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Introducción:El diagnóstico de apendicitis es di-fícil en niños pequeños y en niñas preadolescen-tes que inician su maduración sexual. Objetivo: Determinar la utilidad de la Escala de Alvarado en niños de 1 a 14 años con dolor abdominal.Mate-riales y métodos: Estudio de corte transversal, a partir de información de historias clínicas de me-nores que ingresaron por dolor abdominal al Hos-pital Universitario del Valle entre enero de 2017 y diciembre de 2018. Con punto de corte mayor a 7, se estimaron las características operativas de la escala y su curva de características operativas para el receptor. Resultados:De 451 historias, 323 eran de niños con apendicitis aguda, predominó el sexo masculino con un promedio de edad de 9,4 ± 2,8 años y un 26 % con perforación del apéndice; 13 menores de 4 años con apendicitis tenían un 66,6 % de perforación. La escala obtuvo una especi-ficidad del 96 % y una sensibilidad del 38,8 %. Asimismo, con la curva ROC se encontró que 7,5 es el mejor punto de corte para discriminar entre niños con y sin apendicitis. Conclusión: La escala discriminó bien entre niños con y sin apendicitis; en menores de 4 años se recomienda realizar ul-trasonografía temprana.

Introduction: The diagnosis of appendicitis in young boys and preadolescent girls who are beginning their sexual development is difficult. Objective: To determine the usefulness of the Alvarado scale in children aged between 1 to 14 years, who have abdominal pain. Materials and methods:Cross-sectional study using information from clinical records of minors who were admitted due to abdominal pain at the University Hospital of Valle del Cauca, Colombia, between January 2017 and December 2018. A cut-off point greater than seven was applied to estimate both the ope-rative characteristics of the scale and its operative characteristics curve. Results: 323 out of the 451 records analyzed included children with acute appendicitis. Male patients with an average age of 9.4 ± 2.8 years predominated, 26% of which experienced appendix rupture. 66.6% of the 13 minors aged 4 years old diagnosed with appen-dicitis also had appendix rupture. The scale had a 96% specificity and a 38.8% sensitivity. Likewise, a value of 7.5 was the best cut-off value of the ROC curve to discriminate between children with and without appendicitis. Conclusion: The scale was accurate to discriminate between children with and without appendicitis. Early ultrasonography is recommended for children under 4 years of age.

| 2 |REVISTAY SALUDUNIVERSIDADhttps://doi.org/10.22267/rus.252701.332RESUMOIntrodução:O diagnóstico de apendicite é difícil em meninos e meninas pré-adolescentes que estão iniciando a maturação sexual.Objetivo: Determinar a utilidade da escala Alvarado em crianças de 1 a 14 anos com dor abdominal. Materiais e métodos: Estudo transversal, baseado em informações de prontuários de menores que foram internados por dor abdominal no Hospital Universitário do Valle entre janeiro de 2017 e dezembro de 2018. Com ponto de corte superior a sete, as características operacionais foram estimado da escala e sua curva característica de operação para o receptor. Resultados: Das 451 histórias, 323 eram de crianças com apendicite aguda, predominando o sexo masculino com idade média de 9,4 ± 2,8 anos e 26% com perfuração de apêndice; 13 crianças menores de 4 anos com apendicite tiveram 66,6% de perfuração. A escala obteve especificidade de 96% e sensibilidade de 38,8%. Da mesma forma, com a curva ROC constatou-se que 7,5 é o melhor ponto de corte para discriminar crianças com e sem apendicite.Conclusão:A escala discrimina bem crianças com e sem apendicite; Em crianças menores de 4 anos, recomenda-se a ultrassonografia precoce.

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Introduction To assess the sensitivity fluorescent urine cytology induced by 5- aminolevulinic acid (5-ALA) in the diagnosis of bladder cancer and to compare the sensitivity and specificity with currently available markers approved by the United States Food and Drug Administration (FDA), bladder tumour antigen (BTA-TRAK, Bard Diagnostic Sciences, Redmond, WA, United States) assay based on enzyme-linked immunosorbent assay (ELISA), nuclear matrix protein 22 (NMP-22), and conventional cytology. Materials and Methods Age- and gender-matched patients 18 years of age admitted with imaging-confirmed bladder cancer and non-malignant conditions formed the cases and controls respectively. A freshly-collected voided urine sample was divided into four parts, with each part used to perform: a) conventional cytology with Papanicolaou staining; b) the BTA-TRAK assay; c) the NMP-22 assay; and d) 5-ALA-induced fluorescent urine cytology. The resected bladder specimen was sent for histopathological examination. Results In low-grade bladder cancers, the sensitivity of 5-ALA fluorescent cytology was of 88.02%, which was significantly higher than conventional cytology (p < 0.0001), the NMP-22 assay (p < 0.0035), and the BTA-TRAK assay (p < 0.0007). The sensitivity of 5-ALA fluorescent cytology was significantly higher in high-grade lesions when compared to conventional cytology (p < 0.0005) and the BTA-TRAK assay (p < 0.039). Conclusions Fluorescent urine cytology induced by 5-aminolevulinic acid is a highly-sensitive test in the diagnosis of bladder cancer, and its sensitivity rates are significantly superior to those of conventional cytology, the NMP-22 assay, and the BTA-TRAK assay.

