In vivo study of the behavior of glass ionomer restorations in patients with special needs.

BACKGROUND: Glass ionomers may be a good alternative to composite resin restorations in special needs patients with challenging behaviours. The present study was carried out to evaluate the restorative efficacy of glass ionomer in the occlusal cavities of permanent molars among patients with special needs after one year of follow-up. MATERIAL AND METHODS: A randomized split-mouth study was made of a cohort of patients with special needs. First and second permanent molars with occlusal caries were treated with glass ionomer, silver amalgam and composite resin. Assessments were made at 3, 6 and 12 months, using a scale based on the original code of Ryge and the USPHS criteria. RESULTS: A total of 34 patients and 102 restorations comprised the study sample. The survival rate of both the glass ionomer and silver amalgam was 100%, versus 97.1% in the case of composite resin. The glass ionomer afforded good marginal adaptation and stable color, with no fractures or secondary caries. CONCLUSIONS: The glass ionomer remained successfully for one year in the occlusal cavities of the permanent molars, with the same survival rate as silver amalgam, and better survival than composite resin, in the patients with special needs.

Tritium Beta Spectrum Measurement and Neutrino Mass Limit from Cyclotron Radiation Emission Spectroscopy.

The absolute scale of the neutrino mass plays a critical role in physics at every scale, from the subatomic to the cosmological. Measurements of the tritium end-point spectrum have provided the most precise direct limit on the neutrino mass scale. In this Letter, we present advances by Project 8 to the cyclotron radiation emission spectroscopy (CRES) technique culminating in the first frequency-based neutrino mass limit. With only a cm^{3}-scale physical detection volume, a limit of m_{ß}<155 eV/c^{2} (152 eV/c^{2}) is extracted from the background-free measurement of the continuous tritium beta spectrum in a Bayesian (frequentist) analysis. Using ^{83m}Kr calibration data, a resolution of 1.66±0.19 eV (FWHM) is measured, the detector response model is validated, and the efficiency is characterized over the multi-keV tritium analysis window. These measurements establish the potential of CRES for a high-sensitivity next-generation direct neutrino mass experiment featuring low background and high resolution.

Improving the Recyclability of an Epoxy Resin through the Addition of New Biobased Vitrimer.

In recent decades, the use of thermoset epoxy resins (ER) has spread to countless applications due to their mechanical properties, heat resistance and stability. However, these ERs are neither biodegradable nor recyclable due to their permanent crosslinked networks and usually, they are synthesized from fossil and toxic precursors. Therefore, reducing its consumption is of vital importance to the environment. On the one hand, the solution to the recyclability problems of epoxy resins can be achieved through the use of vitrimers, which have thermoset properties and can be recycled as thermoplastic materials. On the other hand, vitrimers can be made from natural sources, reducing their toxicity. In this work, a sustainable epoxy vitrimer has been efficiently synthesized, VESOV, by curing epoxidized soybean oil (ESO) with a new vanillin-derived Schiff base (VSB) dynamic hardener, aliphatic diamine (1,4-butanediamine, BDA) and using 1,2-dimethylimidazole (DMI) as an accelerator. Likewise, using the same synthesized VSB agent, a commercial epoxy resin has also been cured and characterized as ESO. Finally, different percentages (30, 50 and 70 wt%) of the same ER have been included in the formulation of VESOV, demonstrating that only including 30 wt% of ER in the formulation is able to improve the thermo-mechanical properties, maintaining the VESOV's inherent reprocessability or recyclability. In short, this is the first approach to achieve a new material that can be postulated in the future as a replacement for current commercial epoxy resins, although it still requires a minimum percentage of RE in the formulation, it makes it possible to recycle the material while maintaining good mechanical properties.

