Knowledge and attitudes toward anaphylaxis to local anesthetics in dental practice.

OBJECTIVE/AIM: The absence of a comprehensive understanding of potential anaphylactic reactions to local anesthetics (LAs) and management can result in grave consequences. For this reason we aim to assess Latin American dentists' knowledge, preparedness, and competency in managing anaphylactic reactions to LAs. MATERIALS AND METHODS: Design: A cross-sectional study was conducted from November 2021 to February 2022. Board-certified dentists answered a survey comprising 26 structured questions. Chi-square tests and logistic regression models were performed in Stata 17.0. SETTING: Argentina, Brazil, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Peru, Venezuela, and other Latin American countries. RESULTS: Of 507 respondents, lidocaine was the most frequently used LA (88.1%). While 85.2% could identify dyspnea as a symptom of anaphylaxis, only 50.1% knew the correct route for epinephrine administration, and just 43.5% had epinephrine in their emergency kits. Confidence in managing anaphylactic reactions was low (9.6%). Older age was inversely related to both knowledge of anaphylaxis management and the possession of epinephrine (P = 0.003 and P = 0.0001, respectively). DISCUSSION: Our study highlights a concerning discrepancy between the practical readiness of Latin American dentists in handling anaphylaxis. CONCLUSION: The study's findings underscore the need for educational interventions to improve the readiness to identify and handle anaphylactic emergencies in dental practice.

Association between age people started working and missing teeth in an elderly population in Ecuador: Evidence from a cross-sectional study.

Child labor has significant physical, psychological, and social consequences, which can persist into adulthood. This study investigates the association between the age at which an individual begins working and tooth loss in older adults in Ecuador. We analyzed data from the SABE 2009 survey (Survey of Health, Well-being, and Aging), using binary logistic regression to examine potential relationships. Our analytical sample comprised of 3,899 older adults from mainland Ecuador, with 42.50% having started working between the ages of 5 and 12. Unadjusted logistic regression results indicated that older adults who began working at ages 5-12 had a 42% higher risk of missing more than 4 teeth compared to those who started working at ages 18-25. After adjusting for potential confounders, the resulting risk was 28% higher than for the reference group [OR 1.28 95% CI 1.25-1.30]. Our findings demonstrate that early engagement in labor is a risk factor for tooth loss among older adults, displaying the long-term impacts of child labor on oral health. Health education and benefits should be provided to this vulnerable population for tooth loss prevention.

Systemic lupus erythematosus myocarditis after COVID-19 vaccination.

INTRODUCTION: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine. OBJECTIVE: Describe another possible mechanism of myocarditis after COVID-19 vaccination. CASE PRESENTATION: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex. RESULTS AND DISCUSSION: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine. CONCLUSION: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.

Systemic lupus erythematosus myocarditis after COVID-19 vaccination / Miocarditis por lupus eritematoso sistémico después de la vacunación contra el COVID-19

Introduction: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine. Objective: Describe another possible mechanism of myocarditis after COVID-19 vaccination. Case presentation: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex. Results and discussion: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine. Conclusion: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.(AU)

Introducción: Se han presentado casos de miocarditis aguda tras la administración de las vacunas BNT162b2 y Ad26.COV2.S. Objetivo: Describir otro posible mecanismo de miocarditis posterior a la vacunación contra el COVID-19. Presentación del caso: Describimos el caso clínico de una mujer de 72 años con dolor torácico pleurítico una semana después de la tercera vacuna de ARNm BNT162b2. Las pruebas serológicas para patógenos cardiotrópos fueron negativas y el cribado de autoinmunidad fue positivo con anticuerpos antinucleares (ANA) en dilución 1:160, anticuerpos anti-ADN de doble cadena (anti-dsADN) y antihistonas. La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa (FDG) mostró un proceso inflamatorio miocárdico y pericárdico focal en el ápex cardíaco. Resultados y discusión: Se realizó el diagnóstico de lupus eritematoso sistémico (LES) con afectación miocárdica. Hasta donde sabemos, este es el primer reporte de un caso de miocarditis lúpica después de la vacuna contra el COVID-19. Conclusión: Dadas las justificaciones patogénicas, se debe considerar la asociación entre lupus eritematoso sistémico (LES) y miocarditis.(AU)

Systemic lupus erythematosus myocarditis after COVID-19 vaccination.

Introduction: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine. Objective: Describe another possible mechanism of myocarditis after COVID-19 vaccination. Case presentation: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex. Results and discussion: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine. Conclusion: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.

