Anesthesia using microcannula and sharp needle in upper blepharoplasty: A randomized, double-blind clinical trial evaluating pain, bruising, and ecchymoses.

INTRODUCTION: With the emergence of blunt-tipped microcannulas, there is a hypothesis that these could cause less damage and reduce pain as compared to conventional sharp needles in eyelid surgery. The purpose is to determine whether an 18G blunt-tipped cannula can be better than a 26G needle. METHODS: This prospective, observer-blinded, randomized clinical trial was conducted from June 2017 to December 2018. Sixty-eight patients were randomized to receive local anesthesia injections for upper blepharoplasty. Infiltration was performed by using a 26-gauge sharp needle on one side and on the other side, infiltration was performed by using an 18-gauge stainless-steel blunt-tipped microcannula. A numeric rating scale (NRS) from 0 to 10 was used to blindly assess pain in patients receiving anesthesia injections with both needle types. Photographs of the eyelids of each patient were taken in five different periods and used by three blinded observers to identify bruise or ecchymoses. RESULTS: A total of 136 eyelid operations were performed. There was no statistically significant difference when both groups were compared; however, the average score of pain was higher in patients taking the infiltration through the needle (2.85 versus 2.50). Regarding the evaluation of bruising and ecchymoses, the results showed that, in the five periods evaluated, there was no statistical difference in bruising and ecchymosis in the eyelids when taking the infiltration through a sharp needle when compared with that of the eyelids taking infiltration through a (blunt-tipped) microcannula. CONCLUSION: The evaluation of the blunt-tipped microcannula showed a lower pain score mean than that obtained for the sharp needle (2.5 versus 2.85) (p > 0.05). There was no statistically significant difference in the bruising and ecchymosis courses.

Sexual dimorphism in SARS-COV-2 infection.

Previous studies have demonstrated that female patients with coronavirus disease 2019 (COVID-19) demonstrate more favorable prognosis relative to male patients. In this article, we elaborate the possible role of estrogen in the modulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection severity. The potential interplay between several factors, including inherently lower estradiol (E2) and slightly higher estrogen receptor ß (ERß) levels in males, with inflammatory mediators are described. Altogether, there seems to be a sexually dimorphic response towards SARS-CoV-2 infection, and a possibility that COVID-19 severity is dependent on both E2 levels and ERα:ERß expression ratio in lymphoid and lung cells.

Diversity of Rhabdochona mexicana (Nematoda: Rhabdochonidae), a parasite of Astyanax spp. (Characidae) in Mexico and Guatemala, using mitochondrial and nuclear genes, with the description of a new species.

Among fish parasitic nematodes Rhabdochona is one of the most speciose genera, with c. 100 species. Twelve congeneric species occur in Mexican freshwater fishes, in a region located between the Nearctic and Neotropical biogeographical regions. Host association and biogeographical history have determined the high species richness of Rhabdochona in Mexico. One of these species, Rhabdochona mexicana, is highly specific to the characid genus Astyanax. Characids are a group of freshwater fish with Neotropical affinity. In this paper, we explore the genetic diversity of R. mexicana through samples obtained from populations of Astyanax spp. across river basins of Mexico and Guatemala. Sequences of one mitochondrial and two ribosomal genes were obtained from 38 individuals and analysed using Maximum Likelihood and Bayesian Inference analysis. Phylogenetic analyses using cox1, and a concatenated alignment of 18S + 28S + cox1 recovered two genetic lineages. One of them corresponded with R. mexicana sensu stricto; this lineage included three reciprocally monophyletic subgroups; the other lineage was highly divergent and represented a putative candidate species. A detailed morphological study was conducted to corroborate the molecular findings. We describe a new species herein and discuss the implications of using molecular tools to increase our knowledge about the diversity of a speciose genus such as Rhabdochona.

Synthesis of calcium phosphate nanostructures by combustion in solution as a potential encapsulant system of drugs with photodynamic properties for the treatment of cutaneous leishmaniasis.

