Diagnostic Strategies for Restorations Management: A 70-Month RCT.

We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.

Primary ciliary dyskinesia diagnosis and management and its implications in America: a mini review.

Introduction: Primary ciliary dyskinesia (PCD) is a rare genetic disorder that can result in significant morbidity and mortality if left untreated. Clinical manifestations of PCD include recurrent respiratory infections, laterality defects, and infertility, all of which arise from impaired or absent ciliary motility. Diagnostic approaches for PCD may include high-speed video microscopy, measurement of nasal nitric oxide levels, and genetic testing; however, no single definitive diagnostic test exists. The present study aims to highlight the lack of standardized diagnostic and treatment guidelines for PCD in Latin America (Central and South America, and the Caribbean). To this effect, we compared North American and European recommendations for the diagnosis and management of PCD and found that certain diagnostic tools and treatment options mentioned in these guidelines are not readily accessible in many Latin American countries. Methods & Results: This review gathers disease information in North America, Europe, and Latin America organizing guideline results into tables for clarity and potential interventions. Management information for Latin America is inferred from case reports, as most findings are from North American recommendations and studies on PubMed, Google Scholar, and Scopus. Treatment and management information is based on North American and European standards.Among 5,774 publications reviewed, only 15 articles met the inclusion criteria (focused on PCD management, peer-reviewed, and located in America). No clinical guideline for PCD in Latin America was found, but recommendations on respiratory management from Colombia and Chile were discovered. The lack of guidelines in Latin America may originate from limited resources and research on the disease in those countries. Discussion: PCD lacks documentation, research, and recommendations regarding its prevalence in Latin America, likely due to unfavorable economic conditions. This disadvantage results in limited access to diagnostic tests available in North America and Europe. The PICADAR score, discussed in this review, can be used in low-income nations as a screening tool for the disorder.

Management of acute stroke. Specific nursing care and treatments in the stroke unit.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir and combinations thereof in hospitalized patients with COVID-19: a pragmatic, open-label randomized trial.

BACKGROUND: The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. METHODS: This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095. FINDINGS: Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. INTERPRETATION: The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.

Epistaxis: aspectos nuevos a considerar / Epistaxis: new aspects to consider

La epistaxis es una de las urgencias otorrinolaringológicas más frecuentes, y se estima que un 6% requerirá algún tipo de intervención. Según la localización del sitio de sangrado puede clasificarse en anterior, posterior o superior. A lo largo de la historia su manejo ha seguido ciertos ejes que se mantienen vigentes, como son la compresión nasal, posicionamiento de la cabeza, taponamiento nasal, entre otros. Tras la implementación de la evaluación endoscópica sistemática del sitio de sangrado, estudios han descrito un nuevo punto de sangrado denominado S-point, que debiese ser especialmente considerado en epistaxis severa. Además, durante los últimos años la evidencia ha revelado ciertos aspectos especiales y relevantes en torno a la evaluación y/o manejo de pacientes con epistaxis y condiciones asociadas, como el uso de terapia antitrombótica, telangiectasia hemorrágica hereditaria o con hipertensión arterial. El objetivo de esta revisión es resumir aspectos novedosos en la evaluación, estudio y manejo de la epistaxis, donde se incluirán el uso de ácido tranexámico y de nuevos dispositivos intranasales.

Epistaxis is one of the most frequent otorhinolaryngological emergencies, and it is estimated that 6% require some type of intervention. Depending on the location of the bleeding site, it may be classified as anterior, posterior or superior. Throughout history, its treatment has remained the same, including nasal compression, head positioning, nasal packing, among others. After the implementation of the systematic endoscopic assessment of the bleeding site, studies have described a new point of bleeding called S-point, which should be especially considered in severe epistaxis. In addition, during the last years the evidence has revealed certain special and relevant aspects regarding the evaluation and/or management of patients with epistaxis and associated conditions, such as the use of antithrombotic therapy, hereditary hemorrhagic telangiectasia or arterial hypertension. The objective of this review is to summarize novel aspects in the evaluation, study and management of epistaxis, which include the use of tranexamic acid and new intranasal devices.

Influence of extraordinary floods on wildlife parasites: the case of gastrointestinal helminths and protozoa of wild canids from the Iberá Ecoregion, Argentina.

Parasites are natural components of ecosystems and play a significant role in the dynamics of wild animal populations. Although the environment of parasites is primarily defined by the host, most life cycles involve stages that must endure external conditions. Rainfall and flooding events are important factors that might influence the transport of parasitic stages, altering soil moisture levels, and resulting in a favorable environment for parasite survival and development. We assessed whether an extraordinary flood event modified the occurrence of gastrointestinal parasites (nematodes and protozoa) in wild canids in two protected areas in northern Argentina. From 2016 to 2018, we collected fecal samples of two fox species, Lycalopex gymnocercus and Cerdocyon thous, and examined the presence of nematodes and protozoa. We assessed changes in the occurrence of these parasites after a flood event, while adjusting for potential confounders (i.e., monthly average temperature, season, host species, site). In a second stage of the analysis, we evaluated whether part of the effect was caused by changes in soil moisture, by adding normalized difference water index as an independent variable. We found that the presence of nematodes in foxes was higher after flooding than before flooding, and this association was not explained by changes in the soil moisture. On the other hand, the flood event was not relevant for protozoa. Stronger and long-lasting flood events are expected due to the effect of global warming on El Niño events, and this may increase and intensify the spread of some parasites affecting wildlife, which could also be of public health concern.

