Efecto cicatrizante en incisiones periodontales por extracto hidroalcohólico de Morinda citrifolia / Healing effect on periodontal incisions by hydroalcoholic extract of Morinda citrifolia / Efeito cicatrizante do extrato hidroalcoólico de Morinda citrifolia em incisões periodontais

Los tratamientos periodontales implican cortes y sangrado de la mucosa gingival; la Morinda citrifolia, específicamente sobre los fragmentos encargados de la cicatrización (plaquetas), tiene un efecto más significativo en los procesos curativos de las lesiones. Objetivo. Identificar el potencial cicatrizante de los extractos hidroalcohólicos de Morinda citrifolia (noni peruano) en los procesos regenerativos de las incisiones periodontales al 70% a diversas concentraciones (1%; 5; y 10%) y su efecto coadyuvante acelerador en la vía oral como curación de tejidos. Materiales y Métodos. Se realizó una investigación aplicada, bajo el diseño experimental. Para ello, se llevó a cabo un estudio previo para el análisis farmacognóstico, porcentaje de humedad, pruebas de solubilidad y el análisis fitoquímico cualitativo para garantizar que el análisis farmacológico y la prueba experimental se completaran adecuadamente. Se administraron dosis a cinco ratas albinas macho Holtzman divididas en cuatro grupos a los cuales se les aplicó las concentraciones en cantidades de 0,5 ml dos veces al día en la incisión, la cual se evaluó durante siete días para obtener parámetros específicos, como infección, tono de piel gingival, cierre de heridas, reducción del tamaño de la incisión y porcentaje de curación. Resultados. Indicaron que todos los grupos que se le suministró el extracto hidroalcohólico al 70% en varias concentraciones mejoró su actividad curativa al reducir el tamaño de la incisión en la encía al séptimo día, donde resultó que la mejor concentración fue del 5% en comparación con las otras concentraciones (1% y 10%). Investigación que indica la eficacia de la Morinda citrifolia peruana como acelerador del proceso de curación en la terapia periodontal.

Periodontal treatments involve cuts and bleeding of the gingival mucosa; Morinda citrifolia, specifically on the fragments in charge of healing (platelets), has a more significant effect on the healing processes of the lesions. Objective. To identify the healing potential of hydroalcoholic extracts of Morinda citrifolia (Peruvian noni) in the regenerative processes of periodontal incisions at 70% at various concentrations (1%; 5; and 10%) and its accelerating coadjuvant effect in the oral route as tissue healing. Materials and Methods. An applied research was carried out under an experimental design. For this purpose, a previous study was carried out for pharmacognostic analysis, moisture percentage, solubility tests and qualitative phytochemical analysis to ensure that the pharmacological analysis and experimental test were properly completed. Doses were administered to five male Holtzman albino rats divided into four groups to which the concentrations were applied in 0.5 ml amounts twice daily to the incision, which was evaluated for seven days for specific parameters, such as infection, gingival skin tone, wound closure, incision size reduction and percentage healing. Results. They indicated that all groups that were given the 70% hydroalcoholic extract in various concentrations improved their healing activity by reducing the size of the gingival incision on the seventh day, where it turned out that the best concentration was 5% compared to the other concentrations (1% and 10%). Conclusion. Research indicating the efficacy of Peruvian Morinda citrifolia as an accelerator of the healing process in periodontal therapy.

