Breaking Down the Evidence: Does Perioperative Hypotension Cause Kidney Injury?

BACKGROUND: Acute kidney injury (AKI) is common in the postoperative period and is associated with negative patient outcomes. The definition of perioperative hypotension is wide, but it is associated with various complications, including AKI. SUMMARY: Preclinical data suggest that sustained severe renal hypoperfusion per se does not cause persistent AKI. The evidence associating blood pressure levels and postoperative renal dysfunction is predominantly retrospective and observational, and therefore potentially misled by the complex interactions between exposures, confounders, and mediators. KEY MESSAGES: To better understand how perioperative hemodynamic management could affect the occurrence of kidney injury, it is pivotal to further investigate the association between hypotension and kidney dysfunction in the perioperative period and determine the degree to which hypotension is a causal factor.

Escudo facial (Face Shield) em tempos de covid-19: uma revisão de literatura / Facial shield use during COVID-19: a literature review

Objetivo: A proposta deste estudo foi analisar a efetividade do escudo facial (face shield) como equipamento de proteção da face, fornecendo subsídios para a adoção dele na realização de procedimentos odontológicos durante a pandemia de COVID-19. Materiais e métodos: Trata-se de um estudo bibliográfico, do tipo revisão integrativa da literatura, que consiste em sintetizar o desfecho da pesquisa em questão de maneira ordenada e eficiente, fornecendo uma maior amplitude de informações sobre o assunto, constituindo um corpo de conhecimento. Para tal, a pesquisa bibliográfica foi realizada nas plataformas EBS-COHost e PubMed, utilizando os descritores "face shield", "faceshield" e "COVID-19", foram preconizados os artigos publicados em 2020 e 2021 em língua portuguesa do Brasil, língua inglesa e língua espanhola. Resultados: Foram selecionados 9 artigos para ilustrar as evidências acerca da efetividade do escudo facial (face shield) como barreira de proteção a ser adotada durante a pandemia de COVID-19. Conclusão: Entende-se, portanto, que a adoção do escudo facial (face shield) para reduzir os efeitos contaminantes dos aerossóis durante a pandemia de COVID-19 é fundamental, uma vez que os estudos recentes atestam a possibilidade de redução dos níveis de contaminação.

Objective: This study aimed to analyze the effectiveness of the face shield as a face protection equipment, providing subsidies for its adoption in performing dental procedures during the COVID-19 pandemic. Materials and methods: This is a bibliographic study, an integrative literature review, which consists of synthesizing the outcome of the research in an orderly and efficient way, providing a greater range of information on the subject, constituting a body of knowledge. Therefore, the bibliographic research was carried out on the EBSCOHost and PubMed platforms, using the descriptors "face shield" or "faceshield" and "COVID-19". The Search includes articles published in 2020 and 2021, in Brazilian Portuguese, English, and Spanish. Results: Nine articles were selected to illustrate the evi-dence about the effectiveness of the face shield as a protection barrier to be adopted during the COVID-19 pandemic. Conclusion: It is understood, therefore, that the adoption of the face shield to reduce the contaminating effects of aerosols during the COVID-19 pandemic is fundamental, since recent studies attest to the possibility of reducing such levels of contamination.

Scope of Preparation of Oval and Long-Oval Root Canals: A Review of the Literature.

Successful endodontic treatment depends on cleaning and disinfecting the root canals, in order to provide conditions for three-dimensional filling, which should prevent root canal reinfection. However, anatomical complexities pose a challenge during endodontic treatment. The present study was a literature review carried out in the following databases: PubMed, SciELO, and MEDLINE, which were searched for articles published from 2017 to 2021. Micro-CT studies published in English, which analysed the capacity for preparation of oval and long-oval root canals, were included. The following keywords were used: "oval-shaped canals," "long-oval-shaped canals," "endodontics," and "micro-CT." The aim of this study was to carry out a literature review of micro-CT studies on the scope of the capacity for preparation performed in oval and long-oval root canals with rotary and reciprocating instruments.

Infrarenal inferior vena cava agenesis and recurrent deep vein thrombosis: a case report and literature review.

