Assessing the role of Chemokine (C-C motif) ligand 14 in AKI: a European consensus meeting.

BACKGROUND: Urinary Chemokine (C-C motif) ligand 14 (CCL14) is a biomarker associated with persistent severe acute kidney injury (AKI). There is limited data to support the implementation of this AKI biomarker to guide therapeutic actions. METHODS: Sixteen AKI experts with clinical CCL14 experience participated in a Delphi-based method to reach consensus on when and how to potentially use CCL14. Consensus was defined as ≥ 80% agreement (participants answered with 'Yes', or three to four points on a five-point Likert Scale). RESULTS: Key consensus areas for CCL14 test implementation were: identifying challenges and mitigations, developing a comprehensive protocol and pairing it with a treatment plan, and defining the target population. The majority agreed that CCL14 results can help to prioritize AKI management decisions. CCL14 levels above the high cutoff (> 13 ng/mL) significantly changed the level of concern for modifying the AKI treatment plan (p < 0.001). The highest level of concern to modify the treatment plan was for discussions on renal replacement therapy (RRT) initiation for CCL14 levels > 13 ng/mL. The level of concern for discussion on RRT initiation between High and Low, and between Medium and Low CCL14 levels, showed significant differences. CONCLUSION: Real world urinary CCL14 use appears to provide improved care options to patients at risk for persistent severe AKI. Experts believe there is a role for CCL14 in AKI management and it may potentially reduce AKI-disease burden. There is, however, an urgent need for evidence on treatment decisions and adjustments based on CCL14 results.

The Role of Cell Cycle Arrest Biomarkers for Predicting Acute Kidney Injury in Critically Ill COVID-19 Patients: A Multicenter, Observational Study.

OBJECTIVES: Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) have a high risk for developing acute kidney injury (AKI) which is associated with an increased risk of death and persistent renal failure. Early prediction of AKI is crucial in order to implement preventive strategies. The purpose of this study was to investigate the predictive performance of tissue inhibitor of metalloproteinases 2 and insulin like growth factor binding protein 7 (TIMP-2) × (IGFBP7) in critically ill patients with COVID-19-associated ARDS. DESIGN: Multicenter, prospective, observational study. SETTING: Twelve centers across Europe and United Kingdom. PATIENTS: Patients with moderate or severe COVID-19-associated ARDS were included and serial measurements of (TIMP-2) × (IGFBP7) were performed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the development of moderate or severe AKI according to the Kidney Disease: Improving Global Outcomes definition. Three hundred patients were available for the primary analysis, and 39 met the primary endpoint. At enrollment, urinary (TIMP-2) × (IGFBP7) had high predictive value for the primary endpoint with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.84-0.93). (TIMP-2) × (IGFBP7) was significantly higher in endpoint-positive patients at enrollment and at 12 hours. CONCLUSIONS: Urinary (TIMP-2) × (IGFBP7) predicts the occurrence of AKI in critically ill patients with COVID-19-associated ARDS.

Decision Support System to Classify and Optimize the Energy Efficiency in Smart Buildings: A Data Analytics Approach.

In this paper, an intelligent data analysis method for modeling and optimizing energy efficiency in smart buildings through Data Analytics (DA) is proposed. The objective of this proposal is to provide a Decision Support System (DSS) able to support experts in quantifying and optimizing energy efficiency in smart buildings, as well as reveal insights that support the detection of anomalous behaviors in early stages. Firstly, historical data and Energy Efficiency Indicators (EEIs) of the building are analyzed to extract the knowledge from behavioral patterns of historical data of the building. Then, using this knowledge, a classification method to compare days with different features, seasons and other characteristics is proposed. The resulting clusters are further analyzed, inferring key features to predict and quantify energy efficiency on days with similar features but with potentially different behaviors. Finally, the results reveal some insights able to highlight inefficiencies and correlate anomalous behaviors with EE in the smart building. The approach proposed in this work was tested on the BlueNet building and also integrated with Eugene, a commercial EE tool for optimizing energy consumption in smart buildings.

