Impact of conflict and pandemic on women's health in Latin America: implementation to improve equity in the provision and access to safe obstetric anesthesia.

Latin America is one of the regions with the most significant inequalities in women's health as a result of factors such as social disparity, lack of work opportunities, unemployment, violence, and corruption. Adding a health crisis like the COVID-19 pandemic to these elements created a perfect storm that perpetuated extreme inequalities. The crisis negatively impacted Latin-American women, and economic recession in our region was one of the main consequences, resulting in women compared with men having higher rates of poverty, poorer access to and experience of healthcare, a wider gender gap, and adverse effects on well-being. This consequently made women more vulnerable. Several initiatives to allow better access and to provide safe anesthesia to pregnant patients have been taken in the region to improve obstetric patient care during the pandemic and beyond. Education has been pivotal and one of the most essential tools in bridging the gap in inequalities between men and women.

Microencapsulation of Renealmia alpinia (Rottb.) Maas pulp pigment and antioxidant compounds by spray-drying and its incorporation in yogurt.

Renealmia alpinia (Rottb.) Maas pulp was processed by spray drying using Maltodextrin (MDX), and Gum Arabic (GA), and the mixture of both encapsulating agents (MDX-GA). Yield, moisture, water activity (a w ), apparent and bulk densities, size and morphology of capsules, color, and antioxidant potential (antioxidant activity, total carotenoids, and phenolic compounds) were analyzed. The encapsulates were incorporated as pigments in yogurt and the stability of antioxidant compounds (1, 7, 14, 21, and 28 days of storage) and the sensory properties were evaluated. The yields of all formulations (MDX, GA, MDX-GA) were around 17.86% with low moisture and a w range values (2.62-3.29% and 0.276-0.309, respectively). The microcapsules presented multiples particle sizes (0.67-27.13 µm) with irregular and smooth surfaces. Furthermore, these capsulates preserved yellow color and the retention of carotenoids was significantly higher with MDX (34.12 mg/100 g of powder), while the phenolic compounds and antioxidant activity increased with GA (474.17 mg GAE/100 g and 552.63 mg TE/100 g of powder, respectively). The main compounds ß-carotene and gallic acid were identified and quantified in positive and negative mode respectively using LC-MS/MS. Finally, the addition of the encapsulated pigments to yogurt allowed to obtain a yellow coloration and the yogurt added with MDX-GA presented the best formulation with not significant changes in antioxidant activity and acceptable sensory attributes up 28 days of storage.

Titulación domiciliaria en pacientes con apnea del sueño mediante dos dispositivos de CPAP automática: mismo modo, distintos resultados / CPAP home titration with two different devices: same mode, different results

INTRODUCCIÓN: Dada la gran prevalencia de apnea obstructiva del sueño (AOS) y las dificultades del cumplimiento, es necesario buscar un sistema que permita ajustar el nivel de presión de CPAP para cada paciente. Actualmente, la técnica más utilizada es emplear dispositivos de auto-CPAP capaces de analizar la respuesta del paciente y modificar la presión automáticamente, pero no se tiene en consideración las diferencias entre máquinas. El objetivo del estudio fue comparar los resultados de pruebas de titulación realizadas con dos dispositivos distintos para conocer si existían diferencias entre ellos. MÉTODOS: Estudio observacional retrospectivo que compara los resultados de 1.130 titulaciones automáticas domiciliarias realizadas en una noche con dos dispositivos: S9 AutoSetTM (S9) y DreamStation AutoCPAP (DS). Se determinó la presión óptima por análisis visual y el cumplimiento a 12 meses. RESULTADOS: Se incluyeron 870 pacientes a los que se realizaron 1.130 titulaciones. Los estudios válidos con DS fueron significativamente superiores (OR= 2,5; IC 95%: 1,9 a 3,2). Además, tanto la presión de titulación visual como la automática P90-95 fueron significativamente menores con la DS que con S9 [-1,9 cm H2O (IC: -2,2 a -1,6)] y [-2,2 cm H2O (IC: -2,6 a -1,9)] respectivamente, (p< 0,001). No se objetivó impacto en el cumplimiento. CONCLUSIONES: Los resultados reflejan que las CPAP automáticas no son iguales ni ofrecen los mismos resultados. Realizar una titulación con el dispositivo DS hace más probable que el estudio sea válido y se obtienen presiones más bajas. Se deberán realizar estudios específicos para conocer el porqué de las diferencias y evaluar su impacto clínico