How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Seguimiento por WhatsApp durante un año a pacientes con intento suicida atendidos en el Servicio de Urgencias de un hospital universitario privado / One-year follow- up to suicide attempted patients in the Emergency Department of a private hospital using WhatsApp

El suicidio como problema de salud pública mundial muestra tasas fluctuantes con tendencia a elevarse. Las estrategias en salud pública encaminadas a la reducción del intento y del reintento suicida son la principal alternativa. Objetivo: establecer la incidencia de reintento suicida, oportunidad de atención y adherencia al seguimiento de pacientes atendidos por intento suicida en el servicio de urgencias de un hospital universitario privado. Métodos y participantes: estudio de tipo cohorte prospectiva descriptiva en pacientes ≥18 años con intento suicida de riesgo bajo asignados a tratamiento psiquiátrico ambulatorio y seguido mediante la aplicación WhatsApp durante un año después del egreso. Resultados: la prevalencia de intento suicida de los pacientes que consultaron al servicio de urgencias fue de 0,38%. De 164 pacientes con intento suicida 33 ingresaron al estudio. Tenían una mediana de edad de 23 RI (25-75): 19-33 años, el 87,8% (n: 29) fueron mujeres, 42,4% (n: 22) tenía escolaridad secundaria y 63,6% (n: 21) eran del estrato socioeconómico medio. La incidencia acumulada de reintento suicida fue del 36,3% (n: 12), más frecuente al primer mes. La atención por psiquiatría más temprana fue a las dos semanas del egreso. La adherencia al seguimiento fue del 45,4%. Conclusiones: la incidencia acumulada del reintento suicida fue elevada. La oportunidad de atención y la adherencia al seguimiento fueron bajas. A pesar de los diferentes métodos hasta ahora utilizados, el seguimiento de la conducta suicida sigue siendo difícil. Se necesitan investigaciones que exploren alternativas de intervención de tipo social y comunitario.

Suicide as a global public health issue shows fluctuating rates with a tendency to increase. Public health strategies aimed to reduce suicide attempt and retry are the main alternative. Objective: establish the incidence of suicidal retry, opportunity for care and adherence to treatment in the follow-up of patients treated for suicide attempt in the emergency room of a private University hospital. Methods and participants: a descriptive prospective cohort study in patients ≥18 years of age with a low-risk suicide attempt assigned to outpatient psychiatric treatment and followed up through WhatsApp application for one year after discharge. Results: the prevalence of suicide attempt in patients who consulted the emergency room was 0.38%. Of 164 patients with a suicide attempt, 33 were low risk. With a median age of 23 IR (25-75): 19-33 years, 87.8% (n: 29) were women, 42.4% (n: 22) with secondary school level and 63.6% (n: 21) with middle socioeconomic stratum. 24.2% (n: 8). The accumulate incidence of retry was 36,3% (n: 12), more frequently in the first month. The earlier attention by psychiatry was after two weeks of discharge. The follow-up adherence was of 45,4%. Conclusions: the accumulated incidence for retry was high. The opportunity for outpatient psychiatric care and adherence to follow up were low. Despite the different methods used until now, monitoring suicidal behavior remains difficult. It is necessary research that explore alternatives for community and social intervention.

Diagnóstico. Criterios de seguimiento, control y derivación / Diagnosis. Criteria for follow-up, monitoring and referral

Las derivaciones desde la farmacia comunitaria a los centros de salud y hospitales han sido desde siempre un tema controvertido y sin criterios establecidos, dependiendo la actuación mucho de quien nos atendiera.Para mejorar la atención a los pacientes, es un deber de todos los profesionales sanitarios procurar una buena coordinación interdisciplinar. Con este espíritu, cuando a miembros de semFYC y SEFAC nos propusieron hacer un curso conjunto nos dimos cuenta de lo poco que había escrito sobre esta supuesta coordinación y nos creó la necesidad de escribir este capítulo, que a su vez empujó a SEFAC a liderar el presente documento que os será útil.Este capítulo es, según nuestro conocimiento, uno de los primeros a nivel internacional que intenta englobar el seguimiento del paciente con hipertensión desde la farmacia comunitaria con unas recomendaciones claras para su manejo en condiciones reales. (AU)

Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation.

Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid. This article reviews nine cases treated at our centre to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.

La derivación lumbo-peritoneal en la edad pediátrica y el papel de la imagen en su valoración / Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation

La derivación lumbo-peritoneal permite regular el flujo de líquido cefalorraquídeo estableciendo una conexión entre el saco tecal y la cavidad peritoneal. Entre las indicaciones en la población pediátrica se encuentra principalmente la hipertensión intracraneal idiopática, siendo también útil en el tratamiento de la hidrocefalia postinfecciosa, posthemorrágica y normotensiva, en el seudomeningocele posquirúrgico o ante una fuga de líquido cefalorraquídeo.En este artículo, mediante la revisión de 9 casos de nuestro centro, se pretende mostrar la normalidad del dispositivo en las pruebas de imagen y realizar una breve revisión de las posibles complicaciones asociadas, neurológicas y abdominales.(AU)

Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid.This article reviews nine cases treated at our center to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.(AU)

Aplicación de las ciclodextrinas como excipientes en productos farmacéuticos: ¿por qué no en formulación magistral? / Use of cyclodextrins as excipients in pharmaceutical products: why not in extemporaneous preparations?