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Resumo Objetivo Determinar o grau de concordância, sensibilidade e especificidade da prioridade de atendimento determinada por enfermeiros interavaliadores, a partir do uso do protocolo de acolhimento e classificação de risco em obstetrícia, em unidade de pronto atendimento obstétrico. Métodos Estudo transversal, com abordagem metodológica, realizado em uma maternidade-escola de Belo Horizonte-MG-Brasil, no período de setembro a novembro de 2020. Realizado em duas etapas: 1) Documental com avaliação dos registros de enfermeiros classificadores nos prontuários de gestantes, parturientes ou puérperas; 2) Entrevista com enfermeiros treinados e não treinados na classificação de risco. Realizou-se análise de sensibilidade, especificidade e empregou-se o coeficiente Kappa (k) para avaliar a concordância. Resultados Evidenciou-se que o grau de concordância Interavaliadores (enfermeiros treinados e não treinados) foi considerado moderado a forte (k= 0,47 e 0,77). Verificou-se tendência na subestimação das prioridades vermelha (sensibilidade de 85%; especificidade de 99%) e amarela (sensibilidade de 54%; especificidade de 85%), bem como superestimação na prioridade verde (sensibilidade de 62%; especificidade de 84%) e azul (sensibilidade de 89%, especificidade de 98%), porém sem diferenças significativas. Apesar da concordância e especificidade satisfatória, a sensibilidade foi baixa, devido aos índices de subestimação e superestimação na classificação de risco. Conclusão O protocolo é confiável para determinação da prioridade de atendimento em obstetrícia, porém houve baixa sensibilidade, diante de sua aplicação na determinação da prioridade de atendimento por enfermeiros treinados e não treinados.

Resumen Objetivo Determinar el nivel de concordancia, sensibilidad y especificidad de la prioridad de asistencia determinada por enfermeros interevaluadores, a partir del uso del protocolo de acogida y clasificación del riesgo en obstetricia, en una unidad de servicios de emergencias obstétricas. Métodos Estudio transversal con enfoque metodológico, realizado en una maternidad escuela de Belo Horizonte, Minas Gerais, Brasil, de septiembre a noviembre de 2020. Fue realizado en dos etapas: 1) documental con análisis de los registros de enfermeros clasificadores en las historias clínicas de mujeres embarazadas, parturientas o puérperas; 2) entrevista con enfermeros capacitados y no capacitados en clasificación del riesgo. Se realizó análisis de sensibilidad, especificidad y se empleó el coeficiente Kappa (k) para evaluar la concordancia. Resultados Se observó que el nivel de concordancia entre evaluadores (enfermeros capacitados y no capacitados) fue considerado de moderado a fuerte (k= 0,47 e 0,77). Se verificó una tendencia de subestimación de la prioridad roja (sensibilidad de 85 %; especificidad de 99 %) y amarilla (sensibilidad de 54 %; especificidad de 85 %), así como una sobrestimación de la prioridad verde (sensibilidad de 62 %; especificidad de 84 %) y azul (sensibilidad de 89 %, especificidad de 98 %), pero sin diferencias significativas. A pesar de que la concordancia y la especificidad fueron satisfactorias, la sensibilidad fue baja, debido a los índices de subestimación y sobrestimación en la clasificación del riesgo. Conclusión El protocolo es confiable para determinar la prioridad de asistencia en obstetricia, pero se observó baja sensibilidad al ser aplicado por enfermeros capacitados y no capacitados para determinar la prioridad de asistencia.

Abstract Objective To determine the degree of agreement, sensitivity and specificity of the priority of care determined by inter-rater nurses, based on the use of the protocol for care and risk classification in obstetrics, in an obstetric emergency unit. Method Cross-sectional study with a methodological approach, carried out in a maternity school in Belo Horizonte-MG-Brazil, from September to November 2020. It was carried out in two stages: 1) Documental with an evaluation of the records of nurse classifiers in the medical records of pregnant women, parturients or puerperal women; 2) Interviews with trained and not trained nurses in risk classification. Sensitivity and specificity were analyzed and the Kappa coefficient (k) was used to assess agreement. Results The degree of inter-rater agreement (trained and not trained nurses) was found to be moderate to strong (k= 0.47 and 0.77). There was a tendency to underestimate the red (sensitivity of 85%; specificity of 99%) and yellow priorities (sensitivity of 54%; specificity of 85%), as well as overestimate the green (sensitivity of 62%; specificity of 84%) and blue priorities (sensitivity of 89%, specificity of 98%), although there were no significant differences. Despite satisfactory agreement and specificity, sensitivity was low, due to the rates of underestimation and overestimation in risk classification. Conclusion The protocol is reliable for determining priority of care in obstetrics, but its sensitivity was low when applied to determining priority of care by trained and not trained nurses.

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ABSTRACT This study aimed to propose a guideline for amblyopia treatment and follow-up. Studies show that amblyopia leads to a series of perceptual deficits, including loss of visual acuity, stereoacuity, and contrast sensitivity. Perceptual changes are also found in the sound eye, such as those involving the types of motion perception. The gold standard of treatment remains the prescription of eyeglasses, when indicated, and patching of the dominant eye. The treatment is mostly effective in patients aged <7 years and must be discontinued gradually, tapering off patching for at least 5 weeks. Atropine may be performed for penalization in hyperopic children whose amblyopic eye has better visual acuity under cycloplegia than the fellow eye. The discovery of significant neural plasticity in the amblyopic brain after the critical period opens possibilities for new treatment modalities even after childhood.