Inferior vena cava agenesis is a rare congenital vascular defect often diagnosed as an incidental finding in asymptomatic patients. When symptoms arise, it can present with chronic venous stasis or unprovoked deep vein thrombosis (DVT). A 42-year-old man with history of unprovoked right lower extremity (RLE) DVTs was admitted for swelling, pain and erythema to the RLE, concerning for new DVT. Venous Doppler ultrasound showed a chronic DVT of the right proximal femoral vein in addition to an acute DVT of the distal femoral vein. Extensive thrombophilia workup was negative and additional imaging with abdominal computed tomography scan revealed the absence of the infrarenal inferior vena cava. Patient was treated with oral anticoagulation and compression stockings and discharged with clinical improvement. At 3-month follow-up, patient was completely asymptomatic. Recurrent unprovoked DVTs in young patients require exhaustive work up including imaging studies to rule out vascular anomalies.

Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients.

Background: Several biomarkers of AKI have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research. Methods: Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit (ICU). Samples were collected at 24-48 hours after AKI diagnosis (patients) or ICU admission (controls), 5-7 days later, and 4-6 weeks after discharge for patients with AKI. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite end point of death, RRT dependence, or a decrease in estimated glomerular filtration to <75% of baseline. Results: Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared with those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 versus 0.83; P=0.001 and P=0.02, respectively). Patients without MAKE-DC experienced a greater decline in serum NGAL from first to second measurement than those patients experiencing MAKE-DC. Conclusions: Early measures of kidney biomarkers in patients who are critically ill are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.

Spot urinary citrate-to-creatinine ratio is a marker for acid-base status in chronic kidney disease.

Due to multiple compensating mechanisms, the serum bicarbonate concentration is a relatively insensitive marker of acid-base status; especially in chronic kidney disease (CKD). This is a major drawback that impairs the ability to diagnose acid excess or monitor alkali therapy. We postulated that it is more logical to measure the compensatory defense mechanism(s) rather than the defended parameter, which remains normal if the compensation is successful. Therefore, a retrospective cross-sectional study was performed in 1733 stone formers along with a prospective cross-sectional study of 22 individuals with normal kidney function and 50 patients in different stages of CKD. While serum bicarbonate was flat and did not fall below the reference range until near CKD stage 5, citrate excretion (24-hour urinary citrate excretion rate; urinary citrate-to-creatinine ratio, in the retrospective analysis, and spot urinary citrate-to-creatinine ratio in the prospective study) progressively and significantly declined starting from CKD stage 2. Following an acute acid load in 25 participants with a wide range of estimated glomerular filtration rates, the urinary citrate-to-creatinine ratio inversely and significantly associated with acid accumulation, whereas serum bicarbonate did not. We compared changes in serum bicarbonate and urinary citrate-to-creatinine ratio in response to alkali therapy in patients with CKD stage 3 or 4 started on potassium citrate in our kidney stone database. With alkali therapy, there was no change in serum bicarbonate, but the urinary citrate-to-creatinine ratio rose consistently in all patients adherent to potassium citrate therapy. Thus, the urinary citrate-to-creatinine ratio (the defense mechanism) is a potential easily implementable, pragmatic, and a superior parameter to serum bicarbonate (the defended entity) to assess acid-base status, and monitor alkali therapy. Additional studies are needed before a clinical test can be devised.

[Familiar adenomatous polyposis: report of 2 cases]. / Poliposis adenomatosa familiar: a propósito de 2 casos.

Familial Adenomatous polyposis (FAP) it is based on an autosomal dominant mutation which results in loss of function of theAPC tumor suppressor gene. On the other hand, Gardner syndrome is a type of FAP and is characterized for multiple colonic adenomatous polyps and extracolonic abnormalities as desmoid tumors, osteomas, lipomas, dental abnormalities, dermoid cysts and duodenal adenomas. This report aims to present two patients with FAP: The first one is a patient who presented with osteomas and hematochezia, being diagnosed with Gardner Syndrome after the colonoscopy. The second patient has a family history of colon cancer, who is diagnosed with FAP with tubular adenocarcinoma. We decide to report both cases due to the absence of previous reports in Peru.

