiva crónica es una enfermedad infradiagnosticada, es uno de los padecimientos pulmonares con mayor repercusión en la salud a nivel mundial. Objetivo: Describir la conducta anestésica llevada a cabo en un paciente que se interviene quirúrgicamente para practicarle bullectomía de pulmón derecho. Caso clínico: Se presenta el caso de un paciente de 42 años de edad, fumador que ingresa hace un mes con neumotórax bilateral por bullas enfisematosas, se le realiza anestesia y analgesia multimodal, para realizarle bullectomía, logrando una buena recuperación del mismo y sin complicaciones. Conclusiones: La utilización de estrategias de ventilación controladas en modalidad volumen control regulada por presión. Anestesia combinada y analgesia multimodal, además, de una fisioterapia respiratoria en pacientes que serán operados para realizarles bullectomía es una buena estrategia anestésica que garantiza una adecuada recuperación del enfermo.

Analgesia preventiva con diclofenaco endovenoso en niños operados por cirugía general de forma electiva / Preventive analgesia with intravenous diclofenac for elective paediatric general surgery

Introducción: El dolor es un síntoma tan antiguo como la propia humanidad y ha formado parte inseparable de esta. Objetivo: Evaluar la efectividad de la analgesia preventiva con diclofenaco en el dolor posoperatorio en niños operados por cirugía general electiva. Método: Se realizó un estudio prospectivo, cuasiexperimental, en 230 niños operados por cirugía general electiva. La muestra se distribuyó en dos grupos; analgesia preventiva con diclofenaco (grupo estudio), versus dipirona por vía rectal (grupo control). Las variables analizadas fueron intensidad del dolor, modificaciones hemodinámicas, evolución clínica y eventos adversos. Resultados: En ambos grupos prevalecieron los pacientes entre los 6 y 10 años de edad. En el grupo estudio, el dolor apareció a partir de las 6 h después de la operación, en solo 23 pacientes. No así en el grupo control que desde las 4 h, 19 pacientes refirieron dolor. En el grupo estudio los 23 pacientes tuvieron aproximadamente 2 h de duración del dolor y de ellos, solo 4 con intensidad severa; mientras que en el control 65 refirieron 2 h de dolor y el resto lo refirieron durante 4 h a pesar del rescate analgésico. Nueve de ellos, presentaron intensidad severa. Algunos pacientes presentaron modificaciones de la tensión arterial, frecuencia cardiaca y respiratoria asociadas al dolor. Los efectos adversos frecuentes fueron náuseas y vómitos. Conclusiones: La administración preventiva de diclofenaco disminuye la intensidad del dolor posoperatorio en los procedimientos quirúrgicos de cirugía general electiva en niños(AU)

Introduction: Pain is a symptom as old as humanity itself and has been an inseparable part of it. Objective: To evaluate the effectiveness of preventive analgesia with diclofenac for postoperative pain in elective paediatric general surgery. Methods: A prospective, quasi-experimental study was carried out with 230 children who underwent elective general surgery. The sample was divided into two groups: preventive analgesia with diclofenac (study group) versus dipyrone by the rectal way (control group). The variables analyzed were pain intensity, hemodynamic modifications, clinical evolution and adverse events. Results: In both groups, patients aged 6-10 years of age prevailed. In the study group, pain onset occurred at 6 hours after surgery, in only 23 patients; not being that way in the control group, in which, at 4 hours, 19 patients reported pain. In the study group, the 23 patients had approximately 2 hours of pain duration and, among them, only 4 hours with severe intensity; while in the control group, 65 patients reported 2 hours of pain and the rest referred it for 4 hours despite the analgesic rescue. Nine of them presented severe intensity. Some patients presented changes in blood pressure, heart rate and breathing associated with pain. The frequent adverse effects include nausea and vomiting. Conclusions: The preventive administration of diclofenac decreases the intensity of posoperative pain in surgical procedures of elective paediatric general surgery(AU)

Combining Multi-Scale Wavelet Entropy and Kernelized Classification for Bearing Multi-Fault Diagnosis.