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La sepsis neonatal temprana es un desafío de salud pública en Ecuador, con altas tasas de morbilidad-mortalidad. El diagnóstico precoz es crucial, pero los métodos actuales tienen limita-ciones. El índice neutrófilo linfocito se presenta como un biomarcador prometedor para detec-ción y manejo de la sepsis neonatal temprana. Este estudio busca establecer su punto de corte y evaluar su eficacia en el Hospital de Especialidades Carlos Andrade Marín. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo y descriptivo en este hospital, recopilando datos clínicos neonatales de enero de 2017 a diciembre de 2021. Se incluyeron expedientes de pacientes con sospecha de sepsis neonatal temprana nacidos desde la semana 26, excluyendo historias clínicas incompletas o con sepsis tardía. Se analizaron variables como edad, sexo y biomarcadores, utilizando el software SPSS versión 27. El estudio fue aprobado por el Comité de Ética de Investigación en Seres Humanos del Hospital de Especialidades Carlos Andrade Marín. RESULTADOS: Se analizaron 102 expedientes de recién nacidos con sepsis neonatal en 5 años. La mayoría eran neonatos muy prematuros y nacidos por cesárea. Con punto de cor-te de 0.86 para el índice neutrófilo linfocito, con una sensibilidad del 98.1% y especificidad del 85.4%. DISCUSIÓN: No se encontró una relación significativa entre el sexo y la sepsis. Aunque el índice neutrófilo linfocito mostró alta sensibilidad y especificidad, su baja área bajo la curva indica que no es un marcador fiable para diagnosticar de sepsis neonatal. CONCLUSIÓN: Se requieren estudios adicionales con muestras más grandes y otros marcadores biológicos para mejorar la capacidad diagnóstica de la sepsis neonatal.

Early neonatal sepsis is a public health challenge in Ecuador, with high morbidity and mortality rates. Early diagnosis is crucial, but current methods have limitations. The neutrophil-lympho-cyte ratio, emerges as a promising biomarker for the detection and management of early neo-natal sepsis. This study aims to establish its cutoff point and evaluate its efficacy at the Carlos Andrade Marín Specialty Hospital. MATERIALS AND METHODS: A retrospective and descrip-tive study was conducted at this hospital, collecting neonatal clinical data from January 2017 to December 2021. Records of patients with suspected early neonatal sepsis born from week 26 were included, excluding incomplete medical records or those with late-onset sepsis. Variables such as age, sex, and biomarkers were analyzed using SPSS version 27 software. The study was approved by the hospital's ethics committee. RESULTS: A total of 102 medical records of newborns with neonatal sepsis over 5 years were analyzed. Most were very premature and born by cesarean section. A cutoff point of 0.86 for the neutrophil-lymphocyte ratio was determined, with a sensitivity of 98.1% and a specificity of 85.4%. DISCUSSION: No significant relationship was found between sex and sepsis. Although the neutrophil-lymphocyte ratio showed high sen-sitivity and specificity, its low area under the curve indicates that it is not a reliable marker for diagnosing neonatal sepsis. CONCLUSION: Additional studies with larger samples and other biological markers are needed to improve the diagnostic capacity for neonatal sepsis.

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Background: A urinary tract infection (UTI) occurs when germs infiltrate a sterile urine system. At 18/1000 in the general population, UTIs have been reported to be one of the most common infections to date. As antimicrobial abuse has led to resistance among microorganisms, the sensitivity pattern of the microorganisms isolated from urine culture helps clinician to choose the best antimicrobial agent for the treatment of UTI. Aim and Objectives: (i) The study aimed to identify the microbiological spectrum of organisms isolated from urinary culture and (ii) to assess the antibiotic sensitivity and resistance pattern of the organisms isolated. Materials and Methods: A prospective observational study was conducted between August 2022 and July 2023. The urine samples were analyzed for bacterial growth, antimicrobial sensitivity, and resistance patterns. Results: During the study period, 175 urine samples were sent for culture and sensitivity testing. Out of which 49 showed positive growth. Escherichia coli 25 (51%) was the most commonly isolated organism, followed by Klebsiella 16 (33 %) and Staphylococcus aureus 8 (16%). E. coli was found highly sensitive to imipenem, followed by nitrofurantoin, and was found highly resistant to ceftriaxone and ciprofloxacin. Klebsiella was found highly sensitive to nitrofurantoin and imipenem and was found highly resistant to amoxycillin, norfloxacin, and ciprofloxacin. S. aureus was found highly sensitive to imipenem, followed by gentamicin, and was found highly resistant to amikacin, amoxycillin, and amoxiclav. Conclusion: Ceftriaxone, ciprofloxacin, norfloxacin, amikacin, amoxycillin, and amoxiclav were highly resistant antimicrobials, while imipenem and nitrofurantoin were found to be very sensitive. Therefore, to optimize the therapeutic outcome and curb the spread of drug-resistant strains, clinicians must use these antimicrobial agents judiciously.

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Aims: To investigate the impact of different inter-set rest periods on blood glucose levels and insulin sensitivity (IS) in children with type 1 diabetes. Study Design: An experimental randomized crossover trial. Place and Duration: Recruitment took place in the public health network of Rio Branco, Acre, Brazil. Methodology: Twenty subjects participated in three different HIIT protocols with varying rest intervals. The first protocol consisted of 20 seconds of exercise followed by 10 seconds of rest (HIIT20-10), the second with 20 seconds of rest (HIIT20-20), and the third with 60 seconds of rest (HIIT20-60). The exercise used in all protocols was the burpee, performed at maximum effort for a total of 12 minutes, comprising 24 sets. Blood glucose levels were measured through finger-prick tests before exercise, immediately after, and at 15, 30,60,and120 minutes post-exercise. For insulin sensitivity, 4 ml of venous blood was drawn before, immediately after, and at 30, 60, and 120minutes post-exercise, and the TyG Index was used to calculate IS. Results: No significant differences were observed between the HIIT20-20 and HIIT20-60 groups (p>0.05) regarding glucose levels. However, the HIIT20-10 protocol showed significantly lower glucose levels from 15 minutes to 120 minutes post-exercise (p<0.05) and improved IS at 60 minutes (p<0.05) and 120 minutes (p<0.01) after the exercise session. Conclusion: The inter-set rest period influences glucose metabolism during HIIT in children with type 1 diabetes.