Os tratamentos periodontais envolvem corte e sangramento da mucosa gengival; a Morinda citrifolia, especificamente sobre os fragmentos responsáveis pela cicatrização (plaquetas), tem um efeito mais significativo nos processos de cicatrização das lesões. Objetivo. Identificar o potencial cicatrizante de extratos hidroalcoólicos de Morinda citrifolia (noni peruano) nos processos regenerativos de incisões periodontais a 70% em diversas concentrações (1%; 5; e 10%) e seu efeito coadjuvante acelerador na via oral como cicatrizante tecidual. Materiais e métodos. Foi realizada uma pesquisa aplicada sob um desenho experimental. Para esse fim, foi realizado um pré-estudo para análise farmacognóstica, porcentagem de umidade, testes de solubilidade e análise fitoquímica qualitativa para garantir que a análise farmacológica e o teste experimental fossem adequadamente concluídos. Cinco ratos albinos Holtzman machos divididos em quatro grupos foram dosados e as concentrações foram aplicadas em quantidades de 0,5 ml duas vezes ao dia na incisão, que foi avaliada por sete dias quanto a parâmetros específicos, como infecção, tônus gengivais da pele, fechamento da ferida, redução do tamanho da incisão e porcentagem de cicatrização. Resultados. Eles indicaram que todos os grupos que receberam extrato hidroalcoólico a 70% em várias concentrações melhoraram sua atividade de cicatrização ao reduzir o tamanho da incisão gengival no sétimo dia, sendo que a melhor concentração foi de 5% em comparação com as outras concentrações (1% e 10%). Conclusão. A pesquisa indica a eficácia da Morinda citrifolia peruana como um acelerador do processo de cicatrização na terapia periodontal.

Wearable Sports Technology Development in Costa Rica: Inertial Measurement Unit Integration for Real-Time External Load Monitoring / Desarrollo de tecnología deportiva portátil en Costa Rica: integración de una unidad de medición inercial para monitoreo de carga externa en tiempo real / Desenvolvimento de tecnologia desportiva portátil na Costa Rica: integração de uma unidade de medição por inércia para monitorização da carga externa em tempo real

Abstract: The increasing trend and projection for the use of wearable sensors technology in the general population have led to the development of different inertial measurement units (IMU) to monitor activity and motion variables during exercise or sports. This study aims to systematize the practical experience of developing an inertial measurement device to quantify external load in real time for runners. This article shows the installed capacity of Costa Rican higher education institutions to integrate existing sensors available in the international market in a single device to program it and use it for different sport science purposes. Two scientific laboratories joined resources and integrated an interdisciplinary team composed of exercise physiologists, sports scientists, physiotherapists, and electromechanical engineers who globally faced the challenge of creating SafeRun IMU. In this case, an IMU was constructed with great success, capable of quantifying external load variables controlled from a mobile device in real-time. The results showed an acceptable agreement and reliability of the data extracted from the IMU. The information collected from this IMU could be used to control and quantify external load to develop or redirect exercise programming and prescription and prevent overuse injuries or physical overload conditions. This device differs from other existing ones due to its small size and portability, which benefits its commercialization and massification.

Resumen: La creciente tendencia y proyección para el uso de tecnología de sensores portátiles en la población en general ha llevado al desenvolvimiento de diferentes dispositivos de medición inercial, para monitorear las variables de actividad y movimiento durante el ejercicio o los deportes. El objetivo del presente estudio es sistematizar la experiencia práctica de desarrollar un dispositivo de medición inercial, con el fin de cuantificar la carga externa en tiempo real para los corredores. Este artículo demostró la capacidad instalada de las instituciones de educación superior de Costa Rica para integrar los sensores existentes disponibles en el mercado internacional en un solo dispositivo, con el propósito de programarlo y usarlo en diferentes fines de ciencias del deporte. Dos laboratorios científicos unieron esfuerzos e integraron un equipo interdisciplinario compuesto por fisiólogos del ejercicio, científicos del deporte, fisioterapeutas e ingenieros electromecánicos, quienes, de manera global, afrontaron el reto de la creación de la IMU. En este caso, se desarrolló una IMU con gran éxito, capaz de cuantificar las variables de carga externa controladas desde un dispositivo móvil en tiempo real. Los resultados mostraron un nivel de concordancia y fiabilidad aceptable de los datos extraídos de la IMU. La información obtenida de esta IMU podría usarse para controlar y cuantificar la carga externa, con miras a desplegar o redirigir la programación y prescripción de ejercicios, así como con el afán de prevenir lesiones por sobreuso o condiciones de sobrecarga física.