Introducción: Se han presentado casos de miocarditis aguda tras la administración de las vacunas BNT162b2 y Ad26.COV2.S. Objetivo: Describir otro posible mecanismo de miocarditis posterior a la vacunación contra el COVID-19. Presentación del caso: Describimos el caso clínico de una mujer de 72 años con dolor torácico pleurítico una semana después de la tercera vacuna de ARNm BNT162b2. Las pruebas serológicas para patógenos cardiotrópos fueron negativas y el cribado de autoinmunidad fue positivo con anticuerpos antinucleares (ANA) en dilución 1:160, anticuerpos anti-ADN de doble cadena (anti-dsADN) y antihistonas. La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa (FDG) mostró un proceso inflamatorio miocárdico y pericárdico focal en el ápex cardíaco. Resultados y discusión: Se realizó el diagnóstico de lupus eritematoso sistémico (LES) con afectación miocárdica. Hasta donde sabemos, este es el primer reporte de un caso de miocarditis lúpica después de la vacuna contra el COVID-19. Conclusión: Dadas las justificaciones patogénicas, se debe considerar la asociación entre lupus eritematoso sistémico (LES) y miocarditis.

Recognizing, normalizing and articulating: An approach to highlight plural values of water ecosystem services in Colombia.

The dialectical relationship between ecosystems and society is complex; therefore, holistic approaches are required to address this complexity. This view also stands out in the ecosystem services valuation field, where different scholars and global platforms have drawn attention to the need to incorporate plural valuation initiatives at decision-making. In this sense, through a comprehensive design, we conducted a multi-layered valuation of ecosystem services, and we highlighted multiple values in two areas of the province of Caldas, Colombia. We proposed a three-phase valuation process called Recognizing, Normalizing and Articulating values. Then, in cooperation with the regional environmental authority, we obtained different water-related ecosystem services values. Our results showed some warnings: first, we found mismatches between ecosystem services values; second, people assigned high values to ecosystems but the actual capacity of ecosystems to support ES is low. Finally, monetary values were marginal compared to social and ecological values. We conclude by saying that the more strata are assessed, the more values appear in the valuation scenarios, and those values could be conflicting. Our results have political implications, since they highlight the need to incorporate plural values as a fundamental tool for planning and land use in real scenarios where conflicts of interest and values are evident.

Impact of biosecurity measures, social pressure and bullying on attitudes, perceptions, and job satisfaction levels among healthcare workers during the COVID-19 pandemic: a cross-sectional survey.

INTRODUCTION: The extent and nature of social pressure and bullying towards healthcare workers (HCWs) during the COVID-19 remains unclear. The following study identifies the effect of social pressure and bullying directed towards HCWs when using biosecurity measures during the COVID-19 pandemic; further, the impact on perceptions, attitudes and job satisfaction level is also explored. METHODOLOGY: We conducted a cross-sectional survey-based study among 684 Ecuadorian HCWs. The survey consisted of 38 questions related to the frequency, attitudes, and perceptions of biosecurity measures during the COVID-19 pandemic. Exploratory factor analysis was performed to assess the validity of the questionnaire. Associations between variables were analysed using χ2 and Fisher's exact test. Using SPSS V.25, qualitative and quantitative data were analysed. RESULTS: Of the 684 participants, 175 (25.59%) experienced or felt bullying or social pressure during the COVID-19 pandemic associated with the use of biosecurity measures. Of these, 40.6% believed it was due to an imbalance of power in the workplace. The perception that HCWs wearing personal protective equipment resulting in bullying was noted in 12% of the respondents. Job satisfaction was positive among 73% of the respondents. Gender (female) and type of institution (public) were noted to contribute towards job satisfaction and bullying experiences. CONCLUSION: Exposure to social bullying and pressure due to the use of biosecurity measures during the COVID-19 pandemic may result in reduced job satisfaction and thoughts about quitting work.

Ultra-low dose whole-body CT for attenuation correction in a dual tracer PET/CT protocol for multiple myeloma.