The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department.

OBJECTIVES: To assess the ability of the Glasgow Blatchford Score (GBS) system to identify the need for urgent upper gastrointestinal endoscopy (UGIE) in patients with upper gastrointestinal bleeding (UGIB). METHODS: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2) and low-risk ( < or = 2)- by means of the GBS system. RESULTS: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2) and 14 as "low-risk" ( < or = 2) subjects.The characteristics of patients in the low-risk group included: Mean age: 46.6 +/- 13.7 (18-88) years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7); esophagitis (21.4%; n = 3); gastritis (14.2%; n = 2); Mallory-Weiss syndrome (7.1%; n = 1); non-bleeding varices (7.1%; n = 1). The characteristics of patients in the high-risk group included: Mean age: 68.7 +/- 19.8 (31-91) years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26); normal (17.39%; n = 8); esophagitis (8.69%; n = 4); gastritis (8.69%; n = 4); angioectasia (4.34%; n = 2); bleeding varices (4.34%; n = 2). Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%), with a specificity of 48.28% (95% CI: 29.89, 67.1%). CONCLUSIONS: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

[Chemical pollution, exposome and health in the Canary Islands population: An assessment of the situation.] / Contaminación química, exposoma y salud en la población de las Islas Canarias: una revisión sistemática de los estudios realizados y análisis de la situación.

OBJECTIVE: The set of exposures to chemical substances and their role as a cause of disease gives rise to the concept of the exposome, partially made up of chemical pollutants to which an individual is exposed, which is why, unlike the genome, it is an a priori modifiable factor, its study being crucial in terms of Public Health. The population of the Canary Islands has been studied in terms of its levels of chemical contamination, with numerous biomonitoring studies, which makes it necessary to characterise its exposome and its consequences in terms of disease, in order to implement specific corrective measures to minimize the impact on its health. METHODS: A review of scientific literature (MEDLINE and Scopus) was made, according to PRISMA criteria and PICO methodology, to include studies on biomonitoring of pollutants, or evaluating the effect of pollutants on diseases prevalent in the archipelago. RESULTS: Twenty-five studies, both population-based and hospital-based, were selected. The results show that the exposome is made up of at least 110 compounds or elements, 99 of which appear to be present from the intrauterine stage. The presence of chlorinated pollutants and metals stands out, which seems to be related to the high incidence of metabolic diseases (diabetes), cardiovascular diseases (hypertension) and certain types of neoplasms (breast cancer). In short, the consequences are conditioned by the genome of the exposed population, reinforcing the enormous importance of genome-exposome interactions in the development of pathologies. CONCLUSIONS: Our results indicate that it is necessary to establish corrective measures on the sources of pollution that modify the exposome of this population.

OBJETIVO: El conjunto de exposiciones a sustancias químicas y su papel como causa de enfermedad da lugar al concepto de exposoma, conformado parcialmente por contaminantes químicos a los que un individuo se ve expuesto. Por ello, a diferencia del genoma, es un factor a priori modificable, siendo su estudio crucial en materia de Salud Pública. La población del archipiélago canario ha sido estudiada en cuanto a sus niveles de contaminación química, con numerosos estudios de biomonitorización, lo que hace necesario caracterizar el exposoma de ésta y sus consecuencias en términos de enfermedad, para poder implementar medidas correctoras específicas que minimicen el impacto en su salud. METODOS: Se realizó una revisión de la literatura científica (MEDLINE y Scopus) de acuerdo con los criterios PRISMA y siguiendo la metodología PICO, para incluir estudios de biomonitorización de contaminantes, o que evaluaran el efecto de éstos en enfermedades prevalentes en el archipiélago. RESULTADOS: Se seleccionaron veinticinco estudios, tanto de base poblacional como de base hospitalaria. Los resultados demuestran que el exposoma lo conforman, como mínimo, 110 compuestos o elementos, 99 de los cuales parecen estar presentes desde la etapa intrauterina. Destaca la presencia de contaminantes clorados y metales, lo que parece relacionarse con la alta incidencia de enfermedades metabólicas (diabetes), cardiovasculares (hipertensión) y ciertos tipos de neoplasias (cáncer de mama). Aunque tales consecuencias vienen condicionadas por el genoma de la población expuesta, reforzando la enorme importancia de las interacciones genoma-exposoma en el desarrollo de patologías. CONCLUSIONES: Nuestros resultados indican que es necesario establecer medidas correctoras sobre las fuentes de contaminación que modifiquen el exposoma de esta población.

