Central Diabetes Insipidus Masked by Uncontrolled Diabetes Mellitus: A Challenging Case Managed With Indapamide.

A 44-year-old man with a history of traumatic brain injury (TBI) presented to the emergency room (ER) with diabetic ketoacidosis (DKA). After resolution of DKA, the patient had persistent polyuria (up to 5.5 L/24 h) associated with low specific gravity (1.002-1.005) and severe hypernatremia (up to 186 mmol/L) that led us to consider the possibility of central diabetes insipidus (DI). Due to the lack of desmopressin availability in our country, we managed the patient using indapamide. Polydipsia and polyuria in a patient with controlled diabetes mellitus (DM) should raise suspicion for alternative etiologies, including DI. Appropriate fluid management during hospitalization is critical to avoid life-threatening complications. TBI is an important cause of central DI and should be treated with desmopressin, an arginine-vasopressin (AVP) analog. In the absence of desmopressin, alternative options can help patients with central DI, including thiazides, carbamazepine, chlorpropamide, among others less studied.

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis / Risk of postsurgical hemorrhage in patients with antitrombotic treatment undergoing oral surgery: A systematic review and Metanalysis

RESUMEN: Introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. Materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. Resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93 - 2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. Conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral.

ABSTRACT: Introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. Materials and methods: A search was performed using CENTRAL, Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. Results: A total of 5 studies were included based on inclusion criteria (549 patients). The meta-analysis showed that the maintenance of OAT does not increases the risk of postoperative bleeding (relative risk [RR] 1.41 [0.93 - 2.16]; 95% CI p= 0,11) compared with the discontinuation of therapy. Conclusion: Although a larger quantity of oral postoperative bleeding episodes were found in patients continuing with OAT compared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.

Identification and description of controlled clinical trials in Spanish language dental journals.

BACKGROUND: To identify controlled clinical trials (CCTs) published in Spanish and in Latin American dental journals, and provide access to this body of evidence in a single source. METHODS: Handsearching, following Cochrane Collaboration guidelines, of CCTs published in Spanish dental journals from Spain and Latin America. For each eligible trial, we collected the dental specialty, the interventions evaluated, whether and how randomisation was achieved, and the corresponding bibliographic reference. RESULTS: We handsearched 107 journals published in Spain and Latin America in Spanish. Over 17 051 articles, 244 (1.43%) were CCTs. These studies focused mainly on periodontics (70, 29.0%) and oral and maxillofacial surgery (66, 27.0%), assessing mostly pharmacological interventions (112, 46.0%). One hundred fifty-three studies (62.7%) used a random allocation of participants to study arms. CONCLUSIONS: A significant number of dental journals published in Spain and Latin America in Spanish language present original research relevant to inform clinical practice. These journals are not indexed in the major electronic databases. PRACTICAL IMPLICATIONS: References to the identified CCTs are now available in CENTRAL, the Cochrane Collaboration repository for these studies. We call for adherence to the CONSORT statement in dentistry to improve reporting of CCTs in journals published in Spanish language.

Primeros resultados de la vigilancia integrada de la resistencia antimicrobiana de patógenos transmitidos por alimentos, campylobacter spp y salmonella spp en tres poblaciones distintas. Paraguay. 2011-2012 / First results of the comprehensive surveillance of the antimicrobial resistance of foodborne pathogens, campylobacter spp and salmonella spp in three different populations. Paraguay, 2011-2012