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Background Diabetes is a major public health problem. Diabetes also exhibits an iceberg phenomenon where majority of the cases were hidden in the community as undiagnosed ones. To identify the high-risk subjects for screeningObjectives of undiagnosed diabetes mellitus using IDRS and evaluating the IDRS as a screening tool. The present study was crossMaterial and Methods sectional study carried out among adults more than 18 years in the department of general medicine for a period of 3 months. The sample size was estimated to 135. Those who were already diagnosed to have diabetes and unwilling to participate were excluded from the study. The data was collected in a semi structured questionnaire. Statistical analysis was done using descriptive statistics. The mean IDRS score among theResults participants was 56.29 � 18.71. 54 (40%) were having a score between 50 and 60. 44 (32.6%) were having score between 70 and 80. Among the participants with IDRS score of more than or equal to 60, 27 (36%) were diabetic and among those with IDRS score of less than 60, none was diabetic. The sensitivity was 100%, speci?city was 55.6%, the positive predictive value was 36%, the negative predictive value was 100%. The accuracy of IDRS was found to be 64.4% The IDRS is a valid screening tool among the population undiagnosed with diabetesConclusion mellitus.

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Introduction: Bloodstream infections (BSI) remain a major cause of morbidity and mortality in patients undergoing treatment for cancer. Aim is to access the use of new potent antibiotics against bloodstream infection in cancer patients and to determine the cross resistance of bacterial strains. This retrospective study is a single-center's experienceMaterials and Methods: including both pediatric and adult patients with malignancy, who were receiving care at our hospital which is a Regional Cancer Centre, of over a 6 months period, between January 2022 and June 2022. Blood cultures were done using BacT/ALERT 3D system. We studied the bacterial spectrum & antimicrobial susceptibility pattern of bacterial strains in cancer patients. Susceptibility of microbial isolates to antibiotics was performed with a VITEK 2 compact automated system (Biomerieux Inc., France) according to the Clinical and Laboratory Standards Institute recommendation in 2015. A total of 243 blood cultures were examined. The patient's age ranged from 1 to 72 years. The majority ofResults: patients 139 (57.2%) had hematologic malignancies as opposed to solid and other tumours or malignancies 104 (42.7%). Out of 243 blood samples which came for culture in our Institute, 6 were Central line-associated bloodstream infections ,(CLABSI) cases. Total positives ere 63 (25.9%) and,total negatives were 180 (74.1%) .Among the total positives, Gram-negative bacilli were the predominant causative agents of BSI constituting 61.9% (n = 39/63) of isolated organisms, 33.33% (n = 21/63) of infections were caused by Gram-positive cocci while polymicrobial infections accounted for 4.76% (n = 3/73) of these cases. High resistance observed in this study warrants the needs of surveillanceConclusion: of resistant pattern of antimicrobial agents. Due to increased level of drug resistance, following Culture and Sensitivity patterns as Investigation of choice would be a prudent choice in high- risk cases especially in Blood stream infections in Cancer patients.

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O clareamento dental pode ser realizado através da técnica caseira ou de consultório, utilizando agentes como o peróxido de carbamida (PC) e peróxido de hidrogênio (PH). Apesar de seguro, existem alguns efeitos adversos relacionados ao clareamento dental, como a sensibilidade dentinária (SD), que pode estar presente em diferentes graus dependendo da técnica utilizada. A aplicação de agentes dessensibilizantes antes, durante ou depois do clareamento dental vem sido estudada para evitar ou reduzir a sensibilidade associada ao clareamento. O estudo visa revisar a literatura em relação a aspectos e conceitos importantes do clareamento dental, discutindo seus possíveis efeitos adversos com foco na sensibilidade dentinária. Foi realizada uma pesquisa digital da base de dados Medline, via PubMed, utilizando palavras-chave relacionadas ao tema, priorizando artigos publicados há menos de 20 anos e escritos em inglês ou português. Artigos também foram buscados manualmente e foram utilizados livros de odontologias relacionados ao tema. De um total de 48 artigos, 28 foram escolhidos para a composição do trabalho, além de 2 livros de dentística que abordam o clareamento dental. Constata-se que a sensibilidade dentinária é um efeito adverso comum relacionado ao clareamento dental, que possui causa exata desconhecida, porém sabe-se que está relacionada à difusão do peróxido de hidrogênio pelos tecidos dentários. A sensibilidade dentinária é mais frequente na técnica de clareamento de consultório do que na técnica caseira, e pode ser agravada por fatores relacionados ao indivíduo e/ou ao dente. Alguns agentes como o nitrato de potássio, fosfopeptídeos de caseína-fosfato de cálcio amorfo (CPP-ACP), vidros bioativos e partículas de hidroxiapatita, se mostraram efetivos no controle da sensibilidade dentinária.

Dental bleaching can be performed in at-home or in-office techniques, using agents such as carbamide peroxide or hydrogen peroxide. Although it's safe, there are some side effects related to dental bleaching, such as tooth sensitivity, which may be present in different degrees, depending on the chosen technique. The application of desensitizing agents before, during or after dental bleaching is being studied to avoid or reduce the bleaching related sensitivity. The study aims to review the literature over important aspects and concepts of dental bleaching, discussing its possible side effects, focusing on tooth sensitivity. Methods: an online search was done on Medline's database, through PubMed, using keywords related to the theme, prioritizing articles published less than 20 years ago, written in English or Portuguese. Articles were also researched manually, and dentistry books related to the theme were used as well. Out of 48 articles, 28 were chosen to this study's composition, in addition to 2 books that approach dental bleaching. Tooth sensitivity is a common side effect related to dental bleaching, with an unknown cause, however, it is known that it's related to hydrogen peroxide's diffusion through dental tissues. Tooth sensitivity is more frequent within in-office technique than within at-home technique, and may be worsen by individual and/or dental related factors. Agents such as potassium nitrate, CPP-ACP, bioactive glasses and hydroxyapatite particles, showed up to be effective in dental sensitivity control.

