Systematics and life cycles of four avian schistosomatids from Southern Cone of South America.

Relative to the numerous studies focused on mammalian schistosomes, fewer include avian schistosomatids particularly in the southern hemisphere. This is changing and current research emerging from the Neotropics shows a remarkable diversity of endemic taxa. To contribute to this effort, nine ducks (Spatula cyanoptera, S.versicolor, Netta peposaca), 12 swans (Cygnus melancoryphus) and 1,400 Physa spp. snails from Chile and Argentina were collected for adults and larval schistosomatids, respectively. Isolated schistosomatids were preserved for morphological and molecular analyses (28S and COI genes). Four different schistosomatid taxa were retrieved from birds: Trichobilharzia sp. in N. peposaca and S. cyanoptera that formed a clade; S.cyanoptera and S. versicolor hosted Trichobilharzia querquedulae; Cygnus melancoryphus hosted the nasal schistosomatid, Nasusbilharzia melancorhypha; and one visceral, Schistosomatidae gen. sp., which formed a clade with furcocercariae from Argentina and Chile from previous work. Of the physid snails, only one from Argentina had schistosomatid furcocercariae that based on molecular analyses grouped with T. querquedulae. This study represents the first description of adult schistosomatids from Chile as well as the elucidation of the life cycles of N.melancorhypha and T. querquedulae in Chile and Neotropics, respectively. Without well-preserved adults, the putative new genus Schistosomatidae gen. sp. could not be described, but its life cycle involves Chilina spp. and C. melancoryphus. Scanning electron microscopy of T. querquedulae revealed additional, undescribed morphological traits, highlighting its diagnostic importance. Authors stress the need for additional surveys of avian schistosomatids from the Neotropics to better understand their evolutionary history.

Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties.

AIM: To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties. MATERIALS AND METHODS: An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied. RESULTS: The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques. CONCLUSION: Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found. CLINICAL RELEVANCE: Identify dentist's knowledge about MI.

Tetrathyridia in an endemic lizard from Chile: molecular evidence for South America.

Mesocestoides is a controversial tapeworm with significant lack of data related to systematics and life cycles. This helminth has an indirect life cycle with vertebrates, mostly carnivorous mammals, as definitive hosts. Theoretically, a coprophagous arthropod would be the first intermediate host, and herptiles, mammals, and birds, which prey on these insects, would represent the second intermediate hosts. However, recent evidence suggests that this life cycle would require only two hosts, with no arthropods involved. In the Neotropics, although there are records of mammals and reptiles as hosts for Mescocestoides, no molecular analyses have been performed. This work aimed to record an additional intermediate host and molecularly characterize the isolated larvae. Thus, 18 braided tree iguanas (Liolaemus platei) from Northern Chile were collected and dissected during 2019. One lizard was parasitized by three morphotypes of larvae compatible with tetrathyridia of Mescocestoides. To achieve its specific identity, a molecular approach was performed: 18S rRNA and 12S rRNA loci were amplified through cPCR. The inferred phylogenies confirmed the morphological diagnosis and stated that all morphotypes were conspecifics. The sequences for both loci formed a monophyletic clade with high nodal support, representing a sister taxon to Mescocestoides clade C. This study represents the first molecular characterization of any taxon of Mescocestoides from the Neotropics. Future surveys from potential definitive hosts would help to elucidate its life cycle. Furthermore, an integrative taxonomic approach is required in additional studies from the Neotropical region, which would contribute to a better understanding of the evolutionary relationships of this genus.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH).

AIM: The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. METHODS: For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). RESULTS: MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. CONCLUSION: No association was found between dental fear and dental hypersensitivity in children with MIH.

Effects of 5α-dihydrotestosterone on the modulation of monocyte/macrophage response to Staphylococcus aureus: an in vitro study.