Comparative analysis of mycotoxin, pesticide, and elemental content of Canarian craft and Spanish mainstream beers.

The number of craft breweries and the volume of craft beer produced globally is growing exponentially. However, little is known about their differences with mainstream beers regarding mycotoxin profile, pesticide and pollutant residues and elemental composition. Given that beer is one of the most consumed beverages worldwide, it is important to shed light on its toxicological profile. In this study, samples of 23 craft beers and 19 mainstream Spanish beers were collected to perform a comparative analysis including 8 mycotoxins, 225 pesticide residues and 50 POPs, and 50 elements. Mycotoxins were not detected in craft beers, while 100% of mainstream beers presented at least one mycotoxin. In contrast, craft beers contained higher average pesticide residues than their mainstream counterparts, although significant differences were only found in Mepiquat and Metrafenone content. No persistent organic pollutants were detected in any sample. The elemental composition presented differences between the two groups both in the concentration of elements and their hierarchy. In conclusion, the toxicological profile of all beers was safe and is unlikely to constitute a hazard to consumer health. Craft beers present significant differences from their mainstream counterparts in all the dimensions explored.

[Reducing chronic malnutrition among the disadvantaged populations to promote health and development]. / Reducción de la desnutrición crónica en las bases biosociales para la promoción de la salud y el desarrollo.

This article advances theoretical and conceptual arguments to justify efforts to reduce chronic malnutrition as a basic component of any strategy for promoting health and development in countries with a high malnutrition prevalence. The arguments rest on four cardinal principles of contemporary social epidemiology, in whose framework reducing chronic malnutrition would be a key strategic component: the social determinants approach, the life course as the clinical-epidemiological paradigm, the concept of heredity and population health, and recognition of the family as a social determinant. Added to these are the close association between nutrition, health, and development, on the one hand, and the political significance of any strategy that makes the fight against chronic malnutrition the most visible focus of programmatic action.

Surgical-orthodontic retreatment of a severe skeletal Class III malocclusion following an orthodontic camouflage.

INTRODUCTION: Class III malocclusions are some of the most difficult occlusal anomalies to be treated. Some patients with this condition may require orthognathic surgery, while others may be treated with dental camouflage. Proper patient assessment and selection remains critical in order to achieve favorable results. OBJECTIVES: This report outlines the case of an 18-year-old male who sought retreatment for a severe skeletal Class III dentofacial deformity after undergoing orthodontic camouflage treatment involving mandibular arch extractions. A treatment plan comprising dental decompensation and orthognathic surgery was implemented in order to achieve optimal facial and occlusal results. RESULTS: After 28 months of treatment, skeletal and dental correction was achieved and facial features were significantly improved. The orthognathic surgery required a 20-mm sagittal maxillomandibular skeletal correction, combined with a 4-mm correction of the midlines and a 2-mm impaction of the maxilla. CONCLUSION: Dental compensation may be a risky treatment alternative for severe dentoskeletal discrepancies. In these patients, orthodontics combined with orthognathic surgery is the recommended treatment option.

Elemental composition, rare earths and minority elements in organic and conventional wines from volcanic areas: The Canary Islands (Spain).