Objetivo: Evaluar la utilización de ciclodextrinas como excipientes enformulación magistral desde el punto de vista galénico, biofarmacéuticofarmacocinético,toxicológico, regulatorio, económico y comercial.Método: Búsqueda bibliográfica de artículos de revisión y originalescon alto índice de citas, consulta de documentos regulatorios y legislativosy de farmacopeas de reconocido prestigio.Resultados: La solubilidad, la resistencia a la hidrólisis y la eficienciade complejación varían según la ciclodextrina y el fármaco que se pretendecomplejar. En algunos casos es necesario añadir excipientes paramejorar la eficiencia de complejación. Los procesos de complejación defármacos con ciclodextrinas a nivel de laboratorio son poco robustos yademás existe mucha variabilidad para una misma ciclodextrina entreproveedores y lotes de un mismo proveedor, requiriéndose más controlesen las fórmulas elaboradas. La estabilidad de los complejos ciclodextrinas-fármaco puede alterar la biodisponibilidad oral de los fármacos.Además, algunas ciclodextrinas optimizan la permeabilidad a través demembranas biológicas específicas y el tiempo de contacto con las mismas.Aunque son seguras, superados determinados umbrales de dosis ytiempos de administración pueden producir efectos secundarios. Solo lasciclodextrinas que están reconocidas como excipientes en farmacopeaspueden utilizarse en formulación magistral. Las ciclodextrinas suponen unincremento del coste en formulación magistral y su adquisición a través deproveedores reconocidos no es siempre posible.Conclusiones: A pesar de sus interesantes propiedades como excipientesderivadas de la formación de complejos de inclusión, la necesidadde mayores controles de calidad, estudiar constantes de estabilidad, sualto coste y difícil adquisición pueden explicar por qué la utilización deciclodextrinas en formulación magistral no se considera una alternativaviable en la actualidad.

Objective: To conduct an assessment of cyclodextrins used as excipientsin pharmaceutical formulations, considering compounding, biopharmaceuticalpharmacokinetic,toxicological, regulatory, economic and commercial aspects.Methods: A literature search was performed of highly cited review andoriginal articles. Regulatory and legislative documents and well-establishedpharmacopoeias were also consulted.Results: Solubility, resistance to hydrolysis and complexation efficiencyare variables that depend on the cyclodextrin itself and on the drug to becomplexed. In some cases, addition of excipients is necessary to improvecomplexation efficiency. Complexation of drugs with cyclodextrins atlaboratory scale tends to be rather inconsistent. Moreover, wide variationsexist for the same cyclodextrin across different suppliers and evenacross batches from the same supplier. This means more control analysesmust be carried out of pharmaceutical preparations. Problems with thestability of cyclodextrin-drug complexes could affect the oral bioavailabilityof the drugs. Additionally, some cyclodextrins may optimize the drug’spermeability through specific biological membranes and the length of timeit remains in contact with them. Despite the safety profile of cyclodextrins,exceeding certain dosing thresholds and administration times might causeadverse effects. Only cyclodextrins recognized as excipients by well-established pharmacopeias should be used in pharmaceutical compounding.Cyclodextrins lead to an increase in the global costs of compounding andtheir purchase through recognized suppliers is often unfeasible.Conclusions: Despite their interesting properties as excipients due toinclusion complex formation, the need to carry out more quality controlanalyses and stability constant studies, combined with the high cost anddifficulty to purchase cyclodextrins, may explain why their use in pharmaceuticalcompounding is currently not a viable alternative.

Serotypes and Clonal Composition of Streptococcus pneumoniae Isolates Causing IPD in Children and Adults in Catalonia before 2013 to 2015 and after 2017 to 2019 Systematic Introduction of PCV13.