PURPOSE: To investigate within phantoms the minimum CT dose allowed for accurate attenuation correction of PET data and to quantify the effective dose reduction when a CT for this purpose is incorporated in the clinical setting. METHODS: The NEMA image quality phantom was scanned within a large parallelepiped container. Twenty-one different CT images were acquired to correct attenuation of PET raw data. Radiation dose and image quality were evaluated. Thirty-one patients with proven multiple myeloma who underwent a dual tracer PET/CT scan were retrospectively reviewed. 18F-fluorodeoxyglucose PET/CT included a diagnostic whole-body low dose CT (WBLDCT: 120 kV-80mAs) and 11C-Methionine PET/CT included a whole-body ultra-low dose CT (WBULDCT) for attenuation correction (100 kV-40mAs). Effective dose and image quality were analysed. RESULTS: Only the two lowest radiation dose conditions (80 kV-20mAs and 80 kV-10mAs) produced artifacts in CT images that degraded corrected PET images. For all the other conditions (CTDIvol ≥ 0.43 mGy), PET contrast recovery coefficients varied less than ± 1.2%. Patients received a median dose of 6.4 mSv from diagnostic CT and 2.1 mSv from the attenuation correction CT. Despite the worse image quality of this CT, 94.8% of bone lesions were identifiable. CONCLUSION: Phantom experiments showed that an ultra-low dose CT can be implemented in PET/CT procedures without any noticeable degradation in the attenuation corrected PET scan. The replacement of the standard CT for this ultra-low dose CT in clinical PET/CT scans involves a significant radiation dose reduction.

3D voxel-based dosimetry to predict contralateral hypertrophy and an adequate future liver remnant after lobar radioembolization.

INTRODUCTION: Volume changes induced by selective internal radiation therapy (SIRT) may increase the possibility of tumor resection in patients with insufficient future liver remnant (FLR). The aim was to identify dosimetric and clinical parameters associated with contralateral hepatic hypertrophy after lobar/extended lobar SIRT with 90Y-resin microspheres. MATERIALS AND METHODS: Patients underwent 90Y PET/CT after lobar or extended lobar (right + segment IV) SIRT. 90Y voxel dosimetry was retrospectively performed (PLANET Dose; DOSIsoft SA). Mean absorbed doses to tumoral/non-tumoral-treated volumes (NTL) and dose-volume histograms were extracted. Clinical variables were collected. Patients were stratified by FLR at baseline (T0-FLR): < 30% (would require hypertrophy) and ≥ 30%. Changes in volume of the treated, non-treated liver, and FLR were calculated at < 2 (T1), 2-5 (T2), and 6-12 months (T3) post-SIRT. Univariable and multivariable regression analyses were performed to identify predictors of atrophy, hypertrophy, and increase in FLR. The best cut-off value to predict an increase of FLR to ≥ 40% was defined using ROC analysis. RESULTS: Fifty-six patients were studied; most had primary liver tumors (71.4%), 40.4% had cirrhosis, and 39.3% had been previously treated with chemotherapy. FLR in patients with T0-FLR < 30% increased progressively (T0: 25.2%; T1: 32.7%; T2: 38.1%; T3: 44.7%). No dosimetric parameter predicted atrophy. Both NTL-Dmean and NTL-V30 (fraction of NTL exposed to ≥ 30 Gy) were predictive of increase in FLR in patients with T0 FLR < 30%, the latter also in the total cohort of patients. Hypertrophy was not significantly associated with tumor dose or tumor size. When ≥ 49% of NTL received ≥ 30 Gy, FLR increased to ≥ 40% (accuracy: 76.4% in all patients and 80.95% in T0-FLR < 30% patients). CONCLUSION: NTL-Dmean and NTL exposed to ≥ 30 Gy (NTL-V30) were most significantly associated with increase in FLR (particularly among patients with T0-FLR < 30%). When half of NTL received ≥ 30 Gy, FLR increased to ≥ 40%, with higher accuracy among patients with T0-FLR < 30%.

Pulmonary Artery Sarcoma With Low 18F-FDG Uptake.

ABSTRACT: A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension (>54 mm Hg). A CT pulmonary angiogram showed a filling defect in the pulmonary trunk, right and left pulmonary arteries, raising the possibilities of pulmonary embolism or artery sarcoma. FDG PET/CT was performed for further evaluation and showed low uptake in the pulmonary wall, which supported the diagnosis of pulmonary embolism. Patient was treated with anticoagulants with no changes on repeated CT pulmonary angiogram. Patient underwent surgery, and histopatological examination revealed a pulmonary artery sarcoma.

Nanofilm generated non-pharmacological anabolic bone stimulus.

