MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis.

Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.

"A gente nunca pensou que teria que recomeçar": histórias de vida na extinção das fundações do Rio Grande do Sul / "We never thought we would have to start over": life stories in the extinction of foundations in Rio Grande do S

No âmbito das políticas neoliberais, é possível localizar, na história recente do Estado do Rio Grande do Sul, gestões que aderiram fielmente a esses preceitos, como o recente governo de José Ivo Sartori (2015-2018). Essa optou por combinações de políticas de austeridade e de reformas a partir da diminuição da participação do Estado na sociedade. Nosso artigo busca refletir sobre as condições de vida e de trabalho dos servidores públicos estaduais gaúchos frente à crise e compreender como um casal de servidores engendra possibilidades de enfrentamento à precarização das relações de trabalho - produto da gestão neoliberal - que outrora estruturavam a vida familiar. A partir das histórias de vida de Maria e João, discorremos sobre a flagrante piora nas condições de trabalho, seja na infraestrutura e no remanejamento arbitrário, seja nos planos de carreira ou mesmo em suas estabilidades. Refletimos que, no âmbito da crise, há precarização da vida e na produção da subjetividade desses trabalhadores, o que desemboca na assunção de novos papéis sociais e reconfigurações relacionais na conjugalidade.

Within the scope of neoliberal policies, it is possible to locate, in the recent history of the State of Rio Grande do Sul, administrations that faithfully adhered to these precepts, such as the José Ivo Sartori's administration (2015-2018). This administration opted for austerity and reform policy combinations, based on the decrease of the State's participation in society. Our article seeks to reflect on the living and working conditions of the State's civil servants in the face of the crisis and to understand how a couple of civil servants engender possibilities of coping with the precariousness - a product of neoliberal management - of labor relations that once structured family life. Based on the life stories of Maria and João, we talk about the flagrant worsening in working conditions, whether in infrastructure and arbitrary relocation, in career plans or even in their stability. We reflect that, in the crisis, there is a precariousness in workers' life and production of subjectivity, which leads to the assumption of new social roles and relational configurations in conjugality.

Factores asociados al miedo y ansiedad en pacientes que asisten a consulta odontológica: Estudio Transversal / Factors associated with fear and anxiety in patients attending a dental care: A cross-sectional study

Antecedentes: Las personas que sienten miedo y ansiedad muestran peores condiciones de salud bucal, postergando las citas odontológicas hasta tal punto de evitarlas. Objetivo: Determinar los factores asociados al miedo y la ansiedad en pacientes atendidos en las clínicas de la Facultad de Odontología de la Universidad Cooperativa de Colombia. Materiales y métodos: Se realizó un estudio cuantitativo tipo descriptivo transversal con 198 pacientes atendidos en las clínicas de la facultad de Odontología. Se aplicaron las encuestas: Dental Fear Survey (DFS), Escala de Ansiedad Dental de Corah Modificada (MDAS) y una tercera encuesta para identificar: características sociodemográficas y elementos, situaciones y sensaciones asociados a miedo a la ansiedad durante la consulta. Resultados: El 92,4% de los participantes presentaron algún grado de miedo en la consulta odontológica. El 48,7% presento ansiedad en algún grado. La presencia del miedo y ansiedad se encontró asociada con la evaluación de las experiencias previas en la consulta odontológica (Vp <0,001), evidenciado en la mayor proporción de individuos con miedo alto y ansiedad severa cuya experiencia fue negativa en comparación con las frecuencias observadas para aquellos con clasificación de ansiedad leve o moderada y miedo nulo o bajo. Conclusiones: Las experiencias traumáticas previas están relacionadas con el miedo y la ansiedad dental y pueden influir en el adecuado desarrollo de la consulta odontológica, por lo que se recomienda indagar al paciente acerca de estas antes de iniciar atención odontológica.

Background: People who feel fear and anxiety show worse oral health conditions than those who not, thus delaying dentist appointments to the point of cancelling all together. Aim: Determine the degree of fear, anxiety and associated factors in patients seen in the clinics of the Faculty of Dentistry of the Universidad Cooperativa de Colombia. Materials and methods: A quantitative cross-sectional descriptive study was conducted with patients treated in clinics of the Faculty of Dentistry, for a universe of 941, a sample of 198 participants were calculated, not randomly selected. Three surveys were applied by the DFS (Dental Fear Survey), the MDAS (Anxiety Scale Modified Corah Dental) and a third survey to identify sociodemographic variables and factors associated with fear and anxiety. Results: The 92.4% of the participants presented some degree of fear in the dental practice. 48.7% have anxiety to some degree. The presence of fear and anxiety was found associated with the evaluation of previous experiences in dental practice (Vp <0.001), evidenced in the highest proportion of individuals with high fear and anxiety whose experience was negative compared to the frequencies observed for those with mild or moderate anxiety and zero or low fear. Conclusion: Previous traumatic experiences are related to fear and dental anxiety and can influence the proper development of the dental appointments, so it is recommended to inquire about these before starting with a dental treatment.