The goal of this study was to investigate the distribution of serotypes and clonal composition of Streptococcus pneumoniae isolates causing invasive pneumococcal disease (IPD) in Catalonia, before and after systematic introduction of PCV13. Pneumococcal strains isolated from normally sterile sites obtained from patients of all ages with IPD received between 2013 and 2019 from 25 health centers of Catalonia were included. Two study periods were defined: presystematic vaccination period (2013 and 2015) and systematic vaccination period (SVP) (2017 to 2019). A total of 2,303 isolates were analyzed. In the SVP, there was a significant decrease in the incidence of IPD cases in children 5 to 17 years old (relative risk [RR] 0.61; 95% confidence interval [CI] 0.38 to 0.99), while there was a significant increase in the incidence of IPD cases in 18- to 64-year-old adults (RR 1.33; 95% CI 1.16 to 1.52) and adults over 65 years old (RR 1.23; 95% CI 1.09 to 1.38). Serotype 8 was the major emerging serotype in all age groups except in 5- to 17-year-old children. In children younger than 5 years old, the main serotypes in SVP were 24F, 15A, and 3, while in adults older than 65 years they were serotypes 3, 8, and 12F. A significant decrease in the proportions of clonal complexes CC156, CC191, and ST306 and an increase in those of CC180, CC53, and CC404 were observed. A steady decrease in the incidence of IPD caused by PCV13 serotypes indicates the importance and impact of systematic vaccination. The increase of non-PCV13 serotypes highlights the need to expand serotype coverage in future vaccines and rethink vaccination programs for older adults. IMPORTANCE We found that with the incorporation of the PCV13 vaccine, the numbers of IPD cases caused by serotypes included in this vaccine decreased in all of the age groups. Still, there was an unforeseen increase of the serotypes not included in this vaccine causing IPD, especially in the >65-year-old group. Moreover, a significant increase of serotype 3 included in the vaccine has been observed; this event has been reported by other researchers. These facts call for the incorporation of more serotypes in future vaccines and a more thorough surveillance of the dynamics of this microorganism.

Retrospective diagnosis of lymphatic tuberculosis in frozen samples using two genetic amplification methods, Xpert® MTB/RIF ULTRA and Abbott RealTime MTB Assay.

OBJECTIVE: The main objective of the present study is to assess the sensitivity and specificity of a retrospective diagnostic of lymphatic tuberculosis (LTB), testing frozen samples using gene amplification PCR methods. The secondary objective was to compare the results of two different commercial tuberculosis gene amplification methods for this purpose. METHODS: We retrospectively studied 38 frozen samples, previously processed for mycobacterial culture between January 2014 and August 2019. The results of the previous cultures were: 21 samples positive for Mycobacterium tuberculosis complex (MTB) (5 being smear positive), 7 samples culture positive for Mycobacterium avium-intracellulare complex and 10 samples which were mycobacterial culture negative and discarded for LTB diagnosis, used as controls. The samples were processed using two gene amplification methods: Xpert® MTB/RIF Ultra (Cepheid) and Abbott RealTime MTB Assay (Abbott). RESULTS: Compared to initial culture results the sensitivity and specificity of Xpert® MTB/RIF Ultra were 57.1% and 100% and 52.3 % and 92.5%, respectively for the Abbott RealTime MTB assay. The differences were not statiscally significant. In addition, there were no differences according to the period of freezing. CONCLUSIONS: Gene amplification of frozen samples confirmed the diagnosis of lymphatic TB in almost 60% of cases, allowing retrospective diagnosis in initially non suspected cases. Both gene amplification techniques tested were equally useful.

[Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era]. / Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19.

Introduction: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. Methods: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. Results: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). Conclusions: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19 / Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era