Poliposis adenomatosa familiar: a propósito de 2 casos / Familiar Adenomatous Polyposis: Report of 2 Cases

La poliposis adenomatosa familiar (PAF) se basa en una mutación autosómica dominante de pérdida de la función en el gen supresor tumoral APC. El síndrome de Gardner es un tipo de PAF y está caracterizado por múltiples pólipos adenomatosos colónicos además de anormalidades extracolónicas como tumores desmoides, osteomas, lipomas, anormalidades dentales, quistes dermoides y adenomas duodenales. Este reporte tiene como propósito presentar dos casos referentes a PAF. El primer caso, trata de un paciente con osteomas e historia de hematoquezia, con diagnóstico de sindrome de Gardner posterior a la colonoscopia. El segundo caso es un paciente con historia familiar de cáncer de colon, que al examen colonoscópico se le diagnostica PAF con adenocarcinoma tubular bien diferenciado. Se decide reportar los casos debido a que son los primeros reportes en el Perú sobre esta entidad

Familial Adenomatous polyposis (FAP) it is based on an autosomal dominant mutation which results in loss of function of the APC tumor suppressor gene. On the other hand, Gardner syndrome is a type of FAP and is characterized for multiple colonic adenomatous polyps and extracolonic abnormalities as desmoid tumors, osteomas, lipomas, dental abnormalities, dermoid cysts and duodenal adenomas. This report aims to present two patients with FAP: The first one is a patient who presented with osteomas and hematochezia, being diagnosed with Gardner Syndrome after the colonoscopy. The second patient has a family history of colon cancer, who is diagnosed with FAP with tubular adenocarcinoma. We decide to report both cases due to the absence of previous reports in Peru

Jogos virtuais: desempenho de jovens com síndrome de down / Virtual games: performance of youth with down syndrome

O objetivo do estudo foi avaliar a aceleração do movimento e o desempenho de adolescentes com Síndrome de Down e de com desenvolvimento típico durante o arremesso no jogo de boliche do videogame Nintendo® Wii™. Os participantes foram 20 adolescentes, com idade entre 7 e 14 anos, divididos em dois grupos: GSD (Grupo Síndrome de Down) e GC (Grupo Controle). Ambos os grupos fizeram os arremessos necessários para a finalização do jogo com a mão de preferência e um acelerômetro acoplado ao punho. Os dados foram analisados considerando-se apenas os 3 primeiros arremessos. Observou-se que a aceleração máxima média foi maior para o GC em todas as tentativas, porém com o número médio de tentativas equivalente para alcançar o objetivo do jogo. O boliche apresentou-se ao GSD como uma proposta de fácil compreensão, motivadora e com regras simples. Conclui-se que os jogos de arremesso no ambiente virtual podem favorecer o controle de aceleração do movimento.

The aim of this study was evaluate the acceleration of the movement and performance of adolescents with Down Syndrome and with typical development in pitch movements in the game of bowling video game Nintendo® Wii™. The subject were 20 adolescents, aged between 7 and 14 years, divided into two groups: GSD (Group Down Syndrome) and GC (Control Group). Both of them did the throws necessary to complete the game with the hand of preference and the accelerometer attached to the wrist. The data were analyzed considering only the first 3 pitches. It was observed that the maximum acceleration mean was higher for the GC in all attempts, however, but with the average number of equivalent attempts to achieve the goal of the game. The bowling presented the GSD as a proposal for easy understanding, as a motivational activity and with simple rules. The conclusion show that pitch games in the virtual environment can encourage the throttle control of movement.

Effect on ejaculatory performance and semen parameters of sexually-satiated male goats (Capra hircus) after changing the stimulus female.

The association between stimulation of sexual activity and semen characteristics of sexually mature goats was evaluated. Nine 2-year-old criollo bucks were used. Each buck was subjected to 8-weekly trials in which one of the following two treatments was alternately applied. In treatment 1, males were individually exposed to the same estrus-induced female during a 4-h period, and ejaculates were collected and analyzed throughout. Treatment 2 was the same, except that a different doe replaced the stimulus animal for the third and fourth hours. The total number of ejaculations and total sperm number for four sets of data was different (P<0.01) for treatments 1 and 2 (184 versus 252 ejaculations with a total of 354.3 versus 477.1 billion sperm, respectively). In treatment 2, when first and last ejaculation of each male with the (original) stimulus animal were compared, total sperm per ejaculate decreased (P=0.08) from 4.14+/-3.8 x 10(9) to 0.77+/-0.7 x 10(9), while this value increased (P=0.05) to 3.04+/-2.3 x 10(9) after a new female was introduced, which represented a recovery of 67.35%. All males achieved a first ejaculation with the original stimulus animal while on average, only three achieved a seventh service. After changing the stimulus animal, all males ejaculated again. It is concluded that changing the stimulus animal after a 2-h continuous exposure to an estrous female stimulates sexual activity and increases sperm output in male goats.