Resumo: A crescente tendência e projeção para o uso da tecnologia de sensores portáteis na população em geral levou ao desenvolvimento de diferentes dispositivos de medição inercial para monitorar as variáveis de atividade e de movimento durante o exercício ou esportes. O objetivo do presente estudo é sistematizar a experiência prática de desenvolvimento de um dispositivo de medição inercial, a fim de quantificar a carga externa em tempo real para os corredores. Este artigo demonstrou a capacidade instalada das instituições de ensino superior da Costa Rica para integrar os sensores existentes disponíveis no mercado internacional em um único dispositivo, com a finalidade de programá-lo e usá-lo para diferentes fins de ciência do esporte. Dois laboratórios científicos uniram forças e integraram uma equipe interdisciplinar composta por fisiologistas do exercício, cientistas do esporte, fisioterapeutas e engenheiros eletromecânicos, que, de forma global, enfrentaram o desafio de criar a IMU. Neste caso, foi desenvolvida uma IMU de grande sucesso, capaz de quantificar variáveis de carga externas controladas a partir de um dispositivo móvel em tempo real. Os resultados mostraram um nível aceitável de concordância e confiabilidade dos dados extraídos da IMU. As informações obtidas desta IMU poderiam ser utilizadas para monitorar e quantificar a carga externa, com o objetivo de implantar ou redirecionar a programação e prescrição de exercícios, bem como com o objetivo de evitar lesões por uso excessivo ou condições de sobrecarga física.

Does environment quality affect the health care spending? Nexus among CO2 emissions, non-renewable energy production, financial development, and health care spending.

This study investigates the dynamic associations among carbon dioxide (CO2) emissions, non-renewable energy production from petroleum derivatives, financial development, and healthcare expenditures to improve environmental quality. This research has employed the balanced annual panel of thirty (30) Organizations for Economic Co-operation and Development (OECD) countries' data set and applied panel vector autoregression (VAR) method depending on the generalized method of moments (GMM). Furthermore, the empirical findings reveal that health spending and CO2 emissions have a favorable bidirectional link, but there is no indication that health spending promotes power generation. The results demonstrate that increased energy consumption and productions affect pollution, and higher CO2 emissions increase healthcare costs. Whereas, energy consumption, financial development, and healthcare expenditures have a positive toward environmental quality.

The dynamic relationship between green tax incentives and environmental protection.

The purpose of this study is to examine the impact of green tax incentives such as investment tax credit and taxable income deductions related to the environmental sustainability and climate change which are becoming more popular in developing countries, whereas introducing green tax incentives related to the environment and climate change helps and meets the sustainability objectives of growth and development. For this purpose, we selected the top 100 listed companies on the Swedish stock market (SSM), Nasdaq Stockholm (SN), in order to better understand the real facts and figures of green tax environment. This study uses a longitudinal research design because sample observations vary across firms and over a short time and conducts probit and logistic regression to identify the beneficiaries of the tax incentives. The findings show that different firm-level characteristics significantly impact the probability of being an ITC beneficiary.

Do drivers of renewable energy consumption matter for BRICS economies? Nexus among technological innovation, environmental degradation, economic growth, and income inequality.

In light of increasing concerns about climate change and energy security, renewable energy has been seen as the most promising solution to fulfil future energy needs. This study examines the drivers of renewable energy consumption (REC) and the nexus between GDP growth, technological innovation, gross fixed capital formation, CO2 emissions, income inequality, and renewable energy consumption (REC) using annual data from BRICS countries. To this end, the study uses the augmented mean group (AMG) estimator, a second-generation estimator that takes slope homogeneity and cross-sectional dependence into consideration. For robustness, the pooled mean group (PMG) estimator has also been utilized. The findings of both estimators indicate that carbon emissions, technological innovation, and gross fixed capital formation exert adverse and significant impacts on REC. The findings also show that the use of renewable energy will rise as income inequality declines. We also employ the Dumitrescu and Hurlin (DH) granger causality test. The results of the analysis demonstrate a one-way causal association between income inequality and REC. This finding confirms that a reduction in income inequality will have a major impact on the adoption of renewable energy sources.