Introducción: La suspensión de la mayoría de las cirugías electivas durante la pandemia por COVID-19 ha aumentado las listas de espera de cirugía urológica. El objetivo de este estudio es evaluar el impacto de la pandemia COVID-19 en la lista de espera de cirugía urológica en un hospital de alto volumen.MétodosSe diseñó un estudio descriptivo observacional. Se analizaron todos los pacientes incluidos en la lista de espera de cirugía urológica de nuestro centro de alto volumen el 1 de mayo de 2020 (46 días después de la suspensión de la cirugía electiva). Se registraron las características basales, prioridad en la lista de espera, enfermedad urológica principal, tipo de cirugía programada y tiempo de espera. Otras variables registradas fueron la presencia de catéter urinario, el número de visitas al servicio de urgencias, evidencia de infección por COVID-19, el número de muertes y su causa. El tiempo de espera de cada enfermedad se comparó con el tiempo de espera para la cirugía en 2019.ResultadosUn total de 350 pacientes fueron incluidos en el estudio. El tiempo medio (DE) en la lista de espera fue de 97,33 (55,47) días. Los pacientes de prioridad 1, que normalmente deben ser operados en un plazo de 30 días, estuvieron en la lista de espera por un tiempo medio de 60,51 (20,14) días. Eran principalmente pacientes con litiasis ureteral (25,6%), cáncer de vejiga de alto riesgo o músculo-invasivo (20,9%) y cáncer de próstata de alto riesgo (13,9%). El tiempo medio de espera superaba significativamente el tiempo medio (DE) de espera para cistectomía radical (p = 0,04) y URS (p = 0,003) en 2019.ConclusionesLa suspensión de la mayoría de las cirugías electivas debido a la pandemia por COVID-19 tuvo un impacto significativo en la lista de espera de cirugía urológica de nuestro centro de alto volumen, especialmente en el grupo de prioridad 1. (AU)

Introduction: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital.MethodsAn observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019.ResultsA total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003).ConclusionsThe suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group. (AU)

Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era. / Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19.

INTRODUCTION: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. METHODS: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. RESULTS: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). CONCLUSIONS: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Use of cyclodextrins as excipients in pharmaceutical products: why not in extemporaneous preparations?

OBJECTIVE: To conduct an assessment of cyclodextrins used as excipients in  pharmaceutical formulations, considering compounding,  iopharmaceuticalpharmacokinetic, toxicological, regulatory, economic and  commercial aspects. METHODS: A literature search was performed of highly cited review and original articles. Regulatory and legislative documents and well-established pharmacopoeias were also consulted. RESULTS: Solubility, resistance to hydrolysis and complexation efficiency are  variables that depend on the cyclodextrin itself and on the drug to be complexed. In some cases, addition of excipients is necessary to improve complexation efficiency. Complexation of drugs with cyclodextrins at laboratory scale tends to be rather inconsistent. Moreover, wide variations exist for the same cyclodextrin across different suppliers and even across batches from the same supplier. This means more control analyses must be carried out of pharmaceutical preparations. Problems with  the stability of cyclodextrin-drug complexes could affect the oral bioavailability of the drugs. Additionally, some cyclodextrins may optimize the  drug's permeability through specific biological membranes and the length of  time it remains in contact with them. Despite the safety profile of  cyclodextrins, exceeding certain dosing thresholds and administration times  might cause adverse effects. Only cyclodextrins recognized as excipients by  well-esta blished pharmacopeias should be used in pharmaceutical  compounding. Cyclodextrins lead to an increase in the global costs of  compounding and their purchase through recognized suppliers is often  unfeasible. CONCLUSIONS: Despite their interesting properties as excipients due to inclusion  complex formation, the need to carry out more quality control analyses and stability constant studies, combined with the high cost  and difficulty to purchase cyclodextrins, may explain why their use in  pharmaceutical compounding is currently not a viable alternative.

OBJETIVO: Evaluar la utilización de ciclodextrinas como excipientes en formulación magistral desde el punto de vista galénico,  iofarmacéuticofarmacocinético, toxicológico, regulatorio, económico y  comercial.Método: Búsqueda bibliográfica de artículos de revisión y originales con alto  índice de citas, consulta de documentos regulatorios y legislativos y de  farmacopeas de reconocido prestigio. RESULTADOS: La solubilidad, la resistencia a la hidrólisis y la eficiencia de  complejación varían según la ciclodextrina y el fármaco que se pretende complejar. En algunos casos es necesario añadir excipientes para mejorar la eficiencia de complejación. Los procesos de complejación de fármacos con ciclodextrinas a nivel de laboratorio son poco robustos y además existe mucha variabilidad para una misma ciclodextrina entre proveedores y lotes de un mismo proveedor, requiriéndose más controles en las fórmulas elaboradas. La estabilidad de los complejos  ciclodextrinas-fármaco puede alterar la biodisponibilidad oral de los fármacos. Además, algunas ciclodextrinas optimizan la permeabilidad a través  de membranas biológicas específicas y el tiempo de contacto con las mismas. Aunque son seguras, superados determinados umbrales de dosis y tiempos de administración pueden producir efectos secundarios. Solo las ciclodextrinas que están reconocidas como excipientes en farmacopeas concerpueden utilizarse en formulación magistral. Las ciclodextrinas suponen  un incremento del coste en formulación magistral y su adquisición a través de proveedores reconocidos no es siempre posible. CONCLUSIONES: A pesar de sus interesantes propiedades como excipientes derivadas de la formación de complejos de inclusión, la necesidad de mayores controles de calidad, estudiar constantes de estabilidad, su alto coste y difícil adquisición pueden explicar por qué la utilización de ciclodextrinas en formulación magistral no se considera una alternativa viable en la actualidad.