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Cuando se aislaban bacilos gram positivos de muestras de orina en décadas anteriores, eran considerados como contaminantes de piel. El objetivo de esta revisión fue describir la importancia como uropatógenos de los bacilos gram positivos no esporulados aerobios o anaerobios facultativos. Los avances tecnológicos aplicados al diagnóstico microbiológico revelaron que, en determinados contextos, éstos podían ser reales agentes de infecciones urinarias. Actinotignum schaalii, Actinomyces neuii, Corynebacterium spp. (en especial Corynebacterium urealyticum) y Gardnerella vaginalis deben ser considerados como microorganismos patógenos potenciales de las vías urinarias. Para su aislamiento, en la mayoría de los casos, es esencial que se incorporen placas de agar sangre o mejor agar chocolate con incubación a 35°C en atmósfera con 5% de CO2 . Los bacilos gram positivos aislados de orina son frecuentemente sensibles a beta-lactámicos, linezolid y vancomicina, y presentan sensibilidad variable a otros antibióticos (AU)

In past decades, gram-positive bacilli isolated from urine samples were often dismissed as skin contaminants. This review aims to highlight the significance of aerobic non-sporulating gram-positive bacilli or facultative anaerobic bacilli as true uropathogens. Advances in microbiological diagnostics have shown that, in specific contexts, these bacteria can indeed be causative agents of urinary tract infections. Species such as Actinotignum schaalii, Actinomyces neuii, Corynebacterium spp. (particularly Corynebacterium urealyticum), and Gardnerella vaginalis should be recognized as potential urinary pathogens. For their isolation, it is often crucial to use blood agar or, preferably, chocolate agar plates, incubated at 35°C in a 5% CO2 atmosphere. Gram-positive bacilli isolated from urine are typically susceptible to betalactams, linezolid, and vancomycin, with variable sensitivity to other antibiotics (AU)

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Abstract Diagnostic tests have intrinsic characteristics such as sensitivity, specificity, overall accuracy and likelihood ratios which define their operational performance. It is not uncommon to find in the literature that test value and clinical utility are defined based exclusively on those characteristics. This paper introduces several arguments aimed at prompting a reflection regarding the characteristics that define the true value of diagnostic tests in clinical practice. It concludes with the view that the value of each diagnostic test needs to be established in accordance with the circumstances in which it is used, taking into account extrinsic characteristics such as in whom it is used, when, where and by who.

Resumen Las pruebas diagnósticas tienen características intrínsecas, como la sensibilidad, especificidad, exactitud global y las razones de verosimilitud, que definen su desempeño operacional. No es infrecuente encontrar en la literatura que se valore la prueba y se defina su utilidad clínica exclusivamente de acuerdo con estas características. En este documento se presentan varios argumentos que permiten reflexionar sobre las características que verdaderamente definen el valor de las pruebas diagnósticas en la práctica clínica. Se concluye con una perspectiva en la que el valor de cada prueba diagnóstica se establece de acuerdo con las circunstancias de uso de la misma: de quién, cuándo, dónde y en quién se use la prueba, y todas estas son características extrínsecas de una prueba diagnóstica.

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Introducción: la Sensibilidad química múltiple, es una afección adquirida, crónica, caracterizada por síntomas recurrentes, de intensidad variada, que aparecen ante la exposición a niveles reducidos de diferentes químicos. El objetivo de esta reseña, es estudiarla y su relación con el trabajo. Metodología: se realizó una búsqueda bibliográfica utilizando como descriptores Sensibilidad Química Múltiple; Riesgos Laborales; Medicina del trabajo. Resultados: la estimación de la prevalencia de esa enfermedad es difícil, debido a la amplitud de su sintomatología y su etiología multifactorial. Las causas no son conocidas por lo que existen varias hipótesis epidemiológicas. Generalmente los síntomas aparecen luego de una exposición laboral o medioambiental a algún toxico, que, posteriormente se repiten ante exposiciones de menor intensidad al mismo u otro tóxico. Los síntomas afectan varios órganos y sistemas, variables en intensidad y en curso, con impactos a nivel orgánico, personal, social y laboral. Discusión: el diagnóstico se basa en criterios clínicos, síntomas referidos, y en la historia de la exposición. Como ayuda, existen cuestionarios que permiten identificar los agentes desencadenantes, cuantificar su gravedad, y repercusiones en la vida diaria. Se han aplicado a estos pacientes múltiples presuntos tratamientos, con poca o ninguna eficiencia. Los tratamientos mejor valorados en estas encuestas, fueron la creación de un ambiente libre de químicos, evitar los compuestos lesivos y la plegaria. Esta patología afecta seriamente la calidad de vida de quienes la padecen, siendo uno de los ámbitos más perjudicados, el laboral. Se deben reforzar las acciones preventivas en el trabajo, evitando la re exposición a los agentes desencadenantes. Desde los Servicios de Prevención de Riesgos Laborales se deben estimar y controlar los riesgos y valorar la necesidad de una incapacidad laboral, aunque, es fundamental el reintegro a su vida familiar, social y laboral cuando los síntomas mejoren lo suficiente.