BACKGROUND: Staphylococcus aureus (S. aureus) is a pathogen responsible for a wide range of clinical manifestations and potentially fatal conditions. There is a paucity of information on the influence of androgens in the immune response to S. aureus infection. In this study, we evaluated the influence of the hormone 5α-dihydrotestosterone (DHT) on mouse peritoneal macrophages (MPMs) and human peripheral blood monocytes (HPBMs) induced by S. aureus. METHODS: An in vitro model of MPMs from BALB/c sham males, orchiectomised (OQX) males, and females was used. Cells were inoculated with 10 µL of S. aureus, phage-type 80 or sterile saline (control) for 6 h. The MPMs of OQX males and females were pre-treated with 100 µL of 10-2 M DHT for 24 h before inoculation with S. aureus. The concentration of the cytokines TNF-α, IL-1α, IL-6, IL-8, and IL-10; total nitrites (NO-2); and hydrogen peroxide (H2O2) were measured in the supernatant of MPM cultures. In addition, the toll-like receptor 2 (TLR2) and nuclear factor kappa B (NF-kB) genes that are involved in immune responses were analysed. For the in vitro model of HPBMs, nine men and nine women of childbearing age were selected and HPBMs were isolated from samples of the volunteers' peripheral blood. In women, blood was collected during the periovulatory period. The HPBMs were inoculated with S. aureus for 6 h and the supernatant was collected for the analysis of cytokines TNF-α, IL-6, IL-12; and GM-CSF, NO-2, and H2O2. The HPBMs were then removed for the analysis of 84 genes involved in the host's response to bacterial infections by RT-PCR array. GraphPad was used for statistical analysis with a p value < 0.05. RESULTS: Our data demonstrated that MPMs from sham males inoculated with S. aureus displayed higher concentrations of inflammatory cytokines and lower concentrations of IL-10, NO-2, and H2O2 when compared with MPMs from OQX males and females. A similar result was observed in the HPBMs of men when compared with those of women. Previous treatment with DHT in women HPBMs increased the production of pro-inflammatory cytokines and decreased the levels of IL-10, NO-2, and H2O2. The analysis of gene expression showed that DHT increased the activity of the TLR2 and NF-kB pathways in both MPMs and HPBMs. CONCLUSIONS: We found that DHT acts as an inflammatory modulator in the monocyte/macrophage response induced by S. aureus and females exhibit a better immune defence response against this pathogen.

Test Performance and Potential Clinical Utility of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel.

The test performance and potential clinical utility of the ePlex blood culture identification Gram-negative (BCID-GN) panel was evaluated relative to matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry on bacterial isolates and conventional antimicrobial susceptibility testing. The majority (106/108, 98.1%) of GN bacteria identified by MALDI were on the BCID-GN panel, and valid tests (107/108, 99.1%) yielded results on average 26.7 h earlier. For all valid tests with on-panel organisms, the positive percent agreement was 102/105 (97.2%) with 3 false negatives and the negative percent agreement was 105/105. Chart review (n = 98) showed that in conjunction with Gram stain results, negative pan-Gram-positive (GP) markers provided the opportunity to discontinue GP antibiotic coverage in 63/98 (64.3%) cases on average 26.2 h earlier. Only 8/12 (66.7%) Enterobacterales isolates with resistance to third-generation cephalosporins harbored the CTX-M gene. In contrast, 8/8 CTX-M+ samples yielded a resistant isolate. Detection of 1 Stenotrophomonas maltophilia (18 h), 1 OXA23/48+ Acinetobacter baumannii (52.4 h), and 3 CTX-M+ Enterobacterales isolates on ineffective treatment (47.1 h) and 1 on suboptimal therapy (72.6 h) would have additionally enabled early antimicrobial optimization in 6/98 (6.1%) patients. IMPORTANCE The GenMark Dx ePlex rapid blood culture diagnostic system enables earlier time to identification of antimicrobial-resistant Gram-negative bacteria causing bloodstream infections. Its ability to rule out Gram-positive bacteria enabled early discontinuation of unnecessary antibiotics in 63/98 (64.3%) cases on average 26.2 h earlier. Detection of bacteria harboring the CTX-M gene as well as early identification of highly resistant bacteria such as Stenotrophomonas maltophilia and Acinetobacter baumannii enabled optimization of ineffective therapy in 6/98 (6.1%) patients. Its implementation in clinical microbiology laboratories optimizes therapy and improves patient care.

Analytical performance and potential clinical utility of the GenMark Dx ePlex® blood culture identification gram-positive panel.

The test performance and potential clinical utility of the ePlex® BCID Gram-Positive (GP) Panel was evaluated relative to MALDI-TOF mass spectrometry on bacterial isolates and traditional antimicrobial susceptibility testing. All GP bacteria (n = 100) in the study were represented on the panel including 50 common skin contaminants, and 7/7 coinfections. The positive percent agreement (PPA) was 97/97 with 2 false positives. Detection of vanA yielded a PPA of 4/4 and NPA of 9/9. mecA gene detection exhibited a PPA of 14/14 and NPA of 14/14 for S. aureus and a PPA of 31/32(97%) and NPA of 16/16 for CNS with 1 false negative. Chart reviews (n = 80) identified a mean 24.4h faster time to organism identification, 53.4h earlier optimization in 15(18.8%) patients based on AMR gene detection, 29.2h earlier optimization for 8(10%) patients infected with organisms, such as streptococci, with very low resistance rates, and 42.9h earlier discontinuation of antimicrobials for 14(17.5%) patients with contaminant cultures.