Stimulus-responsive nanomaterials have mainly been employed to ablate or destroy tissues or to facilitate controlled release of drugs or biologics. Herein, we demonstrate the potential of stimulus-responsive nanomaterials to promote tissue regeneration via a non-pharmacological and noninvasive strategy. Thin nanofilms of an optically-absorbing organic dye or nanoparticle (single-walled graphene nanoribbons [SWOGNR]) were placed over (without touching the skin) a rodent femoral fracture site. A nanosecond pulsed near-infrared laser diode was employed to generate photoacoustic (PA) signals from the nanofilms. X-ray micro-computed tomography (microCT), histology, and mechanical testing results showed that daily PA stimulations of upto 45 min for 6 weeks (complete fracture healing) do not adversely affect bone regeneration and quality. Further, microCT and histological analysis showed 10 min daily stimulation for 2 weeks significantly increases bone quantity at the fracture sites of rats exposed to the nanoparticle-generated PA signals. In these rats, up to threefold increase in bone volume to callus volume ratio and twofold increase in bone mineral density within the callus were noted, compared to rats that were not exposed to the photoacoustic signals. The results taken together indicate that nanofilm-generated photoacoustic signals serve as an anabolic stimulus for bone regeneration. The results, in conjugation with the ability of these nanofilms to serve as PA contrast agents, present opportunities toward the development of integrated noninvasive imaging and noninvasive or invasive treatment strategies for bone loss due to disease or trauma.

Appendicular morphology and locomotor performance of two morphotypes of continental anoles: Anolis heterodermus and Anolis tolimensis.

Anolis lizards have been a model of study in ecomorphology in the Caribbean islands because species with the same type of microhabitat share similar morphological features. But despite their great diversity, little is known about continental species. We analyzed the relationship between the anatomical characteristics of the appendicular skeleton and the locomotor performance of two Anolis species found in Colombia that have different use of habitat. Anolis heterodermus, a strictly arboreal species, was compared with Anolis tolimensis, which inhabits the lower strata of vegetation. These two species differ in their body plan not only in body shape and external morphological features, but also in the skeleton and appendicular musculature. The results highlight the muscle and bone specializations associated with the use of habitat in this genus, such as the presence of more robust bones to enlarge the surface of muscle insertion, the thickening and loss of carpal parts, thickening of tendons associated with the manus, and greater development of muscle mass in the forelimbs by A. heterodermus with respect to A. tolimensis. These differences are related to the use of the microhabitat and the locomotor style of each species.

Design of water quality monitoring networks with two information scenarios in tropical Andean basins.

Design and redesign of water quality monitoring networks were evaluated for two similarly sized watersheds in the tropical Andes via optimization techniques using geographic information system technology (GIS) and a matter-element analysis of 5-day biological oxygen demand (BOD5) and total suspended solids (TSS). This resulted in a flexible, objectively based design for a 1128-km2 watershed without prior water quality data (La Miel River), and a network redesign of a 1052-km2 watershed with historical water quality monitoring (Chinchiná River). Monitoring design for the undocumented basin incorporated mathematical expressions for physical, anthropological, and historical factors-and was based on clear objectives for diagnosis and intervention of water pollution. Network redesign identified network redundancy, which resulted in a 64% reduction in the number of water quality monitoring stations along the channel, and a 78% reduction of stations throughout the basin. Most tropical drainage basins throughout the world have little to no prior water quality data. But even in well-studied drainage basins like the Chinchiná River, which is among the most thoroughly studied basins in Colombia, redesign of historical and existing monitoring networks will become a standard tool to advance the restoration of polluted surface waters, not only in Colombia, but also throughout the world.

Left thoracotomy: an ideal approach for mitral valve replacement in patient with severe chest wall deformity.

We report a 65-year-old woman with chronic diastolic congestive heart failure, pulmonary hypertension, and severe mitral valve regurgitation. She was not a candidate for percutaneous mitral valve repair and was turned down for an open heart operation by 2 institutions based on her severe pectus excavatum deformity. A left posterior lateral thoracotomy approach provided excellent exposure for central cannulation and replacement of the mitral valve.

Bullet embolization from an aorto-caval fistula to the heart.

Bullet emboli to the heart as a result of penetrating trauma are rare. We report a case of a 19-year old male who suffered a gunshot wound to the abdomen, resulting in an aorto-caval fistula and subsequent venous embolization of the bullet to the right ventricle. Successful surgical removal of the foreign body under cardiopulmonary bypass was performed.

A study of pipeline drugs in neuroendocrine tumors.