Introduction: Multiple chemical sensitivity is an acquired, chronic condition, characterized by recurrent symptoms of varying intensity, which appear after exposure to low levels of different chemicals. The objective of this review is to study it and its relationship with work. Methodology: A bibliographic search was carried out using the descriptors Multiple Chemical Sensitivity; Occupational Hazards; Occupational Medicine. Results: The estimation of the prevalence of this disease is difficult, due to the extent of its symptoms and its multifactorial etiology. The causes are not known, so there are several epidemiological hypotheses. Generally, symptoms appear after occupational or environmental exposure to a toxicant, which are subsequently repeated after lower intensity exposures to the same or another toxicant. Symptoms affect various organs and systems, varying in intensity and course, with impacts at the organic, personal, social and occupational levels. Discussion: Diagnosis is based on clinical criteria, referred symptoms, and on the history of exposure. As an aid, questionnaires are available to identify the triggering agents, quantify their severity and repercussions on daily life. Multiple presumed treatments have been applied to these patients, with little or no efficiency. The best valued treatments in these surveys were the creation of a chemical-free environment, avoidance of harmful compounds and prayer. This pathology seriously affects the quality of life of those who suffer from it, and one of the most affected areas is work. Preventive actions should be reinforced at work, avoiding re-exposure to triggering agents. The Occupational Risk Prevention Services should evaluate and control the risks and assess the need for incapacity to work, although it is essential to reintegrate the patient's family, social and working life when the symptoms improve sufficiently.

Introdução: A sensibilidade química múltipla é uma doença crônica adquirida, caracterizada por sintomas recorrentes de intensidade variável que aparecem após a exposição a baixos níveis de diferentes produtos químicos. O objetivo desta revisão é estudá-la e sua relação com o trabalho. Metodologia: foi realizada uma pesquisa bibliográfica usando os descritores Multiple Chemical Sensitivity (sensibilidade química múltipla); Occupational Hazards (riscos ocupacionais); Occupational Medicine (medicina do trabalho). Resultados: é difícil estimar a prevalência dessa doença, devido à extensão de seus sintomas e à sua etiologia multifatorial. As causas não são conhecidas, portanto, há várias hipóteses epidemiológicas. Os sintomas geralmente aparecem após a exposição ocupacional ou ambiental a uma substância tóxica e reaparecem com uma exposição menos intensa à mesma substância ou a outra substância tóxica. Os sintomas afetam vários órgãos e sistemas, variando em intensidade e curso, com impactos nos níveis orgânico, pessoal, social e ocupacional. Discussão: O diagnóstico é baseado em critérios clínicos, sintomas relatados e histórico de exposição. Como auxílio, há questionários disponíveis para identificar os agentes desencadeantes, quantificar sua gravidade e as repercussões na vida cotidiana. Vários tratamentos presumidos foram aplicados a esses pacientes, com pouca ou nenhuma eficácia. Os tratamentos mais bem avaliados nessas pesquisas foram a criação de um ambiente livre de produtos químicos, a prevenção de compostos nocivos e a oração. Essa patologia afeta seriamente a qualidade de vida das pessoas que a sofrem, e uma das áreas mais afetadas é o trabalho. As ações preventivas devem ser reforçadas no trabalho, evitando a reexposição aos agentes desencadeantes. Os Serviços de Prevenção de Riscos Ocupacionais devem avaliar e controlar os riscos e avaliar a necessidade de incapacidade para o trabalho, embora seja essencial reintegrar a vida familiar, social e profissional do paciente quando os sintomas melhorarem o suficiente.

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RESUMEN El presente estudio se planteó determinar el rendimiento de antígenos de Leishmania braziliensis y Leishmania peruviana en la detección de LTA, fue desarrollado a partir de muestras de suero obtenidas entre 2013 - 2016. Los antígenos solubles y de excreción/secreción obtenidos fueron transferidos a membrana de nitrocelulosa mediante un ensayo de inmunotransferencia. Se realizó la evaluación frente a sueros confirmados para LTA, a un nivel de confianza al 95%, logrando determinar que, el antígeno soluble de Leishmania braziliensis presenta una sensibilidad del 87,7%, especificidad del 100% y área bajo la curva de 0,95; mientras que, Leishmania peruviana se encontró valores de 92,3%, 95,7% y 0,94 respectivamente. De acuerdo a los resultados, recomendamos realizar la caracterización y análisis de las regiones inmunogénicas reportadas a fin de continuar con el desarrollo de proteínas recombinantes y sintéticas, orientadas a mejorar la eficiencia del diagnóstico serológico de la enfermedad.

ABSTRACT This study aimed to determine the performance of Leishmania braziliensis and Leishmania peruviana antigens in the detection of ATL by using serum samples obtained between 2013 - 2016. The obtained soluble and excretion/secretion antigens were transferred to membrane nitrocellulose by immunoblot assay. The evaluation was carried out against sera confirmed for ATL, at a confidence level of 95%, determining that the soluble antigen of Leishmania braziliensis had a sensitivity of 87.7%, specificity of 100% and area under the curve of 0.95; on the other hand, Leishmania peruviana showed values of 92.3%, 95.7% and 0.94, respectively. According to the results, we recommend that the reported immunogenic regions should be characterized and analyzed in order to continue with the development of recombinant and synthetic proteins, aimed at improving the efficiency of the serological diagnosis of the disease.

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Background and Purpose: Radiation therapy is a crucial treatment for nonsmall cell lung cancer (NSCLC), but its effectiveness is limited by the resistance of tumor cells to radiation. This study aimed to evaluate the effect of epicatechin (EC) on radiosensitivity in NSCLC and to determine its relationships with matrix metalloproteinase (MMP)?9. Methods: MMP?9 expression was detected by Western blotting, and the expression of the DNA damage marker protein was detected by immunofluorescence. Cell viability was assessed using the CCK?8 assay, and cell proliferation was evaluated using the clonogenesis assay. Flow cytometry was used to determine the cell apoptosis, whereas cell migration and invasion were detected using the transwell assays. The cells were treated with ionizing radiation (IR) and EC to verify the sensitizing effect of EC on radiation therapy. Results: MMP?9 expression was elevated in the NSCLC cells and tissues. DNA damage and cell apoptosis were increased, whereas cell vigor, proliferation, migration, and invasion were significantly decreased after IR. MMP?9 knockdown strengthened the impact of IR on the biological behaviors of the cells. EC + IR had the best effect on promoting DNA damage and the biological behaviors of the NSCLC cells; alternatively, the overexpression of MMP?9 weakened the role of EC. Conclusions: This study shows that EC can downregulate MMP?9 expression, promote DNA damage, reduce cell viability, proliferation, migration, and invasion, and facilitate cell apoptosis, thus, showing potential as a radiosensitizer for NSCLC.

