Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial.

OBJECTIVE: The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families. METHODS: This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm. DISCUSSION: Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families. TRIAL REGISTRATION: NCT05929833.

Cold urticaria as a complication of cryotherapy in the treatment of viral warts.

Cryotherapy with liquid nitrogen has been established as the first-line treatment for pediatric patients with viral warts. Cold-induced urticaria (CU) is a rare skin reaction triggered by cold stimuli. We present the case of a pediatric patient with viral warts who developed CU after receiving cryotherapy.

Surgical Control of the Pitch, Roll and Yaw in the Maxillary Arch: A Technical Note.

The adequate three-dimensional location of the maxilla is one of the main objectives in orthognathic surgery. We propose an instrument manufactured from a Fox Plane (FP) modified with red light in the shape of a cross and a bubble level, in which we perform an occlusal registration for the trans-surgical control of the three-dimensional position of the maxilla, By adding an occlusal registration to the FP, the occlusal plane is transferred and amplified to an extraoral reference. The red light in the shape of a cross allows us to assess the success of our movements more accurately.

Tiempo empleado para estimar edad dental en niños peruanos comparando el método de Demirjian y el cuadro integral del enfoque de Demirjian: un estudio piloto / Time spent to estimate dental age in peruvian children comparing the demirjian method and the comprehensive chart based on demirjian method: a pilot study

El objetivo de este estudio fue comparar el tiempo empleado al estimar la edad dental (ED) entre el método propuesto por Demirjian et al. y el cuadro integral del enfoque de Demirjian (DAEcc) utilizando radiografías panorámicas digitales de individuos peruanos de 5 a 13 años residentes en Lima. Se realizó un estudio no experimental, comparativo, transversal y retrospectivo. Se utilizaron 100 radiografías panorámicas digitales que presentaban siete dientes permanentes mandibulares izquierdos. Una odontóloga forense capacitada y calibrada determinó el tiempo utilizado en evaluar la maduración dental y la estimación de ED con dos métodos (Demirjian y DAEcc). La unidad de medida utilizada fue los minutos (min.). No hubo diferencias en el tiempo de evaluación del estadio de maduración dental entre ambos métodos (p<0,05). El tiempo para estimar ED fue estadísticamente inferior con DAEcc (2,09 min) que con Demirjian (4,19 min). La diferencia del tiempo total de evaluación resultó estadísticamente significativa entre ambos métodos (Δ2,1 min.; 2,05-2,11; p=0,000). La aplicación del DAEcc redujo en 50 % el tiempo empleado en estimar ED en comparación con los cuadros propuestos por Demirjian. Aunque la odontología forense se centra en el estudio de la eficacia de estimación de la edad, es necesario abordar también su uso práctico.

SUMMARY: The objective of this study was to compare the time used to estimate dental age (DA) between the method proposed by Demirjian et al., and the comprehensive chart for dental age estimation (DAEcc) using digital panoramic radiographs of Peruvian individuals aged 5 to 13 years residing in Lima. A non- experimental, comparative, cross-sectional and retrospective study was carried out. 100 digital panoramic radiographs showing seven mandibular left permanent teeth were used. A trained and calibrated forensic odontologist determined the time used to assess tooth maturation and DA estimation with two methods (Demirjian and DAEcc). The unit of measurement used was minutes (min.). There were no differences in the evaluation time of the dental maturation stage between both methods (p<0.05). The time spent to estimate DA was statistically less with DAEcc (2.09 min) than with Demirjian (4.19 min). The difference in total evaluation time was statistically significant between both methods (Δ2.1 min; 2.05-2.11; p=0.000).The application of DAEcc reduced by 50 % the time spent estimating DA compared to the method proposed by Demirjian. Although forensic odontology focuses on the study of the effectiveness of age estimation, its practical use needs to be addressed as well.

Does current evidence on disease-modifying antirheumatic drugs for psoriatic arthritis reinforce an effect on radiographic progression? Results from a systematic review and meta-analysis.