The organic wine market is rapidly growing worldwide, both in terms of production and consumption. However, the scientific literature is not conclusive regarding differences in the elemental composition of wines according to their production method, including both major and trace elements. Minerals can be present in wine as a result of both anthropogenic and environmental factors. To date, this has not been evaluated in volcanic contexts, neither has the emergent issue of rare earths and other minority elements as potential sources of food contamination. This study using inductively coupled plasma mass spectrometry (ICP-MS) analyses organic and conventional wines produced in the Canary Islands (Spain), an archipelago of volcanic origin, to compare their content of 49 elements, including rare earths and minority elements. Our results showed that organic wines presented lower potential toxic element content on average than their conventional counterparts, but differences were not significant. Geographical origin of the wine samples (island) was the only significant variable differentiating wine samples by their composition profiles. By comparing our data with the literature, no agreement was found in terms of differences between organic and conventionally-produced wines. This confirms that other factors prevail over elemental composition when considering differences between wine production methods. Regarding the toxicological profile of the wines, five samples (three organic and two conventional) exceeded the maximum limits established by international legislation. This highlights the need for stricter analytical monitoring in the Canary Islands, with a particular focus on Cu and Ni concentration, and potentially in other volcanic areas.

Influence of ligand encapsulation on cobalt-59 chemical-shift thermometry.

Thermometry via magnetic resonance imaging (MRI) would provide a powerful noninvasive window into physiological temperature management. Cobalt-59 nuclear spins demonstrate exceptional temperature dependence of their NMR chemical shifts, yet the insight to control this dependence via molecular design is lacking. We present the first systematic evidence that encapsulation of this spin system amplifies the temperature sensitivity. We tested the temperature dependence of the 59Co chemical shift (Δδ/ΔT) in a series of five low-spin cobalt(iii) complexes as a function of increasing encapsulation within the 1st coordination sphere. This study spans from [Co(NH3)6]Cl3, with no interligand connectivity, to a fully encapsulated dinitrosarcophagine (diNOsar) complex, [Co(diNOsar)]Cl3. We discovered Δδ/ΔT values that span from 1.44(2) ppm °C-1 in [Co(NH3)6]Cl3 to 2.04(2) ppm °C-1 in [Co(diNOsar)]Cl3, the latter among the highest for a molecular complex. The data herein suggest that designing 59Co NMR thermometers toward high chemical stability can be coincident with high Δδ/ΔT. To better understand this phenomenon, variable-temperature UV-Vis, 59Co NMR relaxation, Raman spectroscopic, and variable-solvent investigations were performed. Data from these measurements highlight an unexpected impact of encapsulation - an increasingly dynamic and flexible inner coordination sphere. These results comprise the first systematic studies to reveal insight into the molecular factors that govern Δδ/ΔT and provide the first evidence of 59Co nuclear-spin control via vibrational means.

Build Your Bioprocess on a Solid Strain-ß-Carotene Production in Recombinant Saccharomyces cerevisiae.

Robust fermentation performance of microbial cell factories is critical for successful scaling of a biotechnological process. From shake flask cultivations to industrial-scale bioreactors, consistent strain behavior is fundamental to achieve the production targets. To assert the importance of this feature, we evaluated the impact of the yeast strain design and construction method on process scalability -from shake flasks to bench-scale fed-batch fermentations- using two recombinant Saccharomyces cerevisiae strains capable of producing ß-carotene; SM14 and ßcar1.2 strains. SM14 strain, obtained previously from adaptive evolution experiments, was capable to accumulate up to 21 mg/gDCW of ß-carotene in 72 h shake flask cultures; while the ßcar1.2, constructed by overexpression of carotenogenic genes, only accumulated 5.8 mg/gDCW of carotene. Surprisingly, fed-batch cultivation of these strains in 1L bioreactors resulted in opposite performances. ßcar1.2 strain reached much higher biomass and ß-carotene productivities (1.57 g/L/h and 10.9 mg/L/h, respectively) than SM14 strain (0.48 g/L/h and 3.1 mg/L/h, respectively). Final ß-carotene titers were 210 and 750 mg/L after 80 h cultivation for SM14 and ßcar1.2 strains, respectively. Our results indicate that these substantial differences in fermentation parameters are mainly a consequence of the exacerbated Crabtree effect of the SM14 strain. We also found that the strategy used to integrate the carotenogenic genes into the chromosomes affected the genetic stability of strains, although the impact was significantly minor. Overall, our results indicate that shake flasks fermentation parameters are poor predictors of the fermentation performance under industrial-like conditions, and that appropriate construction designs and performance tests must be conducted to properly assess the scalability of the strain and the bioprocess.