A systematic review and meta-analysis on the effectiveness of xenograft to prevent periodontal defects after mandibular third molar extraction.

BACKGROUND: To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in the distal aspect of the second molar after the surgical removal of the mandibular third molar. MATERIAL AND METHODS: Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched in April 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated by means of the Cochrane Collaboration's Tool. Finally, a meta-analysis of the outcomes of interest was performed. RESULTS: Despite 795 articles were found in the initial search, only three randomized controlled clinical trials were included. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healing in terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment level gain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found. CONCLUSIONS: Within the limitations of the present review, the xenograft plus collagen membrane exhibited better periodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.

Management of acute stroke. Specific nursing care and treatments in the stroke unit. / Manejo del ictus agudo. Tratamientos y cuidados específicos de enfermería en la Unidad de Ictus.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

A toddler with phylloid-type pigmentary mosaicism and ambiguous genitalia resulting from trisomy 14 induced by a der(Y)t(Y;14).

A 1-year-old baby with phylloid-type pigmentary mosaicism, hypotonia, ambiguous genitalia, and a positive screening test for congenital adrenal hyperplasia was referred. Previous sonograph, cytogenetics, and metabolic profile were inconclusive, therefore we performed an additional karyotype and a molecular cytogenetics studies. A mosaic karyotype 45,X/46,X,der(Y)t(Y;14) was characterized in peripheral blood. Congenital adrenal hyperplasia genes were sequenced and the results were negative. The ambiguous genitalia was the result of the special gonosomal mosaicism. The low level of trisomy 14 led to minor physical characteristics and mild mental retardation; also, Turner syndrome features can be expected rather than severe trisomy 14 stigmata.

The varied sources of faculae-forming brines in Ceres' Occator crater emplaced via hydrothermal brine effusion.

Before acquiring highest-resolution data of Ceres, questions remained about the emplacement mechanism and source of Occator crater's bright faculae. Here we report that brine effusion emplaced the faculae in a brine-limited, impact-induced hydrothermal system. Impact-derived fracturing enabled brines to reach the surface. The central faculae, Cerealia and Pasola Facula, postdate the central pit, and were primarily sourced from an impact-induced melt chamber, with some contribution from a deeper, pre-existing brine reservoir. Vinalia Faculae, in the crater floor, were sourced from the laterally extensive deep reservoir only. Vinalia Faculae are comparatively thinner and display greater ballistic emplacement than the central faculae because the deep reservoir brines took a longer path to the surface and contained more gas than the shallower impact-induced melt chamber brines. Impact-derived fractures providing conduits, and mixing of impact-induced melt with deeper endogenic brines, could also allow oceanic material to reach the surfaces of other large icy bodies.

Evaluación del uso de antibióticos en mujeres embarazadas con infección urinaria en el Centro de Salud ¨Juan Eulogio Pazymiño¨ del Distrito de Salud 23D02 / Evaluation of the use of antibiotics in pregnant women with infection urinary at the ¨Juan Eulogio Pazymiño¨ Health Center of the Health District 23D02

RESUMEN Introducción: cada año el índice de infección de vías urinarias es mayor por lo que constituye un problema a nivel mundial. Su inadecuado manejo terapéutico ha derivado en la necesidad de investigar métodos para disminuir la resistencia bacteriana. Las mujeres embarazadas son muy vulnerables a contraer este tipo de infección. Material y métodos: se realizó un estudio retrospectivo de utilización de medicamentos del tipo prescripción-indicación en 64 mujeres embarazadas de la provincia de Santo Domingo de los Tsáchilas, en el Distrito de Salud 23D02, en el centro de Salud Juan Eulogio PazyMiño; en base a la información recopilada se desarrolló un programa de atención farmacéutica basado en el método Dáder para mejorar la calidad de la prescripción y contribuir a la disminución de la resistencia bacteriana en mujeres embarazadas con infección de vías urinarias que consumen antibióticos. Resultados: las pacientes con mayor incidencia con infección urinaria tenían entre 10 y 19 años de edad (48,44 %), la bacteria más frecuente fue la Escherichia coli (55,17 %), el medicamento con mayor resistencia bacteriana fue la cefalexina de 500 mg, se identificaron 2 tipos de Problemas Relacionados con Medicamentos (PRM) a predominio del PRM4 (85,29 %), la intervención farmacéutica realizada farmacéutico-médico fue aceptada en un 86,95 %. Conclusiones: la investigación permitió proponer un programa de atención farmacéutica basado en el método Dáder para identificar los problemas relacionados con este grupo farmacológico.