Clinical course of neonatal acute kidney injury: multi-center prospective cohort study.

BACKGROUND: Neonatal acute kidney injury (AKI) has been associated with unfavorable outcomes, including increased mortality. We aimed to describe the clinical course and outcomes during the first 7 days after diagnosis in newborns with AKI in three neonatal intensive care units in Popayán-Colombia. METHODS: Multi-center prospective cohort study conducted between June 2019 and December 2020 in three NICUs after ethical approval. We included newborns between 2 and 28 days of life, first diagnosed with AKI using the KDIGO classification modified for newborns which consider increased serum creatinine values over baseline values as well as urine output over time in hours or both. Patients with chromosomal abnormalities, major kidney malformations, and complex congenital heart disease were excluded. Patients were followed for up to 7 days after diagnosis and the maximum KDIGO stage, recovery of kidney function, need for renal replacement therapy and cumulative incidence of death were evaluated. RESULTS: Over the 18 months of the study, 4132 newborns were admitted to the NICUs, and 93 patients (2.25, 95% CI 1.82-2.75%) developed neonatal AKI. 59.1% of the newborns were premature and there were no differences in severity according to gestational age. During follow-up, the maximum KDIGO was 64.5% for AKI-stage 1, 11.8% for AKI-stage 2, and 23.7% for AKI-stage 3. Kidney function recovery was higher in AKI-stage 1 patients vs. AKI-severe (AKI-stage 2 and 3) (95% vs. 48.5%). Five patients (5.4%) received renal replacement therapy and 15 died (16.1%), four in AKI-stage 1 vs. 11 in AKI-severe (6.7% vs 33.3%). CONCLUSIONS: Newborns admitted to the NICUs can develop AKI regardless of gestational age, and it is more frequent between the second and ninth days of life. More patients whit AKI-stage 1 recover and die less than those in a severe stage.

Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional / Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study

Antecedentes y objetivos: Existe poca información sobre la evolución, complicaciones y los tratamientos recibidos por los pacientes críticos con COVID-19 que requieren ingreso en una unidad de cuidados intensivos (UCI). El objetivo de este estudio es describir la evolución clínica, los tratamientos utilizados, las complicaciones y resultados de pacientes críticos COVID-19 ingresados en siete UCI de Anestesiología en la Región de Galicia durante el pico de la pandemia en marzo-abril 2020. Métodos: Entre el 21 de marzo y el 19 de abril de 2020 evaluamos a todos los pacientes críticos COVID-19 ingresados en las UCI de Anestesiología de siete hospitales en Galicia, en el Noroeste de España. Los resultados, complicaciones y los tratamientos administrados se registraron hasta el 6 de mayo de 2020, fecha final del seguimiento. Resultados: Un total de 97 pacientes críticos COVID-19 fueron incluidos. Durante su estancia en UCI, 80 pacientes (82,5%) necesitaron ventilación mecánica, y 22 pacientes (22,7%) traqueotomía. El decúbito prono se usó frecuentemente en pacientes intubados (67,5%) y despiertos (27,8%). Las medicaciones usadas fueron antivirales (92,7%), corticoides (93,8%), tocilizumab (57,7%), y dosis intermedias y altas de anticoagulantes (83,5%). Las complicaciones más frecuentes fueron infecciones adquiridas en UCI (52,6%), eventos trombóticos (16,5%), y reintubaciones (9,3%). Tras un seguimiento medio de 42 (34-45) días, 15 pacientes fallecieron (15,5%), 73 pacientes (75,2%) habían sido dados de alta de UCI y nueve pacientes (9,3%) permanecían todavía en la unidad. Conclusiones: Un alto porcentaje de nuestros pacientes críticos COVID-19 requirieron ventilación mecánica, posición prona, medicaciones antivirales, corticoides y anticoagulantes. Las complicaciones en UCI fueron frecuentes, principalmente infecciones y eventos trombóticos. Tuvimos una mortalidad relativamente baja del 15,5%.(AU)

Background and objectives: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. Methods: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. Results: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. Conclusions: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.(AU)

Oral health effects of botulinum toxin treatment for drooling: a systematic review.