Suitability of anodic stripping voltammetry for routine analysis of venous blood from raptors.

Lead (Pb) poisoning is a significant threat faced by raptors. Hence, rapid Pb diagnosis has become a priority during the admission of raptors in wildlife recovery centers, and bench-top analyzers, such as LeadCare II ®, are routinely employed for this purpose. However, this device has been designed for conducting analyses of human blood Pb levels (BLLs), and the validity of this methodology for whole blood from raptors has, to date, rarely been assessed. In addition, a recent recall by the US Food and Drug Administration has recommended discontinuing the use of this analyzer for human venous blood because it may underestimate the BLL. We evaluated the precision of BLL measurements taken with LeadCare II by comparing them with those obtained with inductively coupled plasma mass spectrometry (ICP-MS). Our sample contained venous blood from 105 raptors belonging to 4 species. The results showed a good correlation between the 2 techniques (Spearman's r = 0.927, p < 0.0001). The mean BLL with ICP-MS was 19.6 µg/dL; it was found to be 18.7 µg/dL with LeadCare II. A Bland-Altman analysis indicated that the bias between the mean differences was only 0.5 µg/dL, but it had a high standard deviation of bias (5.7 µg/dL) and 95% limits of agreement from -10.75 to 11.74 µg/dL. The present results indicated that LeadCare II has an overall sensitivity of 71.8% and a positive predictive value of 76.3%. The specificity of LeadCare II for detecting animals with low BLL (<3.4 µg/dL) was 96.4%, and the negative predictive value (the probability that a value below the limit of detection of LeadCare II has a true correspondence with the actual value) was 100%. The present results indicated that, although LeadCare II might be imperfect in the estimation of BLLs in raptors, it performs reasonably well and might be employed in the clinical setting to assess patients potentially suffering from Pb poisoning. Environ Toxicol Chem 2019;38:737-747. © 2018 SETAC.

Contaminación química, exposoma y salud en la población de las Islas Canarias: una revisión sistemática de los estudios realizados y análisis de la situación / Chemical pollution, exposome and health in the Canary Islands population: An assessment of the situation

Fundamentos: El conjunto de exposiciones a sustancias químicas y su papel como causa de enfermedad da lugar al conceptode exposoma, conformado parcialmente por contaminantes químicos a los que un individuo se ve expuesto. Por ello, a diferenciadel genoma, es un factora priori modificable, siendo su estudio crucial en materia de Salud Pública. La población del archipiélagocanario ha sido estudiada en cuanto a sus niveles de contaminación química, con numerosos estudios de biomonitorización, lo quehace necesario caracterizar el exposoma de ésta y sus consecuencias en términos de enfermedad, para poder implementar medidascorrectoras específicas que minimicen el impacto en su salud.Métodos: Se realizó una revisión de la literatura científica (MEDLINE yScopus) de acuerdo con los criterios PRISMA y siguiendo lametodología PICO, para incluir estudios de biomonitorización de contaminantes, o que evaluaran el efecto de éstos en enfermedadesprevalentes en el archipiélago.Resultados: Se seleccionaron veinticinco estudios, tanto de base poblacional como de base hospitalaria. Los resultados de-muestran que el exposoma lo conforman, como mínimo, 110 compuestos o elementos, 99 de los cuales parecen estar presentes desdela etapa intrauterina. Destaca la presencia de contaminantes clorados y metales, lo que parece relacionarse con la alta incidencia deenfermedades metabólicas (diabetes), cardiovasculares (hipertensión) y ciertos tipos de neoplasias (cáncer de mama). Aunque talesconsecuencias vienen condicionadas por el genoma de la población expuesta, reforzando la enorme importancia de las interaccionesgenoma-exposoma en el desarrollo de patologías.Concluiones: Nuestros resultados indican que es necesario establecer medidas correctoras sobre las fuentes de contamina-ción que modifiquen el exposoma de esta población.(AU)

