Secondary Evans Syndrome Presenting With Lupus Anticoagulant.

Evans syndrome (ES), characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), often poses diagnostic challenges due to its varied etiology and clinical presentation. We present a case of secondary ES in a 41-year-old male with a history of AIHA and ITP, who presented with lower extremity erythema, warmth, and sensation of chest pressure. Initial laboratory investigations revealed thrombocytopenia, mild anemia, and a prolonged activated partial thromboplastin time (aPTT), prompting further evaluation. Subsequent testing revealed positive lupus anticoagulant (LA), anti-cardiolipin antibodies, and anti-beta-2-glycoprotein 1 antibodies, along with lower extremity deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE). Treatment with therapeutic anticoagulation led to clinical improvement, highlighting the importance of recognizing hypercoagulable states in ES patients. This case underscores the significance of comprehensive differential diagnosis and timely intervention in optimizing outcomes for patients with ES.

Association between stress and catecholamines with painful TMD in children.

BACKGROUND: Studying biomarkers in children with temporomandibular disorders (TMD) such as epinephrine, norepinephrine, and dopamine may reveal factors like screen time or sleep loss that affect these biomarkers and predict TMD-related pain, offering new research opportunities. AIM: To determine the association between stress and catecholamines with myofascial pain and headache related to TMD in children. DESIGN: Sixty-six 9- to 11-year-old children assisting at the clinics of Pediatric Dentistry of Universidad CES participated in the study. Myofascial pain and headache attributed to TMD were determined according to the Diagnostic Criteria for TMD (DC/TMD) Axis I. Stress was evaluated with the Perceived Stress Scale-Children (PSS-C), and a 24-h urine sample was analyzed using liquid chromatography to assay catecholamines. Single and multiple regression analyses were performed. RESULTS: Children with a mean age of 10.3 years participated in the study. The mean score of stress was 29 ± 4. Perceived stress, dopamine, epinephrine, and norepinephrine were statistically significant predictors of myofascial pain and headache attributed to TMD in the single- and multiple variable logistic regression analyses. CONCLUSION: Stressful states and its biological biomarkers increase the probability of developing myofascial pain and headache attributed to TMD in children.

Thrombosis of the Superior Mesenteric Artery and Hepatic Artery Secondary to Acute Necrotizing Pancreatitis: Case Report and Literature Review

We describe the case of a female patient with severe acute pancreatitis of biliary origin who presented with clinical deterioration. A thrombosis of the superior mesenteric artery and hepatic artery was identified as the cause, thus creating a rare vascular complication. She was taken for pharmacological and mechanical thrombectomy, with the subsequent death of the patient. Arterial vascular complications are an entity little recognized in the medical literature; they have a high mortality rate and pose a significant diagnostic and therapeutic challenge.

Se describe el caso de una paciente femenina con pancreatitis aguda grave de origen biliar quien presentó deterioro clínico, y como causa se identificó una trombosis de arteria mesentérica superior y arteria hepática, de modo que se configuró una complicación vascular poco frecuente. Fue llevada a trombectomía farmacológica y mecánica, con el posterior deceso de la paciente. Las complicaciones vasculares arteriales son una entidad poco reconocida en la literatura médica, tienen una alta tasa de mortalidad y suponen un reto diagnóstico y terapéutico importante.

Sleep bruxism in children, from evidence to the clinic. A systematic review.

Objectives: The present paper aims to systematically review the literature published from 2015 to 2023 on bruxism in children with the aim to compilate the best available evidence. Materials and Methods: A systematic search in the National Library of Medicine's PubMed, Medline (EBSCO), SCOPUS, and Google Scholar databases was performed to identify all studies on humans assessing genetic, biopsychosocial, and sleep factors assessed with any different approach for sleep bruxism (SB) in children and its interventions. The selected articles were assessed independently by the two authors according to a structured reading of the article's format (PICO). The quality of the articles was evaluated using Quality Assessments Tool for Experimental Bruxism Studies (Qu-ATEBS) and the JBI critical appraisal tools. Results: A total of 16 articles were included for discussion in the review and grouped into questionnaire/parental-report (n = 7), SB assessment through parental report of SB and clinical examination (n = 4), and instrumental assessment (n = 5) studies. The total quality scores evaluated with STROBE and Qu-ATEBS were high for all included papers. However, in general, there was no control of bias strategies and there was no control group in the intervention studies. Conclusions: Investigations based on self-report, clinical, and instrumental bruxism assessment showed a positive association with genetics, quality of life aspects (school and emotional functions and overuse of screen-time), mother anxiety and family conformation, diet, alteration in sleep behaviors and architecture, and sleep breathing disorders. Additionally, the literature presents options to increase airway patency and, thus, reduce the occurrence of SB. Tooth wear was not found to be a major sign of SB in children. However, methods of SB assessment are heterogeneous and hamper a reliable comparison of the results.