BACKGROUND: Drooling is a major morbidity in several neurological diseases. Intraglandular botulinum neurotoxin (BoNT) injections have been used to manage this condition. However, by decreasing salivary flow, BoNT injections may result in an increased risk of caries and other oral adverse effects. In this study, we aimed to assess whether, in patients with drooling, intraglandular BoNT injections are associated with increased dental caries development, modifications on salivary composition (oral pH, buffering capacity and osmolality) and cariogenic bacterial load. MATERIAL AND METHODS: We performed a systematic review, searching PubMed, CENTRAL, Web of Science, and Scopus for all experimental and observational studies reporting on adverse effects of intraglandular BoNT injections in patients with drooling. Primary study selection, quality assessment, and data extraction were independently performed by two researchers. No studies were excluded based on their language, publication status or date of publication. Studies' quality was based on revised Cochrane Risk of Bias tools. Meta-analysis was not performed. RESULTS: We retrieved 1025 studies, of which 5 were included. Two studies were two randomized controlled trials and three quasi-experimental studies. None of the included studies found BoNT injections to be associated with dental caries development or with significant reductions in oral pH. One of the included primary studies even observed an increase in salivary buffer capacity. One study found an increase in Lactobacilli counts. As for the risk of bias, two studies were classified as having a critical risk, two as high risk and one as having some concerns. CONCLUSIONS: Currently, there is no evidence that, in patients with drooling, BoNT injections associate with increased risk of dental caries or disturbances in oral pH or salivary buffering capacity. However, the included primary studies had important limitations and differences in their methodologies.

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study. / Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional.

BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Development of dextrin-amphotericin B formulations for the treatment of Leishmaniasis.

The most effective medicines available for the treatment of leishmaniasis, a life-threatening disease, exhibit serious toxicological issues. To achieve better therapeutic efficiency while decreasing toxicity associated with amphotericin B (AmB), water-soluble dextrin-AmB (Dex-AmB) formulations were developed. Self-assembled nanocomplexes were formed by dissolving Dex and AmB in alkaline borate buffer, followed by dialysis and either freeze-drying (FD) or nano spray-drying (SD), yielding water dispersible particles with a diameter of 214 nm and 347 nm, respectively. The very simple production process allowed the formation of amorphous inclusion complexes containing 14% of AmB in the form of monomers and water-soluble aggregates. Nanocomplexes were effective against parasites in axenic culture (IC50 of 0.056 and 0.096 µM for L. amazonensis and 0.030 and 0.044 µM for L. infantum, respectively for Dex-AmB FD and Dex-AmB SD) and in decreasing the intramacrophagic infection with L. infantum (IC50 of 0.017 and 0.023 µM, respectively for Dex-AmB FD and Dex-AmB SD). Also, the formulations were able to significantly reduce the cytotoxicity of AmB. Overall, this study demonstrates the suitability of dextrin as an AmB carrier and the facile and inexpensive development of a delivery system for the treatment of leishmaniasis.

Gammagrafía hepatobiliar en el estudio de las complicaciones del trasplante hepático en adultos. Descripción de la experiencia / Hepatobiliary scintigraphy in the study of complications in adult patients after liver transplant. Description of the experience

OBJETIVO: Mostrar la experiencia del uso de la gammagrafía hepatobiliar en pacientes con sospecha de complicaciones biliares postrasplante hepático en un centro de alta complejidad. MATERIAL Y MÉTODO: Estudio retrospectivo, observacional y descriptivo. Se incluyeron todos los pacientes consecutivos adultos con trasplante hepático entre enero de 2013 y febrero de 2018, con una o más gammagrafías hepatobiliares durante el postoperatorio temprano o tardío. Se analizaron un total de 58 gammagrafías hepatobiliares en 38 pacientes (22 hombres y 16 mujeres). Edad media: 48 años. En 34/38: donante cadavérico (89%), y en 4 (11%): donante vivo. Se obtuvieron otros datos demográficos e información relevante respecto al trasplante y se relacionó el resultado con los hallazgos quirúrgicos para determinar la correlación entre ambos. Se evaluó la influencia de la prueba en las decisiones clínicas finales. RESULTADOS: Hallazgos: 9 gammagrafías hepatobiliares (14%) fueron normales, 36 fueron negativas y 21 fueron positivas para complicaciones biliares. Del total de las 58 gammagrafías hepatobiliares, 50 (86%) tuvieron repercusión en la conducta clínica de observación o intervención. En todos los pacientes con hallazgos de complicaciones biliares (21/21; 100%) hubo una repercusión clínica, ya que a 18/21 se les realizaron estudios o tratamientos invasivos y 3/21 pacientes continuaron en manejo médico por hallazgos de complicaciones biliares no quirúrgicas. En 14/18 pacientes a los que se realizó estudios o procedimientos se encontró correlación con el estudio gammagráfico. En 24/36 (66%) pacientes con una gammagrafía hepatobiliar negativa se encontró impacto en la conducta clínica. CONCLUSIÓN: La gammagrafía hepatobiliar es una forma simple, no invasiva, confiable, vigente y disponible para el estudio de forma temprana de las complicaciones biliares en pacientes con trasplante hepático. Se debe tener en cuenta la disfunción hepatocelular importante como causa frecuente de obtener estudios falsos negativos