Background: The set of exposures to chemical substances and their role as a cause of disease gives rise to the concept of theexposome, partially made up of chemical pollutants to which an individual is exposed, which is why, unlike the genome, it is an a priorimodifiable factor, its study being crucial in terms of Public Health. The population of the Canary Islands has been studied in terms ofits levels of chemical contamination, with numerous biomonitoring studies, which makes it necessary to characterise its exposomeand its consequences in terms of disease, in order to implement specific corrective measures to minimize the impact on its health.Methods: A review of scientific literature (MEDLINE and Scopus) was made, according to PRISMA criteria and PICO methodology, toinclude studies on biomonitoring of pollutants, or evaluating the effect of pollutants on diseases prevalent in the archipelago.Results: Twenty-five studies, both population-based and hospital-based, were selected. The results show that the exposome is madeup of at least 110 compounds or elements, 99 of which appear to be present from the intrauterine stage. The presence of chlorinated po-llutants and metals stands out, which seems to be related to the high incidence of metabolic diseases (diabetes), cardiovascular diseases(hypertension) and certain types of neoplasms (breast cancer). In short, the consequences are conditioned by the genome of the exposedpopulation, reinforcing the enormous importance of genome-exposome interactions in the development of pathologies.Conclusions: Our results indicate that it is necessary to establish corrective measures on the sources of pollution that modifythe exposome of this population.(AU)

Outbreak and Eradication of Tropical Rat Mite (Acari: Macronyssidae) in a European Animal Facility.

A zoonotic, opportunistic out-break of tropical rat mite Ornithonyssus bacoti [Acari: Macronyssidae; Ornithonyssus bacoti (Hirst)] in an animal facility, is described. Immunocompetent mice [Mus musculus (Linnaeus)] and rat [Rattus norvegicus (Berkenhout)] strains in a conventional health status facility suffered from scratching and allopecia and staff members suffered from pruritic, erythemato-papular lesions, presumed to be allergic in origin. O. bacoti was identified and treatment with a 0.1% ivermectin solution led to its complete erradication. Safety assessment revealed no signs of acute toxicity in any animal strain. Following this inexpensive strategy, 7 wk after the initial dose, samples were negative for the presence of acari. At the time of this report, 26 months after diagnosis, O. bacoti remains undetected.

Health and Disease Imprinted in the Time Variability of the Human Microbiome.

The animal microbiota (including the human microbiota) plays an important role in keeping the physiological status of the host healthy. Research seeks greater insight into whether changes in the composition and function of the microbiota are associated with disease. We analyzed published 16S rRNA and shotgun metagenomic sequencing (SMS) data pertaining to the gut microbiotas of 99 subjects monitored over time. Temporal fluctuations in the microbial composition revealed significant differences due to factors such as dietary changes, antibiotic intake, age, and disease. This article shows that a fluctuation scaling law can describe the temporal changes in the gut microbiota. This law estimates the temporal variability of the microbial population and quantitatively characterizes the path toward disease via a noise-induced phase transition. Estimation of the systemic parameters may be of clinical utility in follow-up studies and have more general applications in fields where it is important to know whether a given community is stable or not. IMPORTANCE The human microbiota correlates closely with the health status of its host. This article analyzes the microbial composition of several subjects under different conditions over time spans that ranged from days to months. Using the Langevin equation as the basis of our mathematical framework to evaluate microbial temporal stability, we proved that stable microbiotas can be distinguished from unstable microbiotas. This initial step will help us to determine how temporal microbiota stability is related to a subject's health status and to develop a more comprehensive framework that will provide greater insight into this complex system.