Kinetics and bixine extraction time from achiote (Bixa Orellana L.).

The effects of the use of solvents (96% ethanol and PEG 400), solute ratios: solvent (1: 4 and 1: 6 w/w), extraction temperatures (50 and 60 °C) and leaching techniques (conventional and assisted by ultrasound) on the concentration and time of extraction of bixin from Achiote (Bixa Orellana L.) were evaluated. The extraction kinetics were constructed, and their orders were determined. The experimental values were adjusted through the mathematical models of Peleg and Azuara. ANOVA was used based on a 23 design, blocking type of technology. The kinetics showed two stages of extraction: rapid and slow. The reaction orders were decimal numbers, which indicates the complexity of the extraction mechanism. The highest orders of reaction (2.97 and 2.075) were presented with extraction with ultrasound-assisted and ethanol as solvent, at 50 and 60 °C and solute solvent ratio 1: 4 and 1: 6, respectively. The concentration of Bixin was increased by approximately 30% by increasing the temperature. The Azuara model presented the highest adjustment with a standard error < 0.1. The conventional leaching with PEG-400 required the lowest activation energy (9.2 kJ / mol) and with this treatment in 66 min the highest concentration of bixin (2.74 mgBix / gExt) was obtained. It was concluded that ultrasound-assisted leaching facilitates the extraction of bixin pigment, and the use of PEG 400 solvent is useful to obtain higher yields.

Biodégradation of cyanide via recombinant cyanide dehydratase from Bacillus pumilus expressed heterologously in Escherichia coli / Biodegradación de cianuro por la enzima cianuro dihidratasa de Bacillus pumilus expresada heterologamente en Escherichia coli

ABSTRACT Despite its high toxicity, cyanide is used in several industrial processes, and as a result, large volumes of cyanide wastewater need to be treated prior to discharge. Enzymatic degradation of industrial cyanide wastewater by cyanide dihydratase, which is capable of converting cyanide to ammonia and formate, is an attractive alternative to conventional chemical methods of cyanide decontamination. However, the main impediment to the use of this enzyme for the biodegradation of cyanide is its intolerance to the alkaline pH at which cyanide waste is kept and its low thermoresistance. In the present study, the catalytic properties of whole Escherichia coli cells overexpressing a cyanide dihydratase gene from Bacillus pumilus were compared to those of the purified enzyme under conditions similar to those found in industrial cyanide wastewater. In addition, the capacity of whole cells to degrade free cyanide in contaminated wastewater resulting from the gold mining process was also determined. The characteristics of intracellular enzyme, relative to purified enzyme, included increased thermostability (>60% activity at 50°C), as well as greater tolerance to heavy metals, and to a lesser extent pH (20% activity remaining at pH 9.0) On the other hand, enzymatic degradation of 70% of free cyanide (initial concentration 528 mM) in the industrial sample was achieved only after dilution. Nevertheless, the increased thermostability observed for intracellular CynD suggest that whole cells of E. coli overexpressing CynD are suited for process that operate at elevated temperatures (50°C), a limitation observed for the purified enzyme.