La infección causada por Salmonella spp. y por Campylobacter spp. son las enfermedades transmitidas por alimentos (ETA) reportadas más frecuentemente en el mundo, siendo la carne de pollo uno de los vehículos alimentarios más importantes para ambas. Se presenta los primeros resultados de la vigilancia antimicrobiana integrada de las ETA de Salmonella spp. y Campylobacter spp. en tres poblaciones. En este estudio descriptivo de corte transverso, de casos consecutivos, se recolectaron muestras de diversos orígenes de carne de pollo y distintas poblaciones para su aislamiento, caracterización y perfil de resistencia. Se observó una prevalencia de Campylobacter spp. del 13% en alimentos, 20% en muestras clínicas y 55% en heces cloacales de aves, con alta prevalencia de Campylobacter jejuni en las tres poblaciones; de Salmonella spp fue 6% en alimentos, 13% en muestras clínicas y 3% en heces cloacales de aves, con predominio del serotipo Salmonella ser. Enteritidis en las muestras clínicas y heces cloacales de aves. La resistencia a ciprofloxacina de Campylobacter spp., entre 59-81% se destacó en las tres poblaciones estudiadas. Para Salmonella spp. se observó una resistencia a nitrofurantoina del 73% en heces cloacales de aves, 55% en alimentos y 19,4% en humanos; a tetraciclina, 42% en alimentos, 5% en muestras clínicas y 9% en heces cloacales; para el ácido nalidíxico la resistencia fue del 72% en animales y 53% en muestras clínicas. Es importante fortalecer la vigilancia integrada de la resistencia antimicrobiana en estas tres poblaciones de manera a detectar en forma oportuna mecanismos de resistencia que pudieran afectar al ser humano a través de la cadena alimentaria.

Infection caused by Salmonella ssp. and Campylobacter spp. are the foodborne diseasesreported most frequently throughout the world, and chicken meat is considered one of themost important food vehicles for both. The objective was to present the first resultsobtained from the integrated antimicrobial surveillance of foodborne diseases of Salmonellaspp. and Campylobacter spp in three populations. In this descriptive cross - sectional ofconsecutive sampling, samples were collected from different sources of chicken meat and different populations for isolation, characterization and resistance profile. A prevalence of13% in food, 20% in clinical samples and 55% in cloacal feces was observed in the isolationof Campylobacter spp. with high prevalence of Campylobacter jejuni in all three populationsfollowed by 6% in food, 13% in clinical samples and 3% in birds cloacal feces of Salmonellaspp. with predominance in the isolation of the serotype Salmonella ser. Enteritidis in clinicalsample populations and birds cloacal feces. The resistance of Campylobacter spp. tociprofloxacin of 59-81%, stood out in the three populations under study, in contrast toSalmonella spp. A high resistance to nitrofurantoin of 73% was observed in poultry feces,55% in foods and 19.4% in humans. Resistance to tetracycline was found in foods (42%),5% in clinical samples and 9% in cloacal feces. A resistance of 72% was observed inanimals and 53% in clinical samples for nalidixic acid. It is important to strengthen theintegrated surveillance of antimicrobial resistance in these three populations in order totimely detect mechanisms of resistance that can affect the human being through the foodchain.

Melanoma oral: importancia de un diagnóstico temprano: un caso clínico / Oral melanoma: importance of an early diagnosis: a case report

RESUMEN: Las lesiones pigmentadas malignas en la mucosa oral son de escasa frecuencia, pero de altas tasas de morbilidad y mortalidad, siendo de mal pronóstico a pesar de agresivos tratamientos que pueden combinar grandes resecciones quirúrgicas con quimioterapia y radioterapia. Dado este escenario, la conducta clínica asociada a la pesquisa de lesiones pigmentadas es la biopsia inmediata para la confirmación o descarte de patología maligna y con ello un inicio temprano de tratamiento. Este artículo trata de una paciente recibida en un hospital público aproximadamente seis meses posteriores a las primeras manifestaciones de una lesión pigmentada en mucosa maxilar, que luego de confirmado el diagnóstico de una lesión maligna fue derivada y manejada por un equipo oncológico del mismo centro.

ABSTRACT: Pigmented malignant oral mucosa lesions are infrequent, but with high rates of morbidity and mortality, and have a poor prognosis despite aggressive treatments that can combine large surgical resection with chemotherapy and radiotherapy. Given this scenario, the clinical conduct associated with pigmented lesions is the immediate biopsy to confirm or rule out the disease and thus the early initiation of treatment. This article is about a patient attended in a public hospital about six months after the first signs of an injury to maxillary mucosa, which then confirmed the diagnosis of a malignant lesion, who was referred and treated by a cancer team of the same center.

Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy.

Extracorporeal Membrane Oxygenation (ECMO) for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

Dietary diversity of formal and informal residents in Johannesburg, South Africa.

BACKGROUND: This paper considers the question of dietary diversity as a proxy for nutrition insecurity in communities living in the inner city and the urban informal periphery in Johannesburg. It argues that the issue of nutrition insecurity demands urgent and immediate attention by policy makers. METHODS: A cross-sectional survey was undertaken for households from urban informal (n = 195) and urban formal (n = 292) areas in Johannesburg, South Africa. Foods consumed by the respondents the previous day were used to calculate a Dietary Diversity Score; a score < 4 was considered low. RESULTS: Statistical comparisons of means between groups revealed that respondents from informal settlements consumed mostly cereals and meat/poultry/fish, while respondents in formal settlements consumed a more varied diet. Significantly more respondents living in informal settlements consumed a diet of low diversity (68.1%) versus those in formal settlements (15.4%). When grouped in quintiles, two-thirds of respondents from informal settlements fell in the lowest two, versus 15.4% living in formal settlements. Households who experienced periods of food shortages during the previous 12 months had a lower mean DDS than those from food secure households (4.00 ± 1.6 versus 4.36 ± 1.7; p = 0.026). CONCLUSIONS: Respondents in the informal settlements were more nutritionally vulnerable. Achieving nutrition security requires policies, strategies and plans to include specific nutrition considerations.

A rare head-head binding pattern in bisbenzylisoquinoline alkaloids.

Bioassay-guided fractionation of Berberis tabiensis against Culex quinquefasciatus third instar larvae afforded a new bisbenzyltetrahydroisoquinoline alkaloid having an unusual head-head binding pattern. This new alkaloid (tabienine B) is the first member of this family found to possess a diphenyl ether bridge in C-6 and C-7'.

South African HIV/AIDS programming overlooks migration, urban livelihoods, and informal workplaces.

South Africa has the largest population of people living with HIV globally and is associated with high population mobility. The majority of migrants move in search of improved livelihood opportunities, and many who migrate (both internally and across borders) move into urban areas, often through peripheral informal settlements where HIV prevalence is shown to be double that of urban formal areas. While the relationship between migration and the spread of HIV is acknowledged as complex, the context of migration may place individuals at increased risk for acquiring HIV. Studies have demonstrated the long-wave impact of HIV and AIDS on livelihood activities and, more recently, on patterns of migration. Many migrants engage in livelihood strategies situated within the urban 'informal economy'; these informal workplaces are often overlooked in global and national legislation governing workplace responses to health and HIV and AIDS. This study draws on existing research and limited primary data to explore the implications of HIV/AIDS programming for diverse migrant groups labouring in informal workplaces in Johannesburg, South Africa. We describe three case studies: waste-pickers at a dumpsite in a peripheral urban informal settlement; barmen and cleaners working in inner-city hotels where sex is also sold; and, migrants engaged in informal livelihood activities who are also members of burial societies. Given the importance of varied informal livelihood activities for diverse migrant groups, particularly in urban areas of South Africa, we propose that the national HIV/AIDS response can and should engage with internal and cross-border migrants in informal workplaces - which is in line with the principle of universal access and will strengthen the national response. Especially, we point out the potential for burial societies to provide an entry point for HIV/AIDS programming that targets migrant groups involved in the informal economy of South African cities.

Urban health in Johannesburg: the importance of place in understanding intra-urban inequalities in a context of migration and HIV.

Developing country urban contexts present multiple challenges to those responsible for ensuring the good health of urban populations. These include urban growth, migration, informal settlements, intra-urban inequalities and - in some cases - high HIV prevalence. Using Johannesburg as a case study, this paper explores the complexities of the urban context by comparing the social determinants of urban health between migrant groups residing in the inner-city and a peripheral urban informal settlement. It is argued that any attempt to improve the health of urban populations in the context of migration and HIV requires understanding that 'place matters'.