INTRODUCTION: Due to the high prevalence of obstructive sleep apnea (OSA) and compliance difficulties, it is necessary to find a system for adjusting the CPAP pressure level for each patient. Currently, the most widely used technique is to use auto-CPAP devices which can analyze the patient's response and automatically modify the pressure. However differences between machines are not taken into account. The aim of the study was to compare the results of titration tests carried out with two different devices to find out whether there were differences between them. METHODS: Retrospective observational study comparing the results of 1,130 home automatic titrations performed over one night with two devices: S9 AutoSetTM (S9) and DreamStation AutoCPAP (DS). Optimal pressure was determined by visual analysis and compliance at 12 months. RESULTS: 870 patients were included and 1,130 titrations were carried out. Valid studies with DS were significantly higher (OR= 2.5; 95% CI: 1.9 to 3.2). Furthermore, both visual and automatic titration pressure P90-95 were significantly lower with DS than with S9 [-1.9 cm H2O (CI: -2.2 to -1.6)] and [-2.2 cm H2O (CI: -2.6 to -1.9)] respectively, (p< 0.001). No impact on compliance was observed. CONCLUSIONS: The results saw that neither automatic CPAPs are the same nor offer the same results. Performing a titration with the DS device not only makes the study more likely to be valid but also lower pressures are obtained. Specific studies should be carried out to find out the reason for the differences and evaluate their clinical impact

The Role of Pathogenic E. coli in Fresh Vegetables: Behavior, Contamination Factors, and Preventive Measures.

Many raw vegetables, such as tomato, chili, onion, lettuce, arugula, spinach, and cilantro, are incorporated into fresh dishes including ready-to-eat salads and sauces. The consumption of these foods confers a high nutritional value to the human diet. However, the number of foodborne outbreaks associated with fresh produce has been increasing, with Escherichia coli being the most common pathogen associated with them. In humans, pathogenic E. coli strains cause diarrhea, hemorrhagic colitis, hemolytic uremic syndrome, and other indications. Vegetables can be contaminated with E. coli at any point from pre- to postharvest. This bacterium is able to survive in many environmental conditions due to a variety of mechanisms, such as adhesion to surfaces and internalization in fresh products, thereby limiting the usefulness of conventional processing and chemical sanitizing methods used by the food industry. The aim of this review is to provide a general description of the behavior and importance of pathogenic E. coli in ready-to-eat vegetable dishes. This information can contribute to the development of effective control measures for enhancing food safety.

Capacitively coupled electrical stimulation of rat chondroepiphysis explants: A histomorphometric analysis.

The growth plate is a cartilaginous layer present from the gestation period until the end of puberty where it ossifies joining diaphysis and epiphysis. During this period several endocrine, autocrine, and paracrine processes within the growth plate are carried out by chondrocytes; therefore, a disruption in cellular functions may lead to pathologies affecting bone development. It is known that electric fields impact the growth plate; however, parameters such as stimulation time and electric field intensity are not well documented. Accordingly, this study presents a histomorphometrical framework to assess the effect of electric fields on chondroepiphysis explants. Bones were stimulated with 3.5 and 7 mV/cm, and for each electric field two exposure times were tested for 30 days (30 min and 1 h). Results evidenced that electric fields increased the hypertrophic zones compared with controls. In addition, a stimulation of 3.5 mV/cm applied for 1 h preserved the columnar cell density and its orientation. Moreover, a pre-hypertrophy differentiation in the center of the chondroepiphysis was observed when explants were stimulated during 1 h with both electric fields. These findings allow the understanding of the effect of electrical stimulation over growth plate organization and how the stimulation modifies chondrocytes morphophysiology.

Gene's hubs in retinal diseases: A retinal disease network.

BACKGROUND: Retinal diseases associated with the dysfunction or death of photoreceptors are a major cause of blindness around the world, improvements in genetics tools, like next generation sequencing (NGS) allows the discovery of genes and genetic changes that lead to many of those retinal diseases. Though, there very few databases that explores a wide spectrum of retinal diseases, phenotypes, genes, and proteins, thus creating the need for a more comprehensive database, that groups all these parameters. METHODS: Multiple open access databases were compiled into a new comprehensive database. A biological network was then crated, and organized using Cytoscape. The network was scrutinized for presence of hubs, measuring the concentration of grouped nodes. Finally, a trace back analysis was performed in areas were the power law reports a high r-squared value near one, that indicates high nodes density. RESULTS: This work leads to creation of a retinal database that includes 324 diseases, 803 genes, 463 phenotypes, and 2461 proteins. Four biological networks (1) a disease and gene network connected by common phenotypes, (2) a disease and phenotype network connected by common genes, (3) a disease and gene network with shared disease or gene as the cause of an edge, and (4) a protein and disease network. The resulting networks will allow users to have easier searching for retinal diseases, phenotypes, genes, and proteins and their interrelationships. CONCLUSIONS: These networks have a broader range of information than previously available ones, helping clinicians in the comprehension of this complex group of diseases.