RESUMEN A pesar de su alta toxicidad, el cianuro es usado en diversos procesos industriales, y como resultado, grandes volúmenes de aguas residuales de cianuro deben ser tratados antes de su descarga. Una alternativa atractiva a los métodos químicos convencionales de descontaminación es la degradación enzimática por la enzima cianuro dihidratasa, la cual es capaz de convertir cianuro en amonio y ácido fórmico. No obstante, la inactivación de esta enzima a pH superior a 8.5 y su poca termoestabilidad han sido el principal impedimento para la implementación exitosa de esta alternativa de biorremediación. En el presente estudio, las propiedades catalíticas de células completas de Escherichia coli que sobre expresan el gen de cianuro dihidratasa de Bacillus pumilus se estudian bajo condiciones similares a las encontradas en aguas residuales industriales de cianuro y los resultados se discuten en comparación con las de la enzima purificada. Además, se determinó la capacidad de las células completas para degradar el cianuro libre en aguas residuales resultantes del proceso de extracción de oro. Las características de la enzima intracelular, relativa a la enzima purificada, incluyeron un incremento en la termoestabilidad (>60% actividad a 50°C), así como mayor tolerancia a metales pesados y en menor medida al pH (20% actividad residual a pH 9.0). Por otra parte, la degradación enzimática del 70% del cianuro libre en la muestra industrial (concentración inicial 528 mM) se logró solo después de la dilución de la muestra. Sin embargo, el incremento en la termoestabilidad observado para CynD intracelular sugiere que las células completas de E. coli que sobre expresan CynD son adecuadas para procesos que operan a temperaturas elevadas (50°C), una limitación observada para la enzima purificada.

Self-reported factors associated with dental care utilization among Hispanic migrant farmworkers in South Florida.

OBJECTIVES: To explore patterns of dental care utilization among adult Hispanic migrant farmworkers utilizing the Andersen Behavioral Model of Health Services. METHODS: In 2010, 278 Hispanic migrant workers participated in the oral health assessment. Hierarchical logistic regression modeling was used to assess the effects of multiple factors on having a past-year dental visit. Predisposing variables included age, education, and knowledge toward preventing tooth decay. Enabling factors included medical insurance, place for medical care, and social support. Need measures included oral health problems and treatment. RESULTS: Only 20.5 percent of Hispanic migrant farmworkers reported a past-year dental visit. More than one-half (52.5 percent) needed oral health treatment and nearly two-thirds (61.2 percent) stated that they perceived their mouth to be in poor condition. The final model indicated that those who reported preventing tooth decay by brushing and flossing, brushed their teeth once a day, and stated a good condition of their mouth were more likely to have had a past-year dental visit. CONCLUSIONS: Most Hispanic migrant farmworkers in south Florida have not had a past year dental visit. Similar to other ethnic minorities in the United States, migrant farmworkers experience poor oral health outcomes and have inadequate access to health-care services.

Dental-Related Use of Hospital Emergency Departments by Hispanics and Non-Hispanics in Florida.

OBJECTIVES: To examine differences between Hispanics and non-Hispanics in Florida in the dental-related use of hospital emergency departments (EDs). METHODS: We used ambulatory ED discharge records from 2013 to 2015 to compute rates of ED visits for dental complaints per 10 000 population, by region, age, gender, and the percentage distribution visits by primary payer, day of the week, and hour of arrival. RESULTS: There were 64 100 ED visits for dental complaints by Hispanics and 425 162 by non-Hispanics. Medicaid was the most common primary payer for Hispanics (42.2%) and for non-Hispanics (38.1%). Rates of ED utilization for dental problems per 10 000 population were 45.5 for Hispanics and 95.2 for non-Hispanics. CONCLUSIONS: Rates of ED utilization for dental problems were different between Hispanics and non-Hispanics. Public Health Implications. Effective interventions need to be developed in the context of a social-ecological model to better understand factors such as health, economics, and education, among others. Understanding and intervening with the individual, communities, and policy could help to modify behaviors and improve access to dental care.

Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis.

BACKGROUND: Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism. METHODS: A systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances' effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports' structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model. RESULTS: Five studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15-1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69-5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices. CONCLUSIONS: All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.

Recovery of gold from waste electrical and electronic equipment (WEEE) using ammonium persulfate.

This paper presents a novel methodology to recover gold from waste electrical and electronic equipment (WEEE) using ammonium persulfate ((NH4)2S2O8). Gold was recovered as a fine coating using substrate oxidation without shredding or grinding process. The WEEE sample was characterized giving values of Au: 1.05g/kg, Fe: 86.00g/kg, Ni: 73.64g/kg, Cu: 26.65g/kg. The effect of (NH4)2S2O8 concentration (0.22-1.10M), oxygen (0.0-1.4L/min) and L/S ratio (10-30mL/g) on the main responses (substrate oxidation and Au recovery) was investigated implementing response surface methodology with numerical optimization. A quadratic model was developed and quantities greater than 98% of Au were recovered. The findings presented suggest that, optimized quantities of ammonium persulfate in aqueous highly oxygenated media could be used to extract superficial gold from WEEE.