Efecto del sistema de crianza (extensivo vs semiintensivo) del macho cabrío, sobre la obtención de semen mediante vagina artificial / Effect of rearing conditions (extensive vs semiestabulated) on semen collection in goats via artificial vagina

Con el propósito de evaluar el efecto del sistema de crianza (extensivo vs semi-intensivo) del macho cabrío, en el entrenamiento para colecta de semen mediante vagina artificial, se utilizaron ocho animales criollos, de dos años de edad, con experiencia sexual; cuatro habían sido criados bajo condiciones extensivas, y los restantes bajo un manejo semiintensivo. Todos recibieron ocho sesiones de entrenamiento, exponiéndoles en forma individual, dos veces por semana, ante una hembra en celo durante 20 minutos o menos, para el caso de que eyacularan antes de cubrir el periodo. El orden de exposición se modificó en cada día de entrenamiento, pero siempre alternando los machos de acuerdo con su tipo de crianza. Los cuatro machos criados bajo condiciones semiintensivas eyacularon en la vagina artificial desde la primera exposición, mientras que ninguno de los animales criados bajo condiciones extensivas lograron eyacular durante las ocho sesiones de entrenamiento a que se sometieron. Los resultados sugieren que aquellos animales criados bajo condiciones extensivas, pueden desarrollar altos niveles de miedo durante evaluaciones sexuales ante la presencia cercana del humano, disminuyendo su motivación sexual bajo tales condiciones.

Síndrome poliglanular autoinmune tipo II (síndrome de Schmidt): informe del primer caso diagnosticado en 29,568 autopsias practicadas en el Hospital General de México / Autoimmune polyglandular syndrome type II (Schmidt's Syndrome): report of the first case diagnosed in 29,568 autopsies performed in the Hospital General de Mexico

Se informa el primer caso diagnosticado por autopsia de síndrome poliglandular autoinmune tipo II (Síndrome de Schmidt) en 29,568 necropsias practicadas en el Hospital General de México. Correspondió a una mujer de 18 años con diagnóstico de diabetes mellitus tipo I, que ingresó con datos de desequilibrio hidroelectrolítico y neumonía basal derecha, murió por insuficiencia respiratoria. En la autopsia se encontró desnutrición grado II, tiroiditis de Hashimoto, adrenalitis linfocítica, atrofia en ovario y neumonía derecha, sin alteraciones en otras glándulas endocrinas

Programación de operaciones Unidad Sanitaria Santa Cruz / Es

Informe de la Programación de Operaciones de las unidades ejecutoras de la Unidad Sanitaria de Santa Cruz: Hospital San Juan de Dios, Hospital Japonés, Distrito Centro Oeste (Jorochito), Distrito II, Distrito I, Distrito IV, Maternidad Percy Boland, Distrito Ichilo, Centro Nacional de Enfermedades Tropicales (CENETROP), Distrito V, Distrito Chiquitanía Norte, Distrito Norte. Las siguientes Unidades Ejecutoras no presentaron sus Programaciones de Operaciones. Estas son: Unidad Sanitaria de santa Cruz. Hospital de Niños Mario Ortiz Suárez, Instituto Oncológico, Centro de Salud Mental, Distrito III, Distrito Valles Cruceños, Distrito Cordillera, Distrito Chiquitanía Centro, Distrito Chiquitanía Sud

Consultoria nacional: Programación de operaciones / sss

El objetivo principal de este informe de consultoria fue capacitar al personal de salud para la elaboración de programación de Operaciones y Presupuestaria de 1993, acordes con las políticas de gobierno y del sector en el marco de la Ley

Situación actual del sistema de registro de la información física-financiera / sss

Se realizó el diagnóstico dirigido a los señores directores de hospitales y distritos, planificadores y administradores, a través del llenado de un formulario para la asimilación y sustanciación de la información que procesa cada Unidad Ejecutora, el cual permitió contar con juicio de valor para dar opiniones más convenientes. La muestra fue tomada en algunas Unidades Ejecutoras de las Unidades Sanitarias de La Paz, Cochabamba y Santa Cruz