Surgical-orthodontic retreatment of a severe skeletal Class III malocclusion following an orthodontic camouflage

ABSTRACT Introduction: Class III malocclusions are some of the most difficult occlusal anomalies to be treated. Some patients with this condition may require orthognathic surgery, while others may be treated with dental camouflage. Proper patient assessment and selection remains critical in order to achieve favorable results. Objectives: This report outlines the case of an 18-year-old male who sought retreatment for a severe skeletal Class III dentofacial deformity after undergoing orthodontic camouflage treatment involving mandibular arch extractions. A treatment plan comprising dental decompensation and orthognathic surgery was implemented in order to achieve optimal facial and occlusal results. Results: After 28 months of treatment, skeletal and dental correction was achieved and facial features were significantly improved. The orthognathic surgery required a 20-mm sagittal maxillomandibular skeletal correction, combined with a 4-mm correction of the midlines and a 2-mm impaction of the maxilla. Conclusion: Dental compensation may be a risky treatment alternative for severe dentoskeletal discrepancies. In these patients, orthodontics combined with orthognathic surgery is the recommended treatment option.

RESUMO Introdução: As más oclusões de Classe III são uma das anomalias oclusais mais difíceis de serem tratadas. Alguns pacientes com essa condição podem precisar de cirurgia ortognática, enquanto outros podem ser tratados por meio da camuflagem ortodôntica. A correta avaliação e seleção do paciente para cada tipo de abordagem permanece uma decisão crítica para se obter resultados favoráveis. Objetivos: O presente artigo relata o caso de um paciente do sexo masculino, com 18 anos de idade, que procurou tratamento por causa de uma má oclusão esquelética severa de Classe III, após ter se submetido a camuflagem ortodôntica com extração de dentes inferiores. Um plano de tratamento envolvendo descompensação dentária e cirurgia ortognática foi implementado, com a finalidade de atingir resultados faciais e oclusais ideais. Resultados: Após 28 meses de tratamento, foi alcançada a correção esquelética e dentária, e as características faciais obtiveram uma melhora significativa. A cirurgia ortognática exigiu uma correção esquelética sagital bimaxilar de 20 mm, associada a 4 mm de correção das linhas médias e 2 mm de impacção da maxila. Conclusão: A compensação dentária pode ser um tratamento alternativo arriscado para discrepâncias dentoesqueléticas severas. Nesses pacientes, a Ortodontia associada à Cirurgia Ortognática é a opção de tratamento recomendada.

An exploration of the attitudinal and perceptual dimensions of body image among male and female adolescents from six Latin American cities.

Using survey methodology, this exploratory study examined the attitudinal and perceptual dimensions of body image among 1,272 eighth- and ninth-grade males and females from higher and lower socioeconomic backgrounds in Buenos Aires, Argentina (n = 195), Guatemala City, Guatemala (n = 212), Havana, Cuba (n = 213), Lima, Peru (n = 218), Panama City, Panama (n = 195), and Santiago, Chile (n = 239). The two dimensions of body image were assessed by showing the participants nine male and nine female silhouettes depicting body sizes ranging from extremely thin (#1) to extremely obese (#9). Approximately 50% of the male and female adolescents chose silhouette #3 as best depicting the attractive male body. Silhouette #2 was chosen by 45% of the females as best depicting feminine attractiveness, while 45% of the males chose silhouette #3. When identifying the silhouette that best depicted the healthy male body, 26% of the participants chose silhouette #2, 41% chose #3, and 19% chose #4. Silhouette #2 was selected by 33% of the adolescents as best depicting the healthy female body, 38% chose #3, and 14% chose #4. In all cities, the effect of body mass index (BMI) on body satisfaction was highly significant (p < 0.001). Almost 40% of the middle weight adolescents indicated a preference to be thinner, even though 72% of the males and 84% of the females in this subgroup already perceived themselves as thin. Similarly, 89% of the heavier weight participants indicated a preference to be thinner, even though only 10% of the males and 2% of the females in this subgroup perceived themselves as heavy. In five of the six cities, a significantly higher (p < 0.05) percentage of females than males desired to be thinner, the exception being Havana, where the distribution of desired change in body size was almost identical for males and females. Findings suggest a need for culturally sensitive, age- and gender-specific preventive interventions focusing on the importance of achieving a healthy weight during adolescence to promote body size acceptance among adolescents who are at a healthy weight.