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Background: Urinary tract infections (UTIs) remain the common infections in outpatients as well as hospitalized patients. Antimicrobials are frequently used drugs for the treatment of UTIs. Periodic evaluation of antimicrobial activity of different antimicrobial agents is essential as the pattern of antimicrobial sensitivity may vary over period. The aim of this study was to identify the antimicrobial sensitivity pattern of the isolated uropathogens in female patients in urinary tract infection at a tertiary care hospital in Bangladesh. Methods: This observational cross-sectional type of study was conducted in the department of pharmacology and therapeutics in collaboration with department of microbiology SBMC, outpatient department of medicine, and gynaecology and obstetrics, SBMCH, Barishal, from January 2017 to December 2017. Results: In this study, age of the subjects ranging from 18 to 65 years, majority subjects (57.0%) belonged to age group of 31-44 years. The mean age was found 44.5±9.1 years. Out of 200 cases, 83% cases hailing from rural area and 17% from urban site. In this study microbial culture result of uncomplicated UTI revealed that 103 (51.5%) of urine samples had significant bacteriuria. E. coli was found to be the most prevalent 47 (45.6%), followed by Klebsiella pneumoniae 18 (17.4%), Proteus spp. 11 (10.6%) and Enterobacter spp. 9 (8.7%). Conclusions: The pattern of resistance to commonly used antimicrobials for treating UTI alerts us against indiscriminate usage of antimicrobials.

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Introdução:A sensibilidade dentária é o efeito adverso mais comum relacionado ao clareamento dentário. Na técnica de consultório, o peróxido de carbamida a 37%, surgiu como possibilidade de clarear e não causar sensibilidade.Objetivo:trata-se deum relato de caso, que avaliou a eficácia (mudança de cor) e a presença ou não de sensibilidade dentária quando se fezo uso de um produto àbase de peróxido de hidrogênio a35% e outro de peróxido de carbamida a 37%, na técnica de clareamento dentário de consultório.Relato de caso:Paciente de25 anos, sexo masculino, submetido a estudo de boca dividida, onde no hemiarco esquerdo foi aplicado peróxido de hidrogênio a 35% e no hemiarco direito, peróxido de carbamida a 37%. Foram feitas 3 sessões, sendo Peróxido de Carbamidacom aplicação única de 45 minutos, e Peróxido de Hidrogêniocom 3 aplicações de 15 minutos, em seu respectivo lado de aplicação e intervalo de sete dias entre cada sessão. Os valores de sensibilidade foram analisados antes e depois de cada sessão por meio da escala visual analógica de dor, e a alteração de cor foi avaliada através da Escala Vita, analisando incisivos e caninos superiores, antes de cada sessão.Conclusões:O clareamento dental com o Peróxido de Hidrogênio apresentou melhor eficácia clareadora e o Peróxido de Carbamida apresentou ausência de sensibilidade durante o procedimento clareador. Sugerem-se mais estudos do tipo ensaio clínico, com o Peróxido de Carbamida, para que se possa, com uma amostra maior de pacientes, verificar suas vantagens no quesito sensibilidade, bem como sua efetividade clareadora (AU).

Introduction:Tooth sensitivity is the most common adverse effect related to tooth bleaching. In the in-office technique, 37% carbamide peroxide has emerged as a way of tooth bleaching which does not cause sensitivity.Objective:This paper consists of a case report that evaluated the efficacy (color change) and the presence or absence of tooth sensitivity when using a product based on 35% hydrogen peroxide and another product based on 37% carbamide peroxide in the in-office tooth bleaching technique.Case report:A 25-year-old male patient underwent a split-mouth study in which 35% hydrogen peroxide was applied to the left hemi-arch and 37% carbamide peroxide to the right hemi-arch. Three sessions were carried out, carbamide peroxide with a single 45-minute application, and hydrogen peroxide with three 15-minute applications, on their respective application side and with a seven-day interval between each session. Sensitivity values were analyzed before and after each session using the visual analogue pain scale, and color change was assessed using the Vita Scale, analyzing upper incisors andcanines before each session. Conclusions:Teeth bleaching with hydrogen peroxide showed better bleaching efficacy and carbamide peroxide showed no sensitivity during the bleaching procedure. Further clinical trials with carbamide peroxide are suggested inorder to verify, with a larger sample of patients, its advantages in terms of sensitivity, as well asits bleaching effectiveness (AU).