Discriminative feature extraction and rolling element bearing failure diagnostics are very important to ensure the reliability of rotating machines. Therefore, in this paper, we propose multi-scale wavelet Shannon entropy as a discriminative fault feature to improve the diagnosis accuracy of bearing fault under variable work conditions. To compute the multi-scale wavelet entropy, we consider integrating stationary wavelet packet transform with both dispersion (SWPDE) and permutation (SWPPE) entropies. The multi-scale entropy features extracted by our proposed methods are then passed on to the kernel extreme learning machine (KELM) classifier to diagnose bearing failure types with different severities. In the end, both the SWPDE-KELM and the SWPPE-KELM methods are evaluated on two bearing vibration signal databases. We compare these two feature extraction methods to a recently proposed method called stationary wavelet packet singular value entropy (SWPSVE). Based on our results, we can say that the diagnosis accuracy obtained by the SWPDE-KELM method is slightly better than the SWPPE-KELM method and they both significantly outperform the SWPSVE-KELM method.

Stationary Wavelet-Fourier Entropy and Kernel Extreme Learning for Bearing Multi-Fault Diagnosis.

Bearing fault diagnosis methods play an important role in rotating machine health monitoring. In recent years, various intelligent fault diagnosis methods have been proposed, which are mainly based on the features extraction method combined with either shallow or deep learning methods. During the last few years, Shannon entropy features have been widely used in machine health monitoring, improving the accuracy of the bearing fault diagnosis process. Therefore, in this paper, we consider the combination of multi-scale stationary wavelet packet analysis with the Fourier amplitude spectrum to obtain a new discriminative Shannon entropy feature that we call stationary wavelet packet Fourier entropy (SWPFE). Features extracted by our SWPFE method are then passed onto a shallow kernel extreme learning machine (KELM) classifier to diagnose bearing failure types with different severities. The proposed method was applied on two experimental vibration signal databases of a rolling element bearing and compared to two recently proposed methods called stationary wavelet packet permutation entropy (SWPPE) and stationary wavelet packet dispersion entropy (SWPPE). Based on our results, we can say that the proposed method is able to achieve better accuracy levels than both the SWPPE and SWPDE methods using fewer failure features. Further, as our method does not require any hyperparameter calibration step, it is less dependent on user experience/expertise.

Factores de riesgo asociados a complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia / Risk factors associated with anesthetic complications in chronic renal patients undergoing emergency surgery

INTRODUCTION: Chronic kidney disease is a clinical entity secondary to the common final pathway of multiple etiologies with risk factors common to other chronic diseases. OBJECTIVE: To identify the risk factors related to the appearance of anesthetic complications in chronic renal patients undergoing emergency surgery. METHOD: A prospective cohort study was performed in patients with chronic kidney disease undergoing emergency surgery. The exposed cohort consisted of 15 patients with chronic kidney disease who developed complications during the study period. RESULTS: Age over 40 years, patients with ischemic heart disease and hypertensive patients presented a higher risk of anesthetic complications. Obesity and bronchial asthma were no risk factors. It was demonstrated that when the time elapsed between hemodialysis and the operation was less than 2 hours, the risk of anesthetic complications increased, the stage of the disease and the associated drugs were not related to the appearance of complications. Patients who received general anesthesia had three times more risk of complications than those under regional anesthesia. CONCLUSIONS: Age, arterial hypertension, ischemic heart disease, heart failure and the use of general anesthesia are risk factors associated with complications.

INTRODUCCIÓN: La enfermedad renal crónica es una entidad clínica secundaria a la vía final común de múltiples etiologías con factores de riesgo comunes a otras enfermedades crónicas. OBJETIVO: Identificar los factores de riesgo relacionados con la aparición de complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia. MÉTODO: Se realizó un estudio de cohorte prospectivo en pacientes con enfermedad renal crónica intervenidos por cirugía general de urgencia. La cohorte expuesta estuvo constituida por 15 pacientes con enfermedad renal crónica que desarrollaron complicaciones en el período en estudio. RESULTADOS: La edad mayor o igual a 40 años, los pacientes con cardiopatía isquémica y los hipertensos presentaron mayor riesgo de complicaciones anestésicas, no así la obesidad al igual que el asma bronquial. Se demostró que cuando el tiempo transcurrido entre la hemodiálisis y la operación fue inferior a 2 horas se incrementó el riesgo de complicaciones anestésicas, el estadio de la enfermedad y los medicamentos asociados no estuvieron relacionados con la aparición de complicaciones. Los pacientes a los que se administró anestesia general tuvieron tres veces más riesgo de complicaciones que aquellos que fueron intervenidos con anestesia regional. CONCLUSIONES: La edad, la hipertensión arterial, la cardiopatía isquémica, la insuficiencia cardiaca y el empleo de anestesia general son factores de riesgo asociados a complicaciones, en los pacientes portadores de IRC, sometidos a cirugía de urgencia.