Angiomixoma pélvico agresivo. Reporte de un caso / Aggressive pelvic angiomyxoma. A case report

El Angiomixoma Agresivo (AA) del suelo pélvico es una rara neoplasia mesenquimal de histología benigna, pero con un comportamiento característico localmente agresivo, que frecuentemente se presenta en mujeres en edad reproductiva. Suele presentar un crecimiento insidioso desde su origen en la musculatura perineal, lo que conlleva una clínica inespecífica, sutil y generalmente de larga evolución. El diagnóstico por la imagen, principalmente a expensas de la Tomografía Computarizada (TC) y la Resonancia Magnética (RM) con contraste, es de notable importancia, tanto por permitir detectar y caracterizar fiablemente una entidad poco frecuente, como por facilitar una planificación quirúrgica adecuada que permita obtener márgenes de resección libres de enfermedad, incluso en aquellos con infiltración de las estructuras vecinas. Presentamos el caso de una paciente adolescente con antecedente de tumoración en región vulvar derecha, en relación con extensión de un gran tumor retroperitoneal cuyo estudio histológico confirmó un Angiomixoma Agresivo.

Aggressive angiomyxoma of the pelvic floor is a rare mesenchymal neoplasm of benign histology, but with a characteristic locally aggressive behavior, which mostly occurs in women of reproductive age. It usually presents an insidious growth from its origin in the perineal musculature, which leads to a non-specific, subtle and generally long-lasting clinical course. Diagnostic imaging, mainly at the expense of CT and MRI with contrast, is of notable importance, both for allowing detection and reliable characterization of a rare entity, and for facilitating adequate surgical planning to obtain disease-free resection margins, even in those with infiltration of neighboring structures. We present the case of an adolescent patient with a history of tumor in the right vulvar region, which imaging studies confirmed to be the extension of a large retroperitoneal tumor whose pathological anatomy describes as an aggressive pelvic an angiomyxoma.

Procesos determinantes del acceso a odontología en niños y niñas durante primera infancia / Determinants for access to dental care in early childhood / Determinações dos processos de acesso à odontologia em crianças durante a primeira infância

Resumen (Analítico): El propósito del estudio fue comprender los procesos estructurales, particulares y singulares que determinan el acceso a la atención odontológica durante la primera infancia a partir del enfoque de la determinación social de la salud. Se utilizó un método mixto desde lo cualitativo de orientación etnográfica y cuantitativo de tipo descriptivo. Incluyó observación no participante, entrevistas grupales e individuales y encuestas. Se encontró que el acceso está determinado por procesos generales como inequidad social, fallas estructurales del sistema y procesos particulares como los patrones de trabajo y consumo de las familias, el sistema de creencias de madres y profesionales, y políticas institucionales. Para mejorar el acceso es necesario realizar procesos tendientes a la transformación de la sociedad, del sistema de salud y de las instituciones, profesionales y cuidadores.

Abstract (analytical): The purpose of this study was to understand structural, specific and singular processes that determine access to dental care in early childhood using a social determinant of health approach. The authors used mixed methods involving qualitative ethnographic and quantitative descriptive techniques. Non-participant observations, group interviews and interviews with coordinators and parents were conducted. We found that the access to this group is determined by inequalities in society, a health system with structural failures and specific processes such as work and consumption patterns, the belief systems of parents and professionals and institutional policies. In order to improve the access it is necessary to carry out processes that contribute to in the general transformation of society and the health system, as well as specific processes with institutions, staff, and providers.