PATRIOT: A phase I study to assess the tolerability, safety and biological effects of a specific ataxia telangiectasia and Rad3-related (ATR) inhibitor (AZD6738) as a single agent and in combination with palliative radiation therapy in patients with solid tumours.

PATRIOT is a phase I study of the ATR inhibitor, AZD6738, as monotherapy, and in combination with palliative radiotherapy. Here, we describe the protocol for this study, which opened in 2014 and is currently recruiting and comprises dose escalation of both drug and radiotherapy, and expansion cohorts.

Mechanobiological modeling of endochondral ossification: an experimental and computational analysis.

Long bone formation starts early during embryonic development through a process known as endochondral ossification. This is a highly regulated mechanism that involves several mechanical and biochemical factors. Because long bone development is an extremely complex process, it is unclear how biochemical regulation is affected when dynamic loads are applied, and also how the combination of mechanical and biochemical factors affect the shape acquired by the bone during early development. In this study, we develop a mechanobiological model combining: (1) a reaction-diffusion system to describe the biochemical process and (2) a poroelastic model to determine the stresses and fluid flow due to loading. We simulate endochondral ossification and the change in long bone shapes during embryonic stages. The mathematical model is based on a multiscale framework, which consisted in computing the evolution of the negative feedback loop between Ihh/PTHrP and the diffusion of VEGF molecule (on the order of days) and dynamic loading (on the order of seconds). We compare our morphological predictions with the femurs of embryonic mice. The results obtained from the model demonstrate that pattern formation of Ihh, PTHrP and VEGF predict the development of the main structures within long bones such as the primary ossification center, the bone collar, the growth fronts and the cartilaginous epiphysis. Additionally, our results suggest high load pressures and frequencies alter biochemical diffusion and cartilage formation. Our model incorporates the biochemical and mechanical stimuli and their interaction that influence endochondral ossification during embryonic growth. The mechanobiochemical framework allows us to probe the effects of molecular events and mechanical loading on development of bone.

Cyclic Concatenated Genetic Encoder: A mathematical proposal for biological inferences.

The organization of the genetic information and its ability to be conserved and translated to proteins with low error rates have been the subject of study by scientists from different disciplines. Recently, it has been proposed that living organisms display an intra-cellular transmission system of genetic information, similar to a model of digital communication system, in which there is the ability to detect and correct errors. In this work, the concept of Concatenated Genetic Encoder is introduced and applied to the analysis of protein sequences as a tool for exploring evolutionary relationships. For such purposes Error Correcting Codes (ECCs) are used to represent proteins. A methodology for representing or identifying proteins by use of BCH codes over ℤ20 and F4×ℤ5 is proposed and cytochrome b6-f complex subunit 6-OS sequences, corresponding to different plants species, are analyzed according to the proposed methodology and results are contrasted to phylogenetic and taxonomic analyses. Through the analyses, it was observed that using BCH codes only some sequences are identified, all of which differ in one amino acid from the original sequence. In addition, mathematical relationships among identified sequences are established by considering minimal polynomials, where such sequences showed a close relationship as revealed in the phylogenetic reconstruction. Results, here shown, point out that communication theory may provide biology of interesting and useful tools to identify biological relationships among proteins, however the proposed methodology needs to be improved and rigorously tested in order to become into an applicable tool for biological analysis.

[Quality of life and associated characteristics of restless legs syndrome in the adult population of Burgos, Spain]. / Calidad de vida y caracteristicas asociadas del sindrome de piernas inquietas en la poblacion adulta de Burgos, España.