Infecciones respiratorias recurrentes en paciente escolar, asociadas a Síndrome de Mounier-Khün: reporte de caso / Recurrent respiratory infections associated with Mounier-Khün Syndrome in a school patient: clinical case report / Infecções respiratórias recorrentes associadas à Síndrome de Mounier-Khün num paciente escolar: relato do caso

El síndrome de Mounier Kühn es una patología infrecuente de la vía aérea, caracterizada por una dilatación anormal de tráquea y bronquios. Se debe sospechar ante la presencia de infecciones broncopulmonares recurrentes e irritación traqueobronquial. El diagnóstico se lleva a cabo a través de la medición del diámetro traqueal en tres segmentos de su anatomía, a través de tomografía torácica. Se presenta el caso de un paciente masculino escolar de 10 años de edad, con antecedentes de infecciones respiratorias recurrentes, hospitalizado por un cuadro neumónico; los hallazgos reportados en la tomografía de tórax corresponden a traqueobroncomegalia además de incremento del diámetro esofágico. El tratamiento de esta entidad es sintomático con medidas de sostén y fisioterapia pulmonar.

Mounier Kühn syndrome is a rare airway pathology characterized by abnormal dilatation of the trachea and bronchi. It should be suspected in the presence of recurrent bronchopulmonary infections and tracheobronchial irritation. The diagnosis is made by measuring the tracheal diameter in three segments of its anatomy, through thoracic tomography. We present the case of a 10 year-old male school boy with a history of recurrent respiratory infections, hospitalized for a pneumonic condition; the findings reported in the thoracic tomography correspond to a tracheobronchomegaly in addition to an increase of the esophageal diameter. The treatment of this entity is symptomatic with supportive measures and pulmonary physical therapy.

A síndrome de Mounier Kühn é uma patologia incomumdas vias aéreas, caracterizada por dilatação anormal da traqueia e brônquios. Devese suspeitar na presença de infecções broncopulmonares recorrentes e irritação traqueobrônquica. O diagnóstico é realizado através da medida do diâmetro traqueal em três segmentos de sua anatomia, através da tomografia de tórax. Apresentamos o caso de um paciente escolar de 10 anos de idade, do sexo masculino, com história de infecções respiratórias de repetição, internado por sintomas pneumônicos; os achados relatados na tomografia de tórax correspondem a uma traqueobroncomegalia, além de aumento do diâmetro esofágico. O tratamento dessa entidade é sintomático com medidas de suporte e fisioterapia pulmonar.

Uso de la pasta CDZ en dientes temporarios necrosados con una técnica mínimamente invasiva / Use of CDZ paste in necrotic primary teeth with a minimally invasive technique

Introducción: El tratamiento de los canales radiculares de molares temporales con pulpas infectadas ha sido ampliamente descrito y motivo de discusión por muchos años, no existiendo aún un consenso en cuanto al material de obturación. La pasta CTZ (cloranfenicol, tetraciclina y óxido de zinc más eugenol) acompañada de la Técnica de Endodoncia No Instrumentada ha mostrado una alta efectividad clínica y radiográfica para el tratamiento de molares temporales con compromiso pulpar. Se ha propuesto el reemplazo del componente Tetraciclina por Doxiciclina de la formulación, por las implicancias de un posible amelo-génesis imperfecta y la coloración en la corona de dicho componente. Objetivo. Evaluar la efectividad clínica de la pasta CDZ en el tratamiento endodóntico de dientes primarios necrosados con una técnica mínimamente invasiva. Metodología. Estudio de intervención en el que se incluyeron pacientes que presentaban dientes temporales con indicación de terapia pulpar y en quienes se utilizó la pasta CDZ. El éxito del tratamiento se midió por la desaparición de la sintomatología. Resultados. Se incluyeron en el estudio 76 pacientes entre 2 a 9 años. La eficacia del tratamiento con CDZ fue del 97,6% en 125 dientes. Conclusiones. Los hallazgos son comparables a los estudios que utilizaron el CTZ. Debido a las características biológicas del material, su bajo costo, fácil manipulación y excelentes resultados clínicos, se considera una opción en la terapia pulpar en dientes temporales, como una alternativa en el uso de programas de salud pública.