Resumo (analítico): O objetivo do estudo foi compreender os processos estruturais, específicos e singulares que podem determinar o acesso ao atendimento da consulta de medicina dentária na primeira infância a partir de um enfoque da determinação social da saúde. Utilizou-se um método misto com orientação etnográfica e quantitativo de tipo descritivo. Incluíram-se observação não participante, entrevistas em grupo e individuais. Encontrou-se que o acesso a saúde na primeira infância é determinado por processos gerais como desigualdade social, falhas estruturais do sistema de saúde, e pelos processos específicos como os modos de trabalho e de consumo das famílias, as crenças das mães e profissionais e as políticas institucionais. Para obter uma melhoria do acesso das crianças a saúde é preciso fazer uma transformação da sociedade, do sistema de saúde, das instituições, dos profissionais e dos responsáveis pelas crianças.

Presentación de un paciente con fibroma traumático subyacente a prótesis dental / Presentation of a Patient with Underlying Traumatic Fibrosis Dentures

Se presentó una paciente femenina de 56 años de edad, asintomática, portadora de prótesis dental parcial superior acrílica. El examen intrabucal reveló lesión exofítica de aproximadamente un centímetro de diámetro a nivel de la mucosa, que tapiza la región anterior del paladar duro, de color similar al resto de la mucosa, unida a su base a través de un pedículo, y mostró su superficie aplanada al encontrarse presionada por la base del aparato protésico. Se realizó la escisión quirúrgica y posterior el examen histopatológico, el cual confirmó la presencia de un fibroma traumático completamente resecado. Se apreció una excelente evolución postquirúrgica. Se estableció un plan de tratamiento orientado hacia la total rehabilitación de la paciente(AU)

A ,56, year old female patient, without symptoms, with upper dental prosthesis. The intraoral examination revealed an exophytic growth of approximately one centimeter of diameter, at the mucous membrane of the hard palate's region, with similar color to the rest of the mucous membrane, joined to the base through a peduncle and showing its surface flattened under pressure by the prosthetic appliance's base. The lesion was eliminated by surgical excision. The histologic test confirmed the presence of a traumatic fibroma completely eliminated. An excellent post-surgical evolution was observed. A plan of treatment for the patient's total rehabilitation was established(AU)

Psychological distress and its correlates among dental students: a survey of 17 Colombian dental schools.

BACKGROUND: Links between the demanding nature of studies in the health sciences, students' personality traits and psychological distress have been well-established. While considerable amount of work has been done in medicine, evidence from the dental education arena is sparse and data from Latin America are lacking. The authors conducted a large-scale investigation of psychological distress among dental students in Colombia and sought to determine its curriculum and student-level correlates. METHODS: The Spanish version of the Derogatis' Symptoms Checklist Revised (SCL-90-R) was administered to all students officially registered and attending classes or clinics in 17 dental schools in 4 geographic districts of Colombia between January and April 2012. Additional information was collected on participants' socio-demographic information and first career choice, as well as school's characteristics such as class size. The Global Severity Index (GSI) score, a measure of overall psychological distress, served as the primary analytical endpoint. Analyses relied on multilevel mixed-effects linear and log-binomial regression, accounting for study design and sample characteristics. RESULTS: A total of 5700 dental students completed the survey, a response rate of 67%. Pronounced gradients were noted in the association between socio-economic status and psychological distress, with students in higher strata reporting fewer problems. After adjustment for all important covariates, there was an evident pattern of increasing psychological distress corresponding to the transition from the didactic, to the preclinical and clinical phases of training, with few differences between male and female students. Independent of other factors, reliance on own funds for education and having dentistry as the first career choice were associated with lower psychological distress. CONCLUSIONS: Levels of psychological distress correlated with students' socio-economic and study-level characteristics. Above and beyond the influence of person-level factors, variations in levels of distress paralleled specific transitional stages of the 5-year dental curriculum, providing opportunities for targeted interventions.

Effect of Ca/P ratio and milling material on the mechanochemical preparation of hydroxyapaptite.

The mechanochemical transformation of Ca(OH)(2)-(NH(4))(2)HPO(4) with different Ca/P ratios 1; 1.5; 1.67 and 1.75 was carried out for different periods of time from 10 min to 24 h in a horizontal vibration mill using steel and agate vials and balls. The phase transformations obtained at each milling stage were characterized by X-ray diffraction, infrared spectroscopy and transmission electron microscopy. Complete transformation to hydroxyapatite took place during the first 5 h of milling, for Ca/P ratios 1.5 to 1.7, when milling was carried out with steel vials and balls. The contamination was not significant for the periods of milling studied for both milling media.

Nanocomposites of bacterial cellulose/hydroxyapatite for biomedical applications.