INTRODUCTION: Restless legs syndrome (RLS) is a neurological disorder with a prevalence of up to 15%, although little is known about its impact upon quality of life. AIM: To analyse the impact of RLS on health-related quality of life. SUBJECTS AND METHODS: A descriptive cross-sectional study. A random sample of 1,275 subjects over 18 years old, stratified by age, was taken from the urban area of Burgos, with an estimated prevalence, 10%; alpha, 5%; accuracy, 3%; and losses, 70%, using a two-phase study (screening and diagnosis of cases of RLS and non-cases confirmed by a doctor). The clinical and sociodemographic data were collected by means of semi-structured questionnaires, the European Quality of Life-5 Dimensions, the Restless Legs Syndrome Quality of Life Questionnaire, the Epworth Scale, the Goldberg Scale, the Sleep Scale and the International Restless Legs Syndrome Rating Scale. RESULTS: The prevalence of RLS was 5.6% (CI 95%: 2.5-8.7%). Of the total number of cases, 79.4% were women and only 7% had been previously diagnosed with RLS. Intense pain, insomnia and depression-anxiety were more frequent among the cases of RLS than in the controls (p < 0.001 in the three cases). The quality of life among the cases of RLS, especially in women, was poorer than among the controls (p < 0.001). For 11.7% of the cases, RLS made it difficult for the patients to work. CONCLUSIONS: RLS is associated with depression-anxiety, with a significant impact on sleep, on social and work relationships, and on the health-related quality of life.

TITLE: Calidad de vida y caracteristicas asociadas del sindrome de piernas inquietas en la poblacion adulta de Burgos, España.Introduccion. El sindrome de piernas inquietas (SPI) es un trastorno neurologico con una prevalencia de hasta un 15%, cuyo impacto sobre la calidad de vida resulta poco conocido. Objetivo. Analizar el impacto del sindrome de piernas inquietas (SPI) en la calidad de vida relacionada con la salud. Sujetos y metodos. Estudio descriptivo transversal. Se incluyo una muestra aleatoria, estratificada por edad, de 1.275 sujetos mayores de 18 años en el area urbana de Burgos, con las estimaciones de prevalencia, 10%; alfa, 5%; precision, 3%; y perdidas, 70%, usando un estudio en dos fases (cribado y confirmacion diagnostica de casos de SPI y no casos por un medico). Los datos clinicos y sociodemograficos se recogieron usando cuestionarios semiestructurados: European Quality of Life-5 Dimensions, Restless Legs Syndrome Quality of Life Questionnaire, escala de Epworth, escala de Goldberg, escala del sueño y cuestionario internacional del sindrome de piernas inquietas. Resultados. La prevalencia del SPI fue del 5,6% (IC 95%: 2,5-8,7%). El 79,4% de los casos eran mujeres; solo el 7% tenia un diagnostico previo de SPI. El dolor intenso, el insomnio y la depresion-ansiedad fueron mas frecuentes en los pacientes con SPI que en los controles (p < 0,001 en los tres casos). La calidad de vida entre los pacientes con SPI, especialmente en las mujeres, fue peor que en los controles (p < 0,001). En el 11,7% de los casos, el SPI produjo dificultades para trabajar. Conclusiones. El SPI esta asociado con ansiedad-depresion, con un significativo impacto en el sueño, en las relaciones sociales y laborales, y en la calidad de vida relacionada con la salud.

Cellular scale model of growth plate: An in silico model of chondrocyte hypertrophy.

The growth plate is the responsible for longitudinal bone growth. It is a cartilaginous structure formed by chondrocytes that are continuously undergoing a differentiation process that starts with a highly proliferative state, followed by cellular hypertrophy, and finally tissue ossification. Within the growth plate chondrocytes display a characteristic columnar organization that potentiates longitudinal growth. Both chondrocyte organization and hypertrophy are highly regulated processes influenced by biochemical and mechanical stimuli. These processes have been studied mainly using in vivo models, although there are few computational approaches focused on the rate of ossification rather than events at cellular level. Here, we developed a model of cellular behavior integrating biochemical and structural factors in a single column of cells in the growth plate. In our model proliferation and hypertrophy were controlled by biochemical regulatory loop formed between Ihh and PTHrP (modeled as a set of reaction-diffusion equations), while cell growth was controlled by mechanical loading. We also examined the effects of static loading. The model reproduced the proliferation and hypertrophy of chondrocytes in organized columns. This model constitutes a first step towards the development of mechanobiological models that can be used to study biochemical interactions during endochondral ossification.

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

The Role of CYP2E1 in the Drug Metabolism or Bioactivation in the Brain.