Introduction: Treatment of root canals of primary molars with infected pulps has been widely described and has been the subject of discussion for many years, and there is still no consensus regarding the filling material. The CTZ paste (chloramphenicol, tetracycline and zinc oxide plus eugenol) accompanied by the Non-Instrumented Endodontic Technique has shown high clinical and radiographic effectiveness for the treatment of primary molars with pulp involvement. The replacement of the Tetracycline component by Doxycycline of the formulation has been proposed, due to the implications of a possible amelogenesis imperfecta and the coloration in the crown of said component. Goal. To evaluate the clinical effectiveness of CDZ paste in the endodontic treatment of necrotic primary teeth with a minimally invasive technique. Methodology: Intervention study in which patients with temporary teeth with an indication for pulp therapy and in whom CDZ paste was used were included. Treatment success was measured by the disappearance of symptoms. Results. 76 patients between 2 and 9 years old were included in the study. The efficacy of CDZ treatment was 97.6% in 125 teeth. Conclusions: The findings are comparable to studies using CTZ. Due to the biological characteristics of the material, its low cost, easy handling and excellent clinical results, it is considered an option in pulp therapy in primary teeth, as an alternative in the use of public health programs.

The relationship between staple food crops consumption and its impact on total factor productivity: does green economy matter?

The agriculture sector is a key driver of economic growth and provides employment opportunities across the globe generally. However, in today's world, agricultural product demand is more influenced by taste, prices, and nutritional value due to climatic variation. The study has analyzed the current situation grain productivity by using the data of farm inputs and major grain crops of Pakistan from (1960-2020). The study consists of a two-stage analysis in the first stage, the total factor productivity (TFP) variable is obtained by using the parametric Tornqvisit-Theil index output-input-aggregation method separately for each crop; rice, maize, and wheat. After that, the unit root test is used to check the stationarity and trend of the variables in the long run. Subsequently, the autoregressive distributed lag (ARDL) model is applied to check the existence of cointegration in the long run and short run among the variables. The results of the study disclosed that the consumption of rice has a positive relationship with its total factor productivity, but, wheat and maize have a negative long-run cointegration relationship with the respective productivities. The study results have shown that the consumption pattern of staple crops has substantially changed, due to climatic variation, and the current food consumption trend is revealing new dimensions and trends owing to variation in climate change and anthropogenic pressure which demands to adapt climate resilient farm practices.

Can money supply endogeneity influence bank stock returns? A case study of South Asian economies.

This study tests the Post-Keynesian theory regarding bank stock returns and money supply endogeneity in the context of South Asian countries. This study uses panel data set from different sources over twenty-eight (28) years. The research uses different econometric techniques before switching to the generalized method of moments (GMM). The empirical results indicate a significant positive effect of net interest rate margins on bank loans in South Asian countries, whereas a positive relationship exists between foreign to local interest rates and the money supply. The findings depict that positive associations exist between inflation and money supply of banks, and between the money supply and bank stock returns. More specifically, the GMM results show that the money supply has positively affected the stock prices of banks suggesting strong policies for the stakeholders of these economies for the sake of economic growth and sustainable development.