This study aims to estimate the effect of synthetic and biologic disease-modifying antirheumatic drugs (DMARDs) on radiographic progression and quality of life in adult patients with psoriatic arthritis. A comprehensive search was performed using MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CCRCT). Clinical trials comparing DMARDs with placebo for ≥ 12 weeks were included. The meta-analysis was conducted with a random-effects model using mean differences (MD). A total of 16 trials with overall moderate quality of evidence were included. Exposure to a biologic agent reduced radiographic progression at 24 weeks of treatment (MD: - 0.66; [95% CI - 0.97 to - 0.34]; P < .00001; I2 = 100%). The reduction of the baseline score was more than two times higher for TNF blockers compared with IL-17 and IL-12/IL-23 inhibitors (MD: - 0.94 vs - 0.41). Improvement in health-related quality of life scores was observed in biologic-treated populations (MD: - 0.21; [95% CI - 0.25 to - 0.18]; P < .00001; I2 = 97%). No sufficient data were available regarding conventional synthetic agents. Our data analyses suggest a better control of radiological damage with bDMARDs, as compared to placebo, after 24 weeks of treatment. However, the accuracy of these results in real life are jeopardized by the exceedingly high level of heterogeneity exhibited within and across included studies, and the true intervention effect cannot be determined with confidence. Further research is required to assess long-term outcomes and to control heterogeneity in the evaluation of treatments for psoriatic arthritis. PROSPERO registration number: CRD42019122223. Key Points • Radiographic progression is not the primary outcome for most efficacy studies in psoriatic arthritis; hence, baseline data are substantially diverse in major clinical trials. • The best available evidence on this particular outcome is currently at a moderate risk of bias. • Existing reports of the effect of DMARDs on structural damage must be taken with caution. • Further research is required to assess long-term outcomes and to control heterogeneity between studies.

Strategy for biotechnological process design applied to the enzymatic hydrolysis of agave fructo-oligosaccharides to obtain fructose-rich syrups.

A strategy to optimize biotechnological process design is illustrated for the production of fructose-rich syrups via enzymatic hydrolysis of agave fructo-oligosaccharides. The optimization process includes ecological studies from natural fermentations leading to the selection of a strain with capacity for inulinase synthesis, and variable optimization for the synthesis, and enzymatic hydrolysis using the response surface methodology. The results lead to the selection of Kluyveromyces marxianus , endogenous strains isolated from aguamiel (natural fermented sugary sap from agave plants), as the main strain with high capacity for enzyme synthesis with inulinase activity. Production optimization at bioreactor level revealed that operation at 30.6 degrees C, 152 rpm, 1.3 VVM of aeration, and pH 6.3 leads to maximum inulinase synthesis, whereas 31 degrees C, 50 rpm, and pH 6.2 leads to maximum hydrolysis of agave fructo-oligosaccharides. HPLC analysis of the fructose-rich syrups obtained at these optimal conditions showed an average composition of 95% of fructose and 5% of glucose and the absence of sucrose. The analysis also revealed that the syrups are free of residues and toxic compounds, an undesirable occurrence often present when traditional methods based on thermal or acid hydrolysis are applied for their obtainment. Therefore, the product may be suitable for use as additive in many applications in the food and beverage industries.

Sexual identity formation and AIDS prevention: an exploratory study of non-gay-identified Puerto Rican MSM from working class neighborhoods.

As a subgroup of men who have sex with men (MSM), non-gay-identified (NGI) behaviorally bisexual Latino MSM are associated with heightened probabilities of HIV transmission, yet they have eluded HIV/AIDS interventionists. This exploratory study of Puerto Rican MSM drug users employed multi-session qualitative interviews to examine early life experiences related to gender identity and sexual orientation, and the place of risky drug and sexual behaviors in the process of sexual identity formation. NGI participants experienced sexual debut between ages 13 and 20, and most were recruited to prostitution as young teens by NGI age mates who were also members of drug use networks. Participants emphasized their role as insertive sexual partners and that they maintained relationships with pasivo biological males. It is feasible to recruit NGI MSM through primary male sexual partners and drug use networks. HIV/AIDS prevention based on awareness of developmental histories holds promise for intervening before NGI youth engage in male prostitution or injection drug use.