Combitube SA through submental route. A technical innovation.

Both endotracheal intubation and the laryngeal mask are already established and have their specific applications. The Combitube SA applied submentally is useful for patients with serious craniomaxillomandibular fractures, particularly those which disturb the occlusion and cause serious haemorrhage with attendant difficulties for intubation. Combitube SA used via the submental route will facilitate fracture reduction and temporary maintenance of fractures, so that bleeding, pain and airway problems may be managed more easily until alternative intubation has been achieved.

Transmission assessment surveys (TAS) to define endpoints for lymphatic filariasis mass drug administration: a multicenter evaluation.

BACKGROUND: Lymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings. METHODOLOGY: The TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6-7 year olds or 1(st)-2(nd) graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs. PRINCIPAL FINDINGS/CONCLUSIONS: In 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance requires further investigation.

[Active surveillance of adverse effects of Pandemrix vaccine to prevent influenza A(H1N1) in Cuba]. / Vigilancia activa de eventos adversos a la vacuna Pandemrix para prevenir la influenza AH1N1 en Cuba.

INTRODUCTION: in April 2009, a new virus was identified in Mexico and North America as the cause of a respiratory disease. The virus quickly spread over other countries. On June 11, 2009 the World Health Organization (WHO) reported cases in 74 countries and territories located in 2 of its regions. The high sustained transmission of this virus worldwide led to establish the phase 6 or the pandemic phase, indicating that the situation had to do with spreading rather than increased severity. OBJECTIVES: to report on already known or new events after the administration of vaccine A(H1N1) called Pandemrix, to identify the most frequent events occurred in pregnant women and to research into the associated severe events. METHODS: a prospective descriptive study was designed to characterize the adverse effects of Pandemrix reported across the country from April 1st to June 30th, 2010. A total of 1,123,526 people were vaccinated in which 100% of pregnant women were included. RESULTS: active surveillance nationwide reported 5 763 signs and symptoms detected in 3 401 people (615 reports from pregnant women). The overall rate of reports was 302.7 x 100 000 doses administered. Adverse events such as fever, headache, pain, swelling and redness at the injection site, malaise, arthralgia, allergic reactions, nausea and vomiting were reported as common symptoms. These 10 symptoms and signs accounted for 79.1% of all the reported events. A total number of 80 317 pregnant women were vaccinated of whom 615 reported adverse effects, accounting for 0.8 % of the vaccinated pregnant women. Fever was the most notified symptom in children (193) followed by local reactions at the injection site (23), vomiting (20), arthralgia (17), headache (11), malaise (10) and high fever-related seizures (6). Eight events were analyzed as severe. CONCLUSIONS: the administration of the vaccine was related to 3 events, unrelated to other 3 events and 2 were classified as inconclusive (3 miscarriages). No deaths were reported. The capacity of the Cuban Health System for the administration of this vaccine with active surveillance in a short period of time was proved. Data from monitoring of events that were supposedly attributable to vaccination or immunization did not notify any unusual event. Therefore, no safety problem is associated to the Pandemrix vaccine.