Eritema pigmentado fijo ampolloso medicamentoso relacionado con el uso de ivermectina en paciente con Neumonía por SARS-Cov-2: Reporte de caso / Drug-related bullous fixed pigmented erythema related to the use of ivermectin in a patient with SARS-Cov2 pneumonia: Case Report

RESUMEN Introducción: El eritema pigmentado fijo ampolloso, es una forma de toxicodermia potencialmente grave. Se caracteriza por la aparición de lesiones cutáneas y/o mucosas, únicas o múltiples, pueden aparecer en cualquier zona, tras la administración de un fármaco u otra sustancia. Se presenta un varón de 73 años con diagnóstico de eritema pigmentado fijo ampolloso secundario a la ingesta de ivermectina. Es necesario que el medico sepa reconocer los efectos adversos de la automedicación con ivermectina contra el SARS CoV-2, a fin de realizar un diagnóstico temprano e iniciar un tratamiento oportuno.

ABSTRACT Background: Bullous fixed pigmented erythema is a potentially serious form of toxicoderma. It is characterized by the appearance of cutaneous and / or mucosal lesions, single or multiple, which can appear in any area, after the administration of a drug or other substance. A 73-year-old man is presented with a diagnosis of bullous fixed pigmented erythema secondary to the ingestion of ivermectin. It is necessary for the physician to recognize the adverse effects of self-medication with ivermectin against SARS CoV-2, to make an early diagnosis and initiate timely treatment.

Does digitalization matter in green preferences in nexus of output volatility and environmental quality?

The fact is that output volatility and carbon dioxide (CO2) emissions move together over the period. This empirical study examines the dynamic effect of output volatility on CO2 emissions using the advance nonlinear panel autoregressive distributed lag (ARDL) approach. The empirical analysis is executed for ten high emitters Asian countries covering the period from 1990 to 2019. The findings reveal that positive change in output volatility increases CO2 emissions and negative change in output volatility decreases CO2 emissions in the long run in Asia. The results also show that digitization also positively impacts environmental quality in Asia due to green globalization. The findings are also robust and similar in an alternative indicator of the environment. An important policy is that reducing volatility in output is a suitable way of environmental sustainability, particularly for Asian countries.

Stock markets dynamics and environmental pollution: emerging issues and policy options in Asia.

The fact is the stock market has an asymmetric effect on macroeconomic variables. In this study, we examine the nonlinear stock market reaction to the environment. This is the first study that considers the possibility of asymmetric effects of stock market on environmental pollution in Asia. This study considers the experiences of Asia economies by using the panel NARDL methodology over the data period from 1995 to 2019. The long-run panel NARDL results showed that the positive change in stock market increases carbon emissions. In adverse, the negative change in stock market significantly mitigates the carbon emissions in Asia. The short-run stock market asymmetric effects continued into the long-run asymmetric effects on the environment in Asia. Thus, policymakers and authorities should initiate to promote green financial activities in Asian stock markets.

Clozapine-Induced Pneumonitis: A Case Report.

Introduction: Clozapine is the most effective antipsychotic used for treatment resistant schizophrenia and recurrent suicidal behavior in schizophrenia or schizoaffective disorder. However, it has been underutilized due to its adverse reaction profile. Although clozapine is typically associated with neutropenia leading to increased risk of infection (i.e., pneumonia), there have been a few case reports of non-neutropenic, non-infectious drug-induced lung disease (i.e., pneumonitis). Although pneumonia and pneumonitis may have similar clinical presentation, their etiology, management, and treatment are different. Case presentation: A 53-year-old African American female with schizoaffective disorder was hospitalized for being no longer able to appropriately utilize food, clothing, and shelter. The patient developed a sepsis-like presentation during clozapine titration which resolved after treatment for presumed pneumonia and clozapine discontinuation. When clozapine was resumed due to persistent psychosis, the patient again developed a sepsis-like presentation. Clozapine was again discontinued with no other interventions and the patient's symptoms resolved. Conclusions: Drug-induced pneumonitis is a very rare adverse reaction of clozapine. Recognizing conditions that mimic sepsis may prevent patients from undergoing unnecessary laboratory testing and prevent exposure to unwarranted antibiotics.

Suspected Aripiprazole-induced neutropenia in a geriatric patient: a case report.