OBJECTIVE: To show the experience of the use of hepatobiliary scintigraphy in patients with suspected complications after liver transplantation in a high complexity centre. MATERIAL AND METHOD: Retrospective, observational and descriptive study. All consecutive adult patients with liver transplantation between January 2013 and February 2018 were included, with one or more hepatobiliary scintigraphy during the early or late postoperative period. A total of 58 studies were analyzed in 38 patients (22 men and 16 women). Mean age: 48 years. In 34/38: cadaverous donor (89%), and in 4 (11%): a living donor. Demographic data and relevant information regarding the transplant were obtained, and the result was related to the surgical findings to determine the correlation between them. The influence of the test on the final clinical decisions was evaluated. RESULTS: Findings: 9 scans (14%) were normal, 36 studies were negative, and 21 were positive for biliary complications. Of the total of 58 studies, 50 (86%) had impact on the clinical behaviour of observation or intervention. All the patients with findings of biliary complications (21/21; 100%) had clinical repercussion since 18/21 patients were taken to invasive studies or treatments, and 3/21 patients continued in medical management for findings of non-surgical biliary complications. In 14/18 patients taken to studies or procedures, correlation was found with the scintigraphic study. In 24/36 (66%) of patients with negative scintigraphy, an impact on clinical behaviour was found. CONCLUSION: Hepatobiliary scintigraphy is a simple, non-invasive, reliable, current and available form for the early study of biliary complications in patients with liver transplantation. Important hepatocellular dysfunction should be taken into account as a frequent cause of false negative studies

Hepatobiliary scintigraphy in the study of complications in adult patients after liver transplant. Description of the experience. / Gammagrafía hepatobiliar en el estudio de las complicaciones del trasplante hepático en adultos. Descripción de la experiencia.

OBJECTIVE: To show the experience of the use of hepatobiliary scintigraphy in patients with suspected complications after liver transplantation in a high complexity centre. MATERIAL AND METHOD: Retrospective, observational and descriptive study. All consecutive adult patients with liver transplantation between January 2013 and February 2018 were included, with one or more hepatobiliary scintigraphy during the early or late postoperative period. A total of 58 studies were analyzed in 38 patients (22 men and 16 women). Mean age: 48 years. In 34/38: cadaverous donor (89%), and in 4 (11%): a living donor. Demographic data and relevant information regarding the transplant were obtained, and the result was related to the surgical findings to determine the correlation between them. The influence of the test on the final clinical decisions was evaluated. RESULTS: Findings: 9 scans (14%) were normal, 36 studies were negative, and 21 were positive for biliary complications. Of the total of 58 studies, 50 (86%) had impact on the clinical behaviour of observation or intervention. All the patients with findings of biliary complications (21/21; 100%) had clinical repercussion since 18/21 patients were taken to invasive studies or treatments, and 3/21 patients continued in medical management for findings of non-surgical biliary complications. In 14/18 patients taken to studies or procedures, correlation was found with the scintigraphic study. In 24/36 (66%) of patients with negative scintigraphy, an impact on clinical behaviour was found. CONCLUSION: Hepatobiliary scintigraphy is a simple, non-invasive, reliable, current and available form for the early study of biliary complications in patients with liver transplantation. Important hepatocellular dysfunction should be taken into account as a frequent cause of false negative studies.

Evaluation of antibodies against Toxoplasma gondii and Leptospira spp. in Magellanic penguins (Spheniscus magellanicus) on Magdalena Island, Chile.