Organisms have metabolic pathways that are responsible for removing toxic agents. We always associate the liver as the major organ responsible for detoxification of the body; however this process occurs in many tissues. In the same way, as in the liver, the brain expresses metabolic pathways associated with the elimination of xenobiotics. Besides the detoxifying role of CYP2E1 for compounds such as electrophilic agents, reactive oxygen species, free radical products, and the bioactivation of xenobiotics, CYP2E1 is also related in several diseases and pathophysiological conditions. In this review, we describe the presence of phase I monooxygenase CYP2E1 in regions of the brain. We also explore the conditions where protein, mRNA, and the activity of CYP2E1 are induced. Finally, we describe the relation of CYP2E1 in brain disorders, including the behavioral relations for alcohol consumption via CYP2E1 metabolism.

Cellular automata model for human articular chondrocytes migration, proliferation and cell death: An in vitro validation.

Articular cartilage is characterized by low cell density of only one cell type, chondrocytes, and has limited self-healing properties. When articular cartilage is affected by traumatic injuries, a therapeutic strategy such as autologous chondrocyte implantation is usually proposed for its treatment. This approach requires in vitro chondrocyte expansion to yield high cell number for cell transplantation. To improve the efficiency of this procedure, it is necessary to assess cell dynamics such as migration, proliferation and cell death during culture. Computational models such as cellular automata can be used to simulate cell dynamics in order to enhance the result of cell culture procedures. This methodology has been implemented for several cell types; however, an experimental validation is required for each one. For this reason, in this research a cellular automata model, based on random-walk theory, was devised in order to predict articular chondrocyte behavior in monolayer culture during cell expansion. Results demonstrated that the cellular automata model corresponded to cell dynamics and computed-accurate quantitative results. Moreover, it was possible to observe that cell dynamics depend on weighted probabilities derived from experimental data and cell behavior varies according to the cell culture period. Thus, depending on whether cells were just seeded or proliferated exponentially, culture time probabilities differed in percentages in the CA model. Furthermore, in the experimental assessment a decreased chondrocyte proliferation was observed along with increased passage number. This approach is expected to having other uses as in enhancing articular cartilage therapies based on tissue engineering and regenerative medicine.

Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report.

BACKGROUND: Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use. CASE PRESENTATION: We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %. CONCLUSION: Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued.

Acid ceramidase treatment enhances the outcome of autologous chondrocyte implantation in a rat osteochondral defect model.

OBJECTIVE: The overall aim of this study was to evaluate how supplementation of chondrocyte media with recombinant acid ceramidase (rhAC) influenced cartilage repair in a rat osteochondral defect model. METHODS: Primary chondrocytes were grown as monolayers in polystyrene culture dishes with and without rhAC (added once at the time of cell plating) for 7 days, and then seeded onto Bio-Gide® collagen scaffolds and grown for an additional 3 days. The scaffolds were then introduced into osteochondral defects created in Sprague-Dawley rat trochlea by a microdrilling procedure. Analysis was performed 6 weeks post-surgery macroscopically, by micro-CT, histologically, and by immunohistochemistry. RESULTS: Treatment with rhAC led to increased cell numbers and glycosaminoglycan (GAG) production (∼2 and 3-fold, respectively) following 7 days of expansion in vitro. Gene expression of collagen 2, aggrecan and Sox-9 also was significantly elevated. After seeding onto Bio-Gide®, more rhAC treated cells were evident within 4 h. At 6 weeks post-surgery, defects containing rhAC-treated cells exhibited more soft tissue formation at the articular surface, as evidenced by microCT, as well as histological evidence of enhanced cartilage repair. Notably, collagen 2 immunostaining revealed greater surface expression in animals receiving rhAC treated cells as well. Collagen 10 staining was not enhanced. CONCLUSION: The results further demonstrate the positive effects of rhAC treatment on chondrocyte growth and phenotype in vitro, and reveal for the first time the in vivo effects of the treated cells on cartilage repair.

Epicatechin Reduces Striatal MPP⁺-Induced Damage in Rats through Slight Increases in SOD-Cu,Zn Activity.

Parkinson's disease is a neurodegenerative disorder characterized by movement alterations caused by reduced dopaminergic neurotransmission in the nigrostriatal pathway, presumably by oxidative stress (OS). MPP(+) intrastriatal injection leads to the overproduction of free radicals (FR). The increasing formation of FR produces OS, a decline in dopamine (DA) content, and behavioral disorders. Epicatechin (EC) has shown the ability to be FR scavenger, an antioxidant enzyme inductor, a redox state modulator, and transition metal chelator. Acute administration of 100 mg/kg of EC significantly prevented (P < 0.05) the circling MPP(+)-induced behavior (10 µg/8 µL). Likewise, EC significantly (P < 0.05) reduced the formation of fluorescent lipid products caused by MPP(+). MPP(+) injection produced (P < 0.05) increased enzymatic activity of the constitutive nitric oxide synthase (cNOS). This effect was blocked with acute EC pretreatment. Cu/Zn-dependent superoxide dismutase (Cu/Zn-SOD) activity was significantly (P < 0.05) reduced as a consequence of MPP(+) damage. EC produced a slight increase (≈20%) in Cu/Zn-SOD activity in the control group. Such effects persisted in animals injured with MPP(+). The results show that EC is effective against MPP(+)-induced biochemical and behavioral damage, which is possible by an increase in Cu/Zn-SOD activity.