In the present work, a nanocomposite material formed by bacterial cellulose (BC) networks and calcium-deficient hydroxyapatite (HAp) powders was synthesized and characterized. The HAp nanoparticles were previously prepared by a wet chemical precipitation method, starting from aqueous solutions of calcium nitrate and di-ammonium phosphate salts. Energy-dispersive spectroscopy reveals that the prepared HAp corresponds to calcium-deficient hydroxyapatite. BC-HAp nanocomposites were prepared by introducing carboxymethylcellulose (CMC) into the bacteria culture media. HAp nanoparticles were then introduced and remained suspended in the culture medium during the formation of cellulose nanofibrils. The maximum gel thickness was obtained after 21 days of bacteria cultivation. X-ray diffractograms showed the difference of crystallinity among the materials involved in the formation of nanocomposites. The inorganic and organic bonds that corresponded to hydroxyapatite and bacterial cellulose respectively, were depicted by attenuated total reflectance Fourier transform infrared spectra. Scanning electron microscopy and atomic force microscopy measurements confirmed the formation of networks and fibres with smaller diameter corresponding to BC synthesized in the presence of CMC. Image analysis was also used to assess the orientation distributions and Feret diameters for networks of BC and BC-CMC. Thermogravimetric analysis showed that the amount of the mineral phase is 23.7% of the total weight of the nanocomposite. Moreover, HEK cells were cultivated and the biocompatibility of the materials and the cell viability was demonstrated.

Historia de abuso sexual y su relación con depresión, autoestima y consumo de sustancias psicoactivas en estudiantes de media vocacional del municipio de Caldas Antioquia, Colombia: 2007 / Sexual abuse history and its relation with depression, self-esteem and consumption of Caldas, Antioquia, Colombia: 2007

Objetivo: Determinar la prevalencia de abuso sexual en estudiantes de los grados décimo y undécimo del municipio de Caldas y su relación con depresión, autoestima y consumo desustancias psicoactivas. Metodología: Estudio descriptivo de corte transversal. Se aplicó una encuesta a 565 estudiantes de los grados décimo y undécimo del municipio de Caldas. Se solicitó información acerca de lacomposición familiar, procedencia, edad del menor al momento del abuso sexual, tipo y frecuencia de este, así como edad, género y relación del abusador con la víctima; también se indagaron datos que permitieron analizar depresión, autoestima y consumo de sustancia psicoactivas. Resultados: El promedio de edad al momento de la encuesta fue de 16 años (DE 2,54). El 12 % de losjóvenes indicó que fue víctima de abuso sexual infantil. El 76,5 % de las víctimas eran mujeres. La edad promedio al momento del abuso fue de 10,3 años (DE 3,52). La edad del agresor osciló entre 12 y 80 años, con promedio de 32,18 años (DE 13,36). En 92,6 % de los casos el abusador era hombre. Del total de los casos de abuso, en 48,5 % el agresor era de la familia del menor. Las cariciasíntimas fueron el tipo de abuso más frecuente, específicamente cuando la víctima fue obligada a recibirlas(79,4 %), seguido de exhibicionismo cuando la víctima fue obligada a ver (45,6 %) y luego penetración vaginal oanal (35,8 %). El 52 % de los casos detectados de depresión fueron victimas de abuso sexual. El 21,1 % delos jóvenes con una mala autoestima fueron abusados en la infancia. El 23 % de los consumidores de marihuana,el 60 % de basuco, el 22 % de cocaína, el 24,3 % de inhalables, el 31,6 % de éxtasis y el 21,4 % de hongos fueron víctimas de abuso...

Objective: To determine the prevalence of sexual abuse in students of grades 10th and 11th in the municipality of Caldas and its relation with depression, low self-esteem and consumption of psychoactive substances. Methodology: Cross section descriptive study. A Surrey was applied to 565 students of grades 10th and 11th of the municipality of Caldas. Information was requested about the family composition, where from, age of the youngsters at the moment of sexual abuse, type and frequency of it, as well as age, gender and relation of the abuser with the victim; data was also collected that allowed to analyze depression, low self-esteem and consumption of psychoactive drugs. Results: The average age at the moment of the Surrey was 16 years (DE 2,54). 12% of the youngsters saidthat they were victims of child sexual abuse. 76,5 % of the victims were girls. The average age at the moment of abuse was 10,3 years (DE 3,52). The age of the aggressor varies between 12 and 80 years old, with an average of 32,18 (DE 13,36). In 92,6% of the cases the abuser was a man. Of the total cases of abuses 48,5% of theaggressors were relatives of the youngsters. The intimate caresses were the most frequent type of abuse, specifically when the victim was forced to receive them (79,4%).Second comes the exhibitionism when the victim was forced to see (45,6%) and then vaginal or anal penetration(35,8%). 52% of the depression cases detected were victims of sexual abuse. 21,1% of the youngsters withlow self-esteem were abused in their childhood. 23% of the marihuana smokers, 60% of crack consumer, 22%of cocaine consumer, 23,3 % of inhalants, 31,6% of Ecstasies and 21,4% of mushrooms were victims of abuse...