BACKGROUND: Aripiprazole, a third-generation antipsychotic medication, has been used to treat a range of psychiatric disorders. According to the U.S. Food and Drug Administration's prescribing information, the most common adverse reactions in adult patients in clinical trials (≥10%) were nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, and insomnia. While hematological adverse effects may occur with aripiprazole, there is very limited information in the published literature on such adverse outcomes. CASE PRESENTATION: A 68-year-old Caucasian male with treatment resistant depression was hospitalized for suicidal ideation. The patient developed neutropenia after aripiprazole was introduced as an augmentation agent. The neutropenia was reversible with discontinuation of the medication. CONCLUSIONS: To our knowledge, we describe the first case report of suspected neutropenia-induced by aripiprazole use in a geriatric patient. While hematological adverse reactions are rare, we recommend adding CBC to the standard adverse systemic reaction monitoring of antipsychotic medications, particularly among the elderly.

Assessing Financial Impacts of Subclinical Mastitis on Colombian Dairy Farms.

Bovine mastitis is a dairy cattle disease with high economic impact. Subclinical mastitis (SCM) contributes to most of the financial losses. Colombia dairy sector accounts for 2.3% of the gross domestic product (GDP) and 24.3% of the livestock GDP. Milk production reaches 6,500 million liters/year from nearly 500,000 cattle farms and is mainly based on small-scale production systems. This study evaluates the financial impact of SCM and the potential for its control in three dairy farm strata in a region in Colombia. The objectives of the study were 1) to determine the perception of farmers about the SCM problem on their farms, 2) to assess prevalence and financial impact of SCM on farms and in the "Area five" sanitary region of the Bogota plateau, and 3) to assess costs and effectiveness of control methods of SCM. Information about disease management and decision-making process was obtained through a participatory epidemiology workshop and applying a semi-structured survey. A two-stage stratified cross sectional epidemiological study was conducted on dairy cattle from a region with approximately 400 farms and 12,000 cows, with a sample size of 55 farms. Prevalence of SCM was calculated by defining a cow as positive for the disease when any quarter had a somatic cell count (SCC) higher than 250 × 103 cells/ml. The prevalence of SCM in cows was 55.2%; significant differences were found between strata. Assessment of the financial impact of SCM in terms of milk losses was conducted using spreadsheet models. Milk production losses per farm ranged from 1.3% to 13.5%, and the economic impact in the region was estimated over USD $800.000 per year. The financial impact was greater in small- and medium-sized farms than large farms, and it was associated with the severity of SCC per quarter. Principal component analysis showed interactions, irrespective of the individual effect, and suggested three main groups of control interventions: application of basic milking hygiene practices, increase in the level of hygiene practices and veterinary advice, and SCM diagnosis and dry-cow treatment. Lack of information on management and production at farms promotes intuitive decision-making. Further research for the deeper understanding of intervention costs and effectiveness is suggested.

A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions.