SUMMARY Introduction: the rate of urinary tract infections has increased during the last years, which constitutes a worldwide problem; therefore, the need to investigate methods to reduce bacterial resistance has emerged from inadequate therapeutic management. Pregnant women are more vulnerable to contracting this type of infection. Material and Methods: a retrospective study in the use of medicines of the type prescription - indication was conducted with 64 pregnant women at Juan Eulogio PazyMiño Health Center, which belongs to the 23D02 Health District located in Santo Domingo de los Tsachilas province. Based on the information gathered, a pharmaceutical care program established on the Dader method was developed to improve the prescription quality and thus contribute to the reduction of bacterial resistance in pregnant women with urinary tract infections who consume antibiotics. Results: patients with a higher incidence of urinary tract infections were between 10 and 19 years of age (48.44%), the most common bacteria found was Escherichia coli (55.17%), and, the drug with the highest bacterial resistance was cephalexin of 500 mg. Two types of Medication-Related Problems (MRP) were identified where the most frequent was MRP4 (85.29%). Pharmaceutical - medical intervention was accepted in 86.95% of the doctors. Conclusions: the research allowed to propose a Pharmaceutical Assistance Program based on the Dader method to identify the problems related to this pharmacological group.

Reparación endovascular de aneurisma de aorta torácica en mujeres con aneurisma de aorta torácica descendente / Thoracic Endovascular Aneurysm Repair in women with descending aortic thoracic aneurysm

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Correlates of ideal cardiovascular health in European adolescents: The HELENA study.

BACKGROUND AND AIMS: The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents. METHODS AND RESULTS: The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01). CONCLUSION: Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.

Effect of microbial activity on penetrometer resistance and elastic modulus of soil at different temperatures.

We explore the effect of microbial activity stimulated by root exudates on the penetrometer resistance of soil and its elastic modulus. This is important because it is a measure of the mechanical strength of soil and it correlates closely with the rate of elongation of roots. A sandy soil was incubated with a synthetic root exudate at different temperatures, for different lengths of time and with selective suppression of either fungi or bacteria. The shape of the temperature response of penetrometer resistance in soil incubated with synthetic exudate was typical of a poikilothermic temperature response. Both penetrometer resistance and small strain shear modulus had maximum values between 25 and 30°C. At temperatures of 20°C and less, there was little effect of incubation with synthetic root exudate on the small strain shear modulus, although penetrometer resistance did increase with temperature over this range (4-20°C). This suggests that in this temperature range the increase in penetrometer resistance was related to a greater resistance to plastic deformation. At higher temperatures (> 25°C) penetrometer resistance decreased. Analysis of the DNA sequence data showed that at 25°C the number of Streptomyces (Gram-positive bacteria) increased, but selective suppression of either fungi or bacteria suggested that fungi have the greater role with respect to penetrometer resistance. HIGHLIGHTS: Effect of microbial activity stimulated by synthetic root exudates on the mechanical properties.We compared penetrometer measurements and estimates of elastic modulus with microbial community.Penetrometer resistance of soil showed a poikilothermic temperature response.Penetrometer resistance might be affected more by fungi than bacteria.

Differences in forearm strength, endurance, and hemodynamic kinetics between male boulderers and lead rock climbers.

This study examined differences in the oxygenation kinetics and strength and endurance characteristics of boulderers and lead sport climbers. Using near infrared spectroscopy, 13-boulderers, 10-lead climbers, and 10-controls completed assessments of oxidative capacity index and muscle oxygen consumption (m⩒O2) in the flexor digitorum profundus (FDP), and extensor digitorum communis (EDC). Additionally, forearm strength (maximal volitional contraction MVC), endurance (force-time integral FTI at 40% MVC), and forearm volume (FAV and ΔFAV) was assessed. MVC was significantly greater in boulderers compared to lead climbers (mean difference = 9.6, 95% CI 5.2-14 kg). FDP and EDC oxidative capacity indexes were significantly greater (p = .041 and .013, respectively) in lead climbers and boulderers compared to controls (mean difference = -1.166, 95% CI (-3.264 to 0.931 s) and mean difference = -1.120, 95% CI (-3.316 to 1.075 s), respectively) with no differences between climbing disciplines. Climbers had a significantly greater FTI compared to controls (mean difference = 2205, 95% CI= 1114-3296 and mean difference = 1716, 95% CI = 553-2880, respectively) but not between disciplines. There were no significant group differences in ΔFAV or m⩒O2. The greater MVC in boulderers may be due to neural adaptation and not hypertrophy. A greater oxidative capacity index in both climbing groups suggests that irrespective of climbing discipline, trainers, coaches, and practitioners should consider forearm specific aerobic training to aid performance.