Evalucion del apache II y la historia oncologica, como indicadores pronosticosde mortalidad en la unidad de cuidado intensivo del INC. septiembre 1996 - diciembre 1997 / Evaluation apache II and Mashall and history if Oncology determine mortality in the intensive care unit in the National Cancer Institute september 1996 and december 1997

Son múltiples los índices de severidad que se han realizado para valorar el pronóstico y la calidad de vida de un paciente, especialmente cuando éste ingresa a la Unidad de Cuidado Intensivo (UCI); sin embargo, los pacientes oncológicos presentan particularidades en su morbilidad, lo que supone un comportamiento diferente en los resultados de los índices. En el presente trabajo se compara la escala Apache y la historia oncológica como predictores de morbimortalidad en la UCI. Se incluyeron 207 pacientes que ingresaron a la UCI entre septiembre de 1996 y diciembre de 1997. Se encontró una mortalidad del 29 por ciento, la estancia de la mayoria de este grupo de pacientes menor de 24 horas o mayor de 8 días. Al ingreso, el 50 por ciento de los pacientes presentaba puntajes superiores a 15 en la escala APACHE y a las 48 horas, sólo el 30.4 por ciento continuaba con este valor. Los pacientes con neoplasias hematológicas presentaron puntajes superiores a 15 en el 87 por ciento, con una mortalidad del 63.3 por ciento. Con puntajes entre 15 y 24 al ingreso, el riesgo de morir fue 9.8 veces más que con puntajes inferiores. En los pacientes hematológicos, el riesgo de morir fue 5.7 veces más respecto a los tumores sólidos. El sistema más alterado fue el respiratorio, con un aumento en el riesgo de morir de 2,8 veces por cada utilidad de incremento en la escala. A diferencia de los descrito en la literatura, el diagnóstico oncológico y la estadificación de la neoplasia no influyeron en la mortalidad de los pacientes.

Vigilancia post-egreso de las infecciones de herida quirúrgica: evaluación de sus costos y utilidad / Post discharge vigilance of surgical woundïs infection: cost evaluation and utility

Introducción:Existe la evidencia a favor de una vigilancia extendida de la Infección de Herida Quirúrgica (IHQ) después del egreso. Sin embargo, ello podría no reportar beneficios al sistema de vigilancia convencional, cuando la población que se observa tiene una baja prevalencia de factores de riesgo para IHQ. Objetivo: Descubrir la incidencia real de IHQ (hasta el día 30 del post-operatorio) en un hospital cuyo método de vigilancia de ésta infección hasta el egreso informa bajas tasas y establecer cual es el costo adicional que genera este seguimiento. Diseño: Estudio observacional analítico de tipo cohorte. Sitio:Clínica Carlos Ardila Lülle, Bucaramanga, Colombia. Población y métodos: De pacientes quirúrgicos atendidos en el periodo Agosto-Noviembre de 1997, se seleccionó por muestreo aleatorio y estratificado un grupo para seguimento más allá del egreso (observación extendida). Estos pacientes fuerón seguidos telefónicamente hasta la cuarta semana posterior a la cirugía y visitados cuando existió sospecha de IHQ. Para determinar el costo adicional debido al seguimiento post-egreso, se calculó la diferencia del valor requerido para detectar una IHQ en el método extendido y en el método convencional. RESULTADOS: La tasa de IHQ antes del egreso fue de 1.48 porciento y más allá del egreso hasta el día 30 posterior a la cirugía fue de 1.55 porciento, para un total de 3.03 porciento. El valor adicional de este tipo de vigilancia fue 1.52 veces más que el generado por el sistema convencional de vigilancia de la IHQ. CONCLUSIONES: En instituciones de salud que atienden pacientes con baja prevalencia de factores de riesgo para IHQ y cuyo sistema de vigilancia reporta tasas menores de este tipo de infección, el beneficio de invertir en programas orientados a captar nuevos casos de IHQ después del egreso puede carecer de justificación