Importance: Robust laboratory use data are lacking to support the general assumption that teaching hospitals with trainees routinely order more laboratory tests for inpatients than do nonteaching hospitals. Objective: To quantify differences in the use of laboratory tests between teaching and nonteaching hospitals. Design, Setting, and Participants: A cross-sectional study was performed using a statewide database to identify hospitalizations with a primary diagnosis of bacterial pneumonia or cellulitis from January 1, 2014, to June 30, 2015, at teaching and nonteaching hospitals with 100 or more hospitalizations of each condition. Patients included were adult inpatients with a primary diagnosis of bacterial pneumonia (n = 24 118) or cellulitis (n = 19 211); patients excluded were those with an intensive care unit stay, transfer from another hospital, or a length of stay that was 2 SDs or more of the condition's mean length of stay. Main Outcomes and Measures: Mean laboratory tests per day stratified by illness severity, as well as factors associated with laboratory use rates. Results: A total of 43 329 hospitalized patients (20493 women and 22836 men) had a principal diagnosis of bacterial pneumonia or cellulitis across 11 major teaching hospitals, 12 minor teaching hospitals, and 73 nonteaching hospitals in Texas. Mean number of laboratory tests per day varied significantly by hospital type and was highest for major teaching hospitals for both conditions (bacterial pneumonia: major teaching hospitals, 13.21; 95% CI, 12.91-13.51; nonteaching hospitals, 8.92; 95% CI, 8.84-9.00; P < .001; cellulitis: major teaching hospitals, 10.43; 95% CI, 10.16-10.70; nonteaching hospitals, 7.29; 95% CI, 7.22-7.36; P < .001). This association held for all levels of illness severity for both conditions, except for patients with cellulitis with the highest illness severity level. In generalized mixed linear regression models, controlling for additional patient and encounter covariates, there was a significant difference in the marginal effect of hospital teaching status on mean number of laboratory tests per day between major teaching and nonteaching hospitals (difference in marginal mean laboratory tests per day for bacterial pneumonia, 3.58; 95% CI, 2.61-4.55; P < .001; for cellulitis, 2.61; 95% CI, 1.76-3.47; P < .001). Conclusions and Relevance: Compared with nonteaching hospitals, patients in Texas admitted to major teaching hospitals with bacterial pneumonia or cellulitis received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics. These results support the need to examine how the culture of training environments may contribute to increased use of laboratory tests.

Fibrilación auricular: costo-efectividad de los nuevos anticoagulantes en Latinoamérica / Atrial fibrillation: cost-effectiveness of new anticoagulants in Latin America

Sr. Editor: La fibrilación auricular es una de las arritmias más frecuentes en la práctica médica y representa una de las patologías con mayor aumento en el mundo, con una prevalencia del 0,5 a 1% a nivel poblacional1. Se caracteriza por presentar alteraciones estructurales, en cuyo caso genera una tasa de mortalidad alta debido a complicaciones como infarto de miocardio, insuficiencia cardiaca o ataques cerebrovasculares (ACV). Su prevención se acompaña de una evaluación del riesgo de trombosis a través de distintos scores, con el objetivo de definir el inicio de la terapia antitrombótica y prevenir así los ACV. Durante años, la terapia antitrombótica ha incluido anticoagulantes clásicos como la warfarina, conducta que se ha visto modificada con la aparición de nuevos anticoagulantes orales (NACO) como dabigatrán, rivaroxabán y apixabán, aunque en la actualidad existe gran controversia en las guías de práctica clínica respecto a la recomendación del uso de estos sobre la warfarina2), (3. Los NACO han demostrado ser efectivos en la terapia antitrombótica y su uso se ha incrementado en los países desarrollados, especialmente en Canadá, debido a la preferencia de éstos por la guía canadiense4. Sin embargo, en el mundo aún existe controversia respecto a su uso y la Asociación Americana del Corazón (AHA/ASA) no realiza recomendaciones específicas para el empleo de estos sustentándose en los costos altos y la adherencia de los pacientes5, e individualizando la elección con base en factores de riesgo, costos, tolerabilidad, preferencia de los pacientes e interacciones potenciales6. El costo elevado de la terapia antitrombótica con NACO en países latinoamericanos hace que su uso dependa del grado de cobertura de salud, por lo que un alto porcentaje de pacientes con indicación de anticoagulación no la recibe7 debido a diversos factores sociodemográficos y culturales. Países como Cuba, Brasil o Costa Rica cuentan con una cobertura universal en salud, mientras que en el resto de países latinoamericanos la cobertura se divide en tres grupos: primer grupo de pacientes de escasos recursos o desempleados que acuden a los servicios públicos (Ministerios de Salud o Sanidad); segundo grupo de personas empleadas con seguro social o atención en entidades prestadoras/promotoras de salud (EPS), o seguros de las fuerzas armadas y policiales; y el tercer grupo personas de alto ingreso económico que acuden a los seguros privados8.

Fístula colouterina secundaria a enfermedad diverticular del colon. Hallazgo radiográfico incidental / Colo-uterine fistula due to colonic diverticulitis. Incidental radiological finding

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