Introducción: La sensibilidad de la dentina es el efecto adverso más común relacionado con el blanqueamiento dental. En la técnica en clínica, el peróxido de carbamida al 37% ha surgido como una posibilidad de blanqueamiento sin causar sensibilidad.Objetivo: Se tratade un informe de caso que evaluó la eficacia (cambio de color) y la presencia o ausencia de sensibilidad de la denina al utilizar un producto a base de peróxido de hidrógeno al 35% y otro a base de peróxido de carbamida al 37% en la técnica de blanqueamiento dental en clínica.Informe de caso:Un paciente del sexo maculino de 25 años fue sometido a un estudio de boca dividida en el que se aplicó peróxido de hidrógeno al 35% en la hemiarcada izquierda y peróxido de carbamida al 37% en la hemiarcada derecha.Se realizaron tres sesiones, la peróxido de carbamida con una única aplicación de 45 minutos, y la peróxido de hidrógeno con tres aplicaciones de 15 minutos, en sus respectivos lados de aplicación y con un intervalo de siete días entre cada sesión. Se analizaron los valores de sensibilidad antes y después de cada sesión mediante la escala analógica visual del dolor, y se evaluó el cambio de color mediante la Escala Vita, analizando los incisivos superiores y los caninos antes de cada sesión. Conclusiones: El blanqueamiento dental con peróxido de hidrógeno demostró una mayor eficacia blanqueadora y el peróxido de carbamida no manifestó sensibilidad durante el procedimiento de blanqueamiento. Se sugiere realizar más ensayos clínicos con peróxido de carbamidaparapoder utilizar una muestra mayor de pacientes y verificar sus ventajas en términos de sensibilidad, así como su eficacia blanqueadora (AU).

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Background: One of the most common reasons for preventable mortality is the smoking habit. Cigarette smoke promotes the process of atherogenesis by producing oxygen-derived free radicals which cause damage to the lipids. Cigarette smoking is associated with impaired endothelium-dependent vasodilatation and cardiovascular disease (CVD). Aims and Objectives: The objectives of the study were the following: (i) to compare the levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very LDL (VLDL) in asymptomatic male smokers and non-smokers of the age group 25–50 years; (ii) to determine and compare the levels of high sensitivity C-reactive protein (hs-CRP) in the above two groups, and (iii) to study and compare the levels of malondialdehyde (MDA) in the above groups. Materials and Methods: The study was conducted on 60 males in which 30 smokers and 30 non-smokers of the age group 25–50 years were incorporated. It was a cross-sectional comparative study, which included the participants who met all the inclusion and exclusion criteria. Before the conduct of the study, informed consent was obtained from all the participants. Moreover, the selection of participants was done in a consecutive manner until the sample size was achieved. TC and TGs were estimated by the enzymatic colorimetric method, HDL cholesterol by the phosphotungstic acid method, and LDL and VLDL by Friedwald’s formula. MDA was determined by spectrophotometry and hs-CRP by the immunoturbidometric method. The data acquired were analyzed by utilizing the Statistical Package for the Social Sciences version 18. Results: Dyslipidemia was seen in smokers as evidenced by significantly elevated levels of TC, TG, LDL, and VLDL; and significantly reduced levels of HDL. The mean values of hs-CRP were significantly elevated in smokers when compared to that of non-smokers. Oxidative stress was increased in subjects who were smokers. The mean values of MDA were significantly elevated in the smokers. Conclusion: The smoking habit is associated with dyslipidemia, oxidative stress, and inflammation which predisposes to the development of endothelial dysfunction and atherosclerosis. The significance of early screening measures to be undertaken in asymptomatic smokers for dyslipidemia, oxidative stress, and hs-CRP is unveiled by the present study. Therefore, early screening can be used to advise smokers to refrain from smoking to avoid complications of CVDs, so that they can upgrade the quality of their life.

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Aims: The study aimed to detect and classify Enterococci isolates from Thayir, a traditional fermented dairy product. Study Design: A statistically significant number of Thayir samples were collected from across the study area to isolate and characterise Enterococci. Place and Duration of Study: The study took place in Wayanad District of Kerala, India in 2022-2023. Methodology: The Thayir samples were aseptically collected and bacteriologically cultured to detect enterococci. The isolates obtained were tested for the ability to form biofilms and hydrolyse gelatin. The antibiotic sensitivity pattern was studied using disk diffusion assay. A simple Kmeans clustering algorithm was applied to group the isolates. Phage-sensitive and resistant isolates were identified among the safer isolates. Results: Eight isolates were obtained. None of the isolates hydrolysed gelatin, but four produced biofilm. Antibiogram revealed increased sensitivity to nitrofurantoin, but most isolates were sensitive to antimicrobials. Clustering analysis revealed a set of three safer isolates, of which one was sensitive to the phage EF?91. Conclusion: The study revealed the presence of Enterococcus fecalis and Enterococcus faecium in thayir samples. Analyses revealed that the isolates were diverse and continued monitoring for antimicrobial resistance against Enterococci in food samples is necessary.

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Background: This study aimed to identify the distribution of pathogens and their antimicrobial resistance patterns in the neonates admitted to the NICU of a tertiary care hospital in northern India.Methods: After obtaining written informed consent, neonates with confirmed or suspected cases of neonatal sepsis (n=167) aged 0-28 days were included. As soon as the baby arrived, all the clothes were removed and kept in a pre-heated warmer. Before administering I/V antibiotics, all the routine and culture samples were taken. The clinical data were collected and analysed using SPSS.Results: Most of the neonates were from lower middle class, out-born, LSCS, early preterm, and low birth weight (LBW). 167 neonates had culture-confirmed infections [blood culture positive (13.8%) and sepsis screen positive (86.2%)]. Gastric aspirate cytology was positive in 61.7% of patients. Maximum cytology-positive cases were seen in neonates with EOS. The most common risk factors were birth asphyxia. 142 individuals were discharged, with 72.5% diagnosed with EOS and 89% with LOS. There was a significant difference in gastric aspirate cytology when associated with expiry and discharge. Out of 167 neonates, 13.77% were culture-positive for neonatal sepsis. Out of 23 organisms, 82.6% were resistant, while, 17.4% were not. Staph aureus was the major causative organisms. Among the Gram Positive and Negative bacteria, the highest sensitivity was observed for imipenum. All gram-positive bacteria were resistant to cotrimazole, tobramycin, and erythromycin.Conclusions: Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.