Project Salud: Efficacy of a community-based HIV prevention intervention for Hispanic migrant workers in south Florida.

Project Salud evaluates the efficacy of a community-based intervention to reduce risk behaviors and enhance factors for HIV-preventative behaviors. A randomized controlled trial of 278 high risk Latino migrant workers was conducted between 2008 and 2010. Participants completed an audio computer-assisted self-interview questionnaire at baseline and 3- and 9-month post-intervention follow-ups. Participants were randomly assigned to the community-based intervention (A-SEMI) or the health promotion condition (HPC). Both interventions consisted of four 2.5-hour interactive sessions and were structurally equivalent in administration and format. Relative to the comparison condition, A-SEMI participants reported more consistent condom use, were less likely to report never having used condoms, and were more likely to have used condoms at last sexual encounter during the past 90 and 30 days. A-SEMI participants also experienced a positive change in regard to factors for HIV-preventive behaviors over the entire 9-month period. Our results support the implementation of community-based, culturally tailored interventions among Latino migrant workers.

The Latino Migrant Worker HIV Prevention Program: building a community partnership through a community health worker training program.

There is limited information on the impact of the HIV/AIDS epidemic on Latino migrant workers (LMWs), although available data indicate that this community is being disproportionally affected. The need for prevention programs that address the specific needs of LMWs is becoming well recognized. HIV prevention interventions that train and employ community health workers are a culturally appropriate way to address the issues of community trust and capacity building in this community. This article describes the Latino Migrant Worker HIV Prevention Program and its efforts to train and engage community health workers in the prevention of HIV among LMWs in South Florida.

Project Salud: Using community-based participatory research to culturally adapt an HIV prevention intervention in the Latino migrant worker community.

Despite the unique and challenging circumstances confronting Latino migrant worker communities in the U.S., debate still exists as to the need to culturally adapt evidence-based interventions for dissemination with this population. Project Salud adopted a community-based participatory research model and utilized focus group methodology with 83 Latino migrant workers to explore the relevance of culturally adapting an evidence-based HIV prevention intervention to be disseminated within this population. Findings from this study indicate that, despite early reservations, Latino migrant workers wanted to participate in the cultural adaptation that would result in an intervention that was culturally relevant, respectful, responsive to their life experiences, and aligned with their needs. This study contributes to the cultural adaptation/fidelity debate by highlighting the necessity of exploring ways to develop culturally adapted interventions characterized by high cultural relevance without sacrificing high fidelity to the core components that have established efficacy for evidence-based HIV prevention interventions.

Tratamiento de la onicofagia en niños: revisión sistemática

Objetivo: Realizar una revisión sistemática para evaluar y analizar la evidencia científica disponible en terapias para la onicofagia en niños. Materiales y métodos: La literature se analizó a partir de Medline, Pubmed, ovid, EBSCO, ISI, Cochrane Library, Lylacs, Scielo, Scirus and the Internet, published from March 1985 to 2008. Se analizaron estudios de intervención o comparativos,ensayo clínico, metanálisis o estudio multicéntrico que incluyeran todas las terapias disponibles para resolver la Onicofagia en niños y niñas. Los niños y niñas incluidos en los estudios, debían presentar ausencia de otro tipo de hábitos y/o alteraciones neurológicas. Losestudios incluídos requerían haber hecho un diagnóstico inicial de Onicofagia a través de anamnesis y de ayudas diagnósticas. Resultados: De los 92 estudios revisados, uno cumplió los criterios de calidad. Los estudios seleccionados soportan las técnicas psicológicas para eltratamiento de la Onicofagia, más no el uso de aparatos intraorales o farmacoterapia en niños y niñas. Conclusión: Muy pocos estudios acerca de la terapia para la Onicofagia cumplen los criterios de calidad requeridos para la práctica basada en la evidencia. Aunque el estudio seleccionado cumplió con los criterios de calidad, no es suficiente para afirmar que existe adecuada evidencia para el tratamiento de la Onicofagia en niños y niñas, por lo que se requieren futuros estudios que comparen los diferentes tiposde terapia. (AU) FONTE