Subcutaneous Midazolam with and without Ketamine for Sedation In Children Undergoing Dental Treatment: A Pilot Study.

AIM: The objective of this study was to evaluate the efficacy of subcutaneous (SC) sedation using midazolam with and without ketamine in non-cooperative pediatric patients undergoing dental treatment. STUDY DESIGN: A prospective, randomized, controlled, double-blind, crossover pilot clinical trial was carried out in 13 children, aged between 17-46 months, ASA l, Frankl 1. Two sedation schemes were administered SC: Midazolam alone (M), and a combination of Midazolam-Ketamine (MK). Both regimens were administered to the same patient in two consecutive treatment sessions, in accordance with a random assignment. Overall behavior, movement, and crying were assessed according to the modified Houpt scale. Heart rate, blood pressure, blood oxygen saturation, and possible side effects were also monitored. RESULTS: The percentage of non-crying children was always higher in the treatment with MK compared with the treatment with M, but without a significant statistical difference. Regarding variable body movement, the percentage of children without movement was higher in the MK group, although only up to minute 10; no significant differences were found at 20, 30, and 40 minutes, and from minute 40, body movement was lower in the M group. CONCLUSIONS: Midazolam alone and the midazolam-ketamine combination administered subcutaneously resulted in a safe and efficient pharmacological method for providing moderate sedation to non-cooperative pediatric patients undergoing dental treatment.

Growth plate stress distribution implications during bone development: a simple framework computational approach.

Mechanical stimuli play a significant role in the process of long bone development as evidenced by clinical observations and in vivo studies. Up to now approaches to understand stimuli characteristics have been limited to the first stages of epiphyseal development. Furthermore, growth plate mechanical behavior has not been widely studied. In order to better understand mechanical influences on bone growth, we used Carter and Wong biomechanical approximation to analyze growth plate mechanical behavior, and explore stress patterns for different morphological stages of the growth plate. To the best of our knowledge this work is the first attempt to study stress distribution on growth plate during different possible stages of bone development, from gestation to adolescence. Stress distribution analysis on the epiphysis and growth plate was performed using axisymmetric (3D) finite element analysis in a simplified generic epiphyseal geometry using a linear elastic model as the first approximation. We took into account different growth plate locations, morphologies and widths, as well as different epiphyseal developmental stages. We found stress distribution during bone development established osteogenic index patterns that seem to influence locally epiphyseal structures growth and coincide with growth plate histological arrangement.

Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria / Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy

Objetivo: Evaluar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el síndrome de apnea-hipopnea durante el sueño (SAHS) en la infancia mediante poligrafía respiratoria (PR). Material y métodos: Estudio prospectivo en niños menores de 14 años remitidos con la sospecha clínica de SAHS. A todos ellos se les realizó una historia clínica, examen físico general y otorrinolaringológico, así como PR previa a la adenoamigdalectomía y 6 meses después. Se excluyeron los síndromes cráneo-faciales, las alteraciones neuromusculares y la enfermedad concomitante grave. Resultados: Se estudiaron 150 casos (67,3% varones), con una edad media de 3,74±1,80 años y un percentil de IMC de 41,70±31,75, diagnosticados de SAHS, cuando el número total de eventos respiratorios, apneas más hipopneas, dividido por el tiempo total del estudio (IER) era mayor de 4,6, mediante PR previa a la cirugía. El IER medio fue de 15,18±11,11; del total, 58,7% (88) presentaba un SAHS grave (IER>10). Después de 6 meses tras la cirugía, mejoraron todos los parámetros clínicos y poligráficos. Persistió enfermedad (IER>4,6) en 21 pacientes (14%). Ninguno de ellos presentó IER>10 tras la cirugía. El IER preoperatorio se relacionó significativamente con la persistencia de enfermedad (p=0,042). Conclusiones: La PR es útil para monitorizar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el SAHS infantil (AU)

Objetive: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). Material and methods: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. Results: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=0.042). Conclusions: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS (AU)