¿Por qué el propofol en el paciente con cáncer? / ¿Why propofol in the cancer patient?

INTRODUCTION: Cancer is a chronic, incapacitating and high mortality disease. OBJECTIVE: To carry out an update on the beneficial properties of the use of propofol as an anesthetic agent in cancer patients. METHODOLOGICAL DESIGN: A manual and digital search was performed in different databases such as MEDLINE, Scielo, IBECS and Cochrane, with the following descriptors: propofol, cancer, immunity and cancer. Development: 90% of deaths related to cancer are due to the progression of the disease, to metastases and not to the primary tumor. Therefore, preventing immunosuppression in the perioperative period is particularly important. During the perioperative period, there are factors that activate or inhibit immune responses. Recent findings have suggested that anesthesia can induce metabolic, inflammatory and immunological changes in the perioperative period. Propofol promotes the cytotoxicity of natural killer cells, reduces the motility of tumor cells, inhibits cyclo-oxygenase. It has been revealed that this drug exhibits anticancer properties in some types of cancer: colon cancer, gastric cancer, bile duct cancer. CONCLUSIONS: Propofol has a potential benefit as an anesthetic agent in patient with cancer. Only the accumulation of even more scientific evidence would allow us to give greater value to the use of this drug.

INTRODUCCIÓN: El cáncer es una enfermedad crónica, incapacitante y de gran mortalidad. OBJETIVO: Realizar una actualización sobre las beneficiosas propiedades del uso del propofol como agente anestésico en el paciente oncológico. DISEÑO METODOLÓGICO: Se realizó una búsqueda manual y digital en diferentes bases de datos como MEDLINE, Scielo, IBECS y Cochrane, con los descriptores siguientes: propofol, cáncer, inmunidad y cáncer. Desarrollo: El 90% de las muertes relacionadas con el cáncer son debido a la progresión de la enfermedad, a las metástasis y no al tumor primario. Por ello, prevenir la inmunosupresión en el período perioperatorio toma particular importancia. Durante el periodo perioperatorio existen factores que activan o inhiben las respuestas inmunitarias. Los descubrimientos recientes han sugerido que la anestesia puede inducir cambios metabólicos, inflamatorios e inmunológicos en el período perioperatorio. El propofol favorece la citotoxicidad de las células naturalkiller, reduce la motilidad de las células tumorales, inhibe la ciclooxigenasa. Ha sido revelado que este fármaco exhibe propiedades anticancerosas en algunos tipos de cáncer: cáncer de colon, cáncer gástrico, cáncer de vías biliares. CONCLUSIONES: El propofol presenta un potencial beneficio como agente anestésico en el paciente con cáncer. Solo bastaría la acumulación de aún más evidencia científica que nos permita darle mayor valor al uso de este fármaco.

Infusión continua de lidocaína en pacientes operados de cirugía oncológica. Serie de casos / Continuous infusion of lidocaine in patients operated on oncological surgery. Series of cases

El uso de lidocaína intravenosa para el control del dolor posoperatorio ha ganado interés en los últimos años. Su aplicación en el periodo perioperatorio a dosis bajas y similares a las usadas para la profilaxis de arritmias, reduce el dolor y el consumo de opioides en el posoperatorio. La presente investigación se realizó con el objetivo de describir la eficacia de la utilización de la lidocaína en infusión continua intraoperatoria para lograr una disminución del dolor y complicaciones posoperatorias. Se describe la respuesta clínica de una serie de 17 casos de pacientes operados de cirugía abdominal oncológica a los que se les administró infusión continua de lidocaína. A estos pacientes se les evaluó la intensidad del dolor con la escala visual análoga. Esta se aplicó a los 30 minutos, 2, 6, 12 y 24 horas después de la operación. Se evaluó la presencia de complicaciones intraoperatorias y posoperatorias. El 58 por ciento de los pacientes fueron masculinos. Se logró una intensidad del dolor de leve a moderado, con necesidad de administrar solo a 6 pacientes tramadol en el posoperatorio. La infusión de lidocaína intraoperatoria constituye una opción en los pacientes en quienes la administración de opioides sea desfavorable(AU)