Comité de Ética Asistencial (CEA) del Hospital Regional de Talca, en pandemia COVID-19 / Care Ethics Committee (CEA) of Talca Regional Hospital, in COVID-19 pandemic

The healthcare ethics committee of the Regional Hospital of Talca, shares with the hospital community, ethical considerations in medical-clinical decisions, in the context of the COVID 19 pandemic. Focus attention on the person, with dignified treatment, with the center in quality and proportional to the individual condition, within the framework of protected teamwork, and that everyone is responsible for mutual care. The considerations of admission to critical units of complicated patients, with principles of caring over healing, without abandoning those who require assistance. Resources are scarce and must be protected, people must not be discriminated against, age is a precedent that must be considered, given the chances of survival, without going beyond the limitations to the therapeutic effort, which must be shared with the treating medical team and of the hospital ethics committee if required. A dignified death is an element to be considered with respect for the person, their families and the community.

Association between dental anxiety and intraoperative pain during root canal treatment: a cross-sectional study.

AIM: To investigate whether dental anxiety influences the intraoperative pain felt by patients during root canal treatment. METHODOLOGY: In a cross-sectional design, 180 patients (90 men and 90 women) were included. Pre-operative anxiety levels were assessed using the short-form Dental Anxiety Inventory (S-DAI). Pain during root canal treatment was evaluated using a 10-cm visual analogue scale (VAS) that ranked the level of pain between 'Absence of pain' and 'Unbearable pain'. The minimal sample size was determined using the software of the National Center for Advancing Translational Sciences (NIH, UK). Multivariate logistic regression analysis was used to identify relationships between variables. RESULTS: Mean pain level during root canal treatment was 2.2 ± 2.1. The mean anxiety S-DAI score was 27.2 ± 12.5. Fifty percent of men had mild anxiety levels, while in 70% of women anxiety was moderate or high (P = 0.017). Anxiety correlated positively with intraoperative pain (R = 0.406). Multivariate logistic regression analysis revealed that anxiety was significantly associated with intraoperative pain felt by patients (OR = 4.0; 95% C.I. = 1.7-9.3; P = 0.001). CONCLUSIONS: Anxious patients were more than twice as likely to feel moderate or intense intraoperative pain during root canal treatment. To know the patient´s degree of anxiety could help the dentist to decide whether to use anxiolytic premedication and/or supplemental local anaesthesia to assure better control of pain during root canal treatment.

Results of a Search for Sub-GeV Dark Matter Using 2013 LUX Data.

The scattering of dark matter (DM) particles with sub-GeV masses off nuclei is difficult to detect using liquid xenon-based DM search instruments because the energy transfer during nuclear recoils is smaller than the typical detector threshold. However, the tree-level DM-nucleus scattering diagram can be accompanied by simultaneous emission of a bremsstrahlung photon or a so-called "Migdal" electron. These provide an electron recoil component to the experimental signature at higher energies than the corresponding nuclear recoil. The presence of this signature allows liquid xenon detectors to use both the scintillation and the ionization signals in the analysis where the nuclear recoil signal would not be otherwise visible. We report constraints on spin-independent DM-nucleon scattering for DM particles with masses of 0.4-5 GeV/c^{2} using 1.4×10^{4} kg day of search exposure from the 2013 data from the Large Underground Xenon (LUX) experiment for four different classes of mediators. This analysis extends the reach of liquid xenon-based DM search instruments to lower DM masses than has been achieved previously.