Toxoplasmosis has been reported in many avian species, but little information is available from wild penguin populations. Leptospira can infects domestic and wild animals. Spheniscus magellanicus belong to the order Sphenisciformes, family Spheniscidae, and are colonial birds. These seabirds live in temperate waters along the Atlantic shores of South America, and their total population has been estimated to be 1,300,000 breeding pairs. Magdalena Island (Chile) hosts an important breeding colony but, over recent decades, a marked decline in the number of birds has been seen. The objective of this study was to determine occurrences of antibodies against T. gondii and Leptospira spp. in penguins (Spheniscus magellanicus) on Magdalena Island, from where no previous data on these agents were available. Serum samples were collected from 132 penguins on Magdalena Island. Antibodies against Toxoplasma gondii were detected using the modified agglutination test (Titer ≥20), and anti-Leptospira spp. antibodies were detected using the microscopic agglutination test (Titer ≥100). T. gondii antibodies were detected in 57 (43.18%) of the 132 serum samples, with titers that ranged from 20 to 320. None of the penguins in this study was reactive to anti-Leptospira spp. antibodies. This is the first report of T. gondii seropositivity in free-living Magellanic penguins in Chile.

New records of ticks infesting bats in Brazil, with observations on the first nymphal stage of Ornithodoros hasei.

In Brazil, at least 14 species of soft ticks (Argasidae) are associated with bats. While Ornithodoros hasei seems to be abundant among foliage-roosting bats, other groups of ticks are found exclusively inside caves. In this paper, noteworthy records of soft ticks infesting bats are documented in new localities from Bahia, Pernambuco, Piauí, and Rondônia states. Out of 201 bats examined, 25 were infested by 152 ticks belonging to seven taxa: Ornithodoros cavernicolous, O. hasei, Ornithodoros marinkellei, Ornithodoros cf. fonsecai, Ornithodoros cf. clarki, Antricola sp., and Nothoaspis amazoniensis. These findings provide new insights into the geographical distribution and host association of soft ticks occurring in the Neotropical region. Remarkably, morphological and biological observations about O. hasei are inferred based on the examination of on-host-collected first stage nymphs.

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis.

OBJECTIVE: The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before. MATERIALS AND METHODS: Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. RESULTS: The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively. CONCLUSIONS: ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect. CLINICAL RELEVANCE: ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

Replacing amalgam with a high-viscosity glass-ionomer in restoring primary teeth: A cost-effectiveness study in Brasilia, Brazil.

OBJECTIVES: When planning primary oral health care services the cost implications of adopting new intervention practices are important, especially in resource-strapped countries. Although on a trajectory to be phased-out, amalgam remains the standard of care in many countries. METHODS: Adopting a government perspective, this study compared the costs of performing amalgam and ART/high-viscosity glass-ionomer cement (HVGIC) restorations and the consequences of failed restorations over 3 years in suburban Brasilia, Brazil. Cost data were collected prospectively; cost estimates were developed for the study sample and a projection of 1000 single- and 1000 multiple-surface restorations per group. Probabilistic sensitivity analysis was conducted in TreeAge Pro. RESULTS: Results were mixed. For single-surface restorations, ART/HVGIC will cost US$51 per failure prevented, while for multiple-surface restorations, ART/HVGIC was cost-effective with a savings of US$11 compared to amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost-effective 49.2% of the time compared to HVGIC at 50.6% of the time at a willingness to pay threshold of US$237 per failure prevented. Personnel accounted for more than half the cost burden for both methods; instruments and supplies accounted for about one third. The per restoration cost to replace amalgam with HVGIC ranges from US$1 to a savings of US$0.84. CONCLUSION: Replacing amalgam with a high-viscosity glass-ionomer as part of the ART method comes at a minimal increase in cost for governments. Increasing the number of restorations seems to diminish the cost burden. CLINICAL SIGNIFICANCE: ART/HVGIC could be considered a viable alternative to amalgam in primary teeth.

A New Collection of Amblyomma parvitarsum (Acari: Ixodidae) in Peru, With Description of a Gynandromorph and Report of Rickettsia Detection.

Adult stages of Amblyomma parvitarsum Neumann parasitize wild and domestic camelids of the genera Lama and Vicugna in highlands of Andean Plateau and Patagonia. Within the Peruvian Andes, few reports have documented this tick-host association, and although reported in Chile and Argentina, Rickettsia-infected A. parvitarsum remains undocumented for this country. Here we report a new collection of A. parvitarsum from Peru, the finding of the first gynandromorph for the species and high prevalence of Rickettsia in adult stages.