The traditional drugs used in the treatment of cutaneous leishmanisis (CL) have multiple disadvantages, such as high toxicity, high costs, and more recently the appearance of parasites resistant to those drugs. For this reason, some research has focused on the development of new drugs or treatment therapies. Photodynamic therapy (PDT) that involves the use of a photosensitive or photosensitizing compound capable of producing reactive oxygen species to which Leishmania parasites are sensitive, has emerged as an alternative for the treatment of CL. However, some of these sensitizing compounds exhibit some toxicity (cytotoxicity, allergic reaction, etc), low selectivity, and some of them are insoluble in aqueous media limiting their use. Therefore, the PDT can be improved using encapsulation systems which protect drugs, prevent their degradation, help them overcome physical barriers and increase their selectivity. In this study, we propose the use of calcium phosphate as a potential encapsulant or photodynamic support for photoactive drugs, using hypericin (HY) as a photosensitizer agent. The self-combustion route was used to synthesize the CP nanostructures. The structure and morphology of CP nanoparticles were evaluated via X-ray diffraction (XRD), Raman and field-emission scanning electron microscopy (FE-SEM). Phases rich in hydroxyapatite and CP ß phase, with granular morphology and an average grain size of 42.9 nm were obtained. The encapsulation uptake and the interactions between HY and the encapsulated system were evaluated by fluorescence spectroscopy and Fourier-transform infrared spectroscopy (FTIR), respectively. Approximately 13% of HY was enapsulated per 1 µg of nanoparticles of calcium phosphate. Composites were submitted to in vitro assays of cytotoxicity and anti-leishmanial activity. The CP nanoparticles did not affect the photodynamic activity of HY. On the contrary they showed antileishmanial response.

Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia.

This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.

Genetic diversity shaped by historical and recent factors in the live-bearing twoline skiffia Neotoca bilineata.

The endangered twoline skiffia Neotoca bilineata, a viviparous fish of the subfamily Goodeinae, endemic to central Mexico (inhabiting two basins, Cuitzeo and Lerma-Santiago) was evaluated using genetic and habitat information. The genetic variation of all remaining populations of the species was analysed using both mitochondrial and microsatellite markers and their habitat conditions were assessed using a water quality index (I(WQ)). An 80% local extinction was found across the distribution of N. bilineata. The species was found in three of the 16 historical localities plus one previously unreported site. Most areas inhabited by the remaining populations had I(WQ) scores unsuitable for the conservation of freshwater biodiversity. Populations showed low but significant genetic differentiation with both markers (mtDNA φ(ST) = 0.076, P < 0.001; microsatellite F(ST) = 0.314, P < 0.001). Borbollon, in the Cuitzeo Basin, showed the highest level of differentiation and was identified as a single genetic unit by Bayesian assignment methods. Rio Grande de Morelia and Salamanca populations showed the highest genetic diversity and also a high migration rate facilitated by an artificial channel that connected the two basins. Overall, high genetic diversity values were observed compared with other freshwater fishes (average N(a) = 16 alleles and loci and mean ±S.D. H(o) = 0.63 ± 0.10 and nucleotide diversity π = 0.006). This suggests that the observed genetic diversity has not diminished as rapidly as the species' habitat destruction. No evidence of correlation between habitat conditions and genetic diversity was found. The current pattern of genetic diversity may be the result of both historical factors and recent modifications of the hydrological system. The main threat to the species may be the rapid habitat deterioration and associated demographic stochasticity rather than genetic factors.

Utilidad del cultivo en el diagnóstico de la TBC pulmonar en Chile: cuantos casos se dejan de diagnosticar por la indicacion selectiva de esta tecnica? / Utility of the culture in the diagnosis of pulmonary tuberculosis in Chile: how many cases left out to diagnose by the selective indication of this?

Las normas del Programa de Control de la Tuberculosis en cuanto a utilización de la Bacteriología no contempla la indicación del cultivo bacilar para exámenes de localización de casos en la investigación de Tuberculosis Pulmonar. Por esta razón existe un porcentaje de pacientes que no se diagnostica precozmente. De acuerdo a los resultados obtenidos se concluye que es indispensable hacer extensiva la indicación del cultivo como complemento de la baciloscopía a toda muestra para la investigación de Tuberculosis Pulmonar