The use of intravenous lidocaine for the control of postoperative pain has gained interest in recent years. Its application in the perioperative period at low doses and similar to those used for the prophylaxis of arrhythmias, reduces pain and opioid consumption in the postoperative period. The present investigation was carried out with the objective of describing the efficacy of the use of lidocaine in continuous intraoperative infusion to achieve a decrease in pain and postoperative complications. We describe the clinical response of a series of 17 cases of patients operated on oncological abdominal surgery who were given continuous infusion of lidocaine. These patients were evaluated for pain intensity with the visual analogue scale. This was applied at 30 minutes, 2, 6, 12 and 24 hours after the operation. The presence of intraoperative and postoperative complications was evaluated. 58 percent of the patients were male. A mild to moderate intensity of pain was achieved, with the need to administer only 6 tramadol patients in the postoperative period. The infusion of intraoperative lidocaine is an option in patients in whom the administration of opioids is unfavourable(EU)

Administración de lidocaína en infusión continua en pacientes sometidos a procedimientos quirúrgicos abdominales oncológicos / Administration of lidocaine by continuous infusion in patients undergoing oncological adnominal surgical procedures

Introducción: La administración de lidocaína intravenosa para el control del dolor posoperatorio ha ganado interés. Su aplicación en el periodo perioperatorio a dosis baja reduce el dolor y el consumo de opioides en el posoperatorio. Objetivo: Evaluar la eficacia de la administración de lidocaína en infusión continua en el tratamiento del dolor posoperatorio en pacientes intervenidos quirúrgicamente por enfermedad abdominal oncológica. Métodos: Se realizó un estudio cuasi experimental en pacientes intervenidos por procedimiento quirúrgico abdominal oncológico a quienes se les administró infusión continua de lidocaína. Seguidamente se les evaluó la intensidad del dolor con la escala visual análoga. Esta se aplicó a los 30 min, 2, 6, 12 y 24 h después de la operación. Se determinó la presencia o no de complicaciones intra- y posoperatorias. Resultados: Los pacientes entre 31 y 50 años de edad prevalecieron en ambos grupos. El sexo masculino predominó en el grupo estudio y el femenino en el control. En el grupo estudio la respuesta no fue satisfactoria solo en dos pacientes, en 11 pacientes fue satisfactoria, en el testigo en cinco pacientes fue no satisfactoria. En el grupo estudio tres pacientes tuvieron dolor por menos de 2 h y fue catalogado entre ligero y moderado. En el control 12 presentaron dolor por más de 4 h catalogado entre moderado y grave. En dos pacientes aparecieron efectos adversos. Conclusiones: Con la administración de lidocaína se logra una disminución del dolor y del consumo de opioides(AU)

Introduction: The intravenous administration of lidocaine for postoperative pain control has gained interest. Its administration in the perioperative period and at a low dose reduces postoperative pain and opioid use. Objective: To evaluate the effectiveness of continuous infusion of lidocaine in the treatment of postoperative pain in surgically intervened patients with oncologic abdominal disease. Methods: A quasiexperimental study was performed in patients undergoing oncologic abdominal surgical procedures and who were given continuous infusion of lidocaine. The pain intensity was then evaluated with the analogue visual scale. This was applied after 30 minutes, two, six, twelve and twenty-four hours after the operation. The presence or absence of intraoperative and postoperative complications was determined. Results: Patients aged 31-50 prevailed in both groups. The male gender predominated in the study group and the female gender, in the control group. In the study group, the response was not satisfactory only in two patients, while it was satisfactory in 11 patients; in the control group, it was not satisfactory in 5 patients. In the study group, three patients had pain for less than 2 hours and this was classified as mild to moderate. In the control group 12 of them presented pain for more than 4 hours, which was classified as moderate and severe. Adverse effects appeared in two patients. Conclusions: The administration of lidocaine leads to a decrease in pain and opioid consumption(AU)