PURPOSE: Inhibition of neovessel development can stabilize tumor growth. A rapid in vitro method that can evaluate the effectiveness of anti-angiogenic drugs would aid in drug development. We tested a series of investigational agents to determine their ability to inhibit angiogenesis in our in vitro human angiogenesis model. METHODS: A total of 74 neuroendocrine tumors were tested with five therapeutic agents for anti-angiogenic activity. Angiogenic responses were assessed visually and the percent of tumor explants that developed an angiogenic response was determined. The extent of neovessel growth was rated using a validated semi-quantitative visual scale. Analysis of variance was used to compare treatment outcome results to control values for these angiogenic parameters. RESULTS: Vatalanib (2 × 10(-5) M) and patupilone (1 × 10(-8) M) were highly effective inhibitors of human tumor angiogenesis (mean overall angiogenic response for drug versus control 1.3 vs. 5.9 and 0.2 vs. 5.2, respectively) and were statistically significant at p <0.0001. Imatinib (2.5 × 10(-6) M) and everolimus (1 × 10(-8) M) were also effective (mean overall angiogenic response for drug versus control 2.2 vs. 5.9 and 4.5 vs. 5.9, respectively), and these were also statistically significant at p <0.0001. Pasireotide (1 × 10(-8) M) had no effect on angiogenesis (mean overall angiogenic response for drug vs. control 5.5 vs. 5.2). CONCLUSIONS: Significant differences in angiogenic response to test drugs were noted in this neuroendocrine patient population. In vitro screening of a large series of fresh human tumors may be a cost-effective way to select drugs for continued clinical development.

Spigelian hernia as a cause of small bowel obstruction.

Spigelian hernia is a rare abdominal wall defect usually appearing between the abdominal muscle lateral to the rectus abdominis and through a debilitated spigelian aponeurosis. Spigelian hernias account for 0.12% to 2.4% of all abdominal wall hernias with a 17-24% risk of strangulation. We report the case of a 77-year-old male that presented with small bowel obstruction with incarcerated spigelian hernia which was successfully treated with a Ventralex hernia patch (Bard Access Systems, Inc., Murray Hill, NJ). A small open incision over the incarcerated hernia was a safe and effective method of repairing an incarcerated spigelian hernia in an urgent fashion.

Epiploic appendagitis in a 24-year-old woman.

Epiploic appendagitis is a very rare condition that results from acute inflammation of an appendix epiploica. We report a case involving a 24-year-old woman who presented to the emergency department with abdominal pain localized to the left lower quadrant. The patient was diagnosed with epiploic appendagitis, which was confirmed through findings obtained from a contrast-study computed tomography of the abdomen. The patient was subsequently taken to the operating room for a diagnostic laparoscopy due to persistent pain. Necrotic epiploic appendagitis was found on the descending colon, which was removed laparoscopically.

Valor diagnóstico del autorrefractómetro y toma de agudeza visual con cartilla hotv en el screening de ambliopía en niños / Value diagnosis of autorrefractómetro and taking of visual sharpness with record hotv in screening of ambliopía in children

La ambliopía es una patología que tiene una prevalencia de aproximadamente 0.5 a 7 por ciento, susceptible de recibir tratamiento exitoso si éste se instaura a tiempo (antes de los 12 años), obteniéndose mejor respuesta si se inicia a corta edad (2 a 3 años), y va disminuyendo su eficacia al aumentar la edad de inicio. Para su diagnóstico se utiliza tradicionalmente la toma de agudeza visual con la cartilla de Snellen, siendo ésta muy difícil de realizar en pacientes de corta edad. Se han utilizado otros métodos alternativos para agilizar su diagnóstico y el de sus factores de riesgo, los cuales pueden ser utilizados en pacientes que aun no son candidatos para una buena toma de agudeza visual con los métodos convencionales. Comprobamos la eficacia de dos de estos (la cartilla HOTV y el uso del autorrefractómetro) como métodos de screening para la detección de ambliopía...

Efectos de la diabetes en el embarazo sobre el recién nacido

La presencia de diabetes en el embarazo afecta a un número significativo de mujeres y es considerada como un factor con importante papel en la morbilidad y mortalidad perinatal. Con el objetivo de determinar los efectos de esta enfermedad sobre el recién nacido, se realizó un estudio retrospectivo en 35 casos de mujeres con diabetes mellitus o diabetes gestacional que habían tenido un parto previamente. Se escogieron además al azar, 26 controles de partos de mujeres normales para establecer las comparaciones respectivas. Se observó un efecto de la enfermedad en variables como el Apgar, la talla y los perímetros cefálico y torácico de los recién nacidos. No se encontraron efectos sobre el peso como tampoco diferencias sobre la presencia de malformaciones. Por la importancia de esta situación tanto para la madre como para el recién nacido, se recomiendan medidas de control estricto durante el embarazo de estas mujeres, así como en la atención del recién nacido buscando minimizar los riesgos