A multicenter study of the risk of major bleeding in patients with and without cirrhosis undergoing percutaneous liver procedures.

Percutaneous liver procedures are frequently performed in patients with abnormal coagulation tests. Current guidelines suggest prophylactic transfusion is not mandatory in all patients with liver disease or cirrhosis, depending on the risk of bleeding. This study aims to describe the incidence and risk of major bleeding after percutaneous liver procedure in patients with and without cirrhosis. This retrospective study includes patients who underwent percutaneous liver biopsy and radiofrequency and microwave ablation of liver lesions at 3 centers in Spain. A transfusion protocol was considered for platelet counts <50,000 and/or international normalized ratio >1.5. The primary outcome was major bleeding. A total of 1797 patients were included in the study, with 316 having cirrhosis (18%) and 1481 without cirrhosis (82%). Among the patients with cirrhosis, 80 were classified as Child A, and percutaneous liver biopsy was the most frequent procedure (86%). Fourteen patients (0.8%) experienced major bleeding, with 0.4% occurring in radiofrequency and microwave ablation and 0.8% in percutaneous liver biopsy. Bleeding occurred in 0.6% of patients with cirrhosis compared to 0.8% in those without ( p = ns). No clinical or procedural variables were associated with bleeding. Twenty-five patients (1.4%) had an international normalized ratio >1.5, and 22 patients (1.2%) had a platelet count <50,000. Only 24% (6/25) of patients with an international normalized ratio >1.5 were transfused with fresh frozen plasma, and 72% (16/22) of those with platelet counts <50,000 received platelet transfusion. Patients with cirrhosis were more frequently transfused (5.9% vs. 1.5%). None of the patients who met the criteria for transfusion experienced major bleeding, regardless of whether they received a transfusion, and none of the patients who had a major bleeding episode met the transfusion criteria. In this cohort, major bleeding after percutaneous liver procedure occurred in <1% of patients, making it a low-risk procedure for patients with and without cirrhosis. Although not uniformly adopted, the current transfusion protocol still led to unnecessary blood product administration.

RPL22 is a tumor suppressor in MSI-high cancers and a splicing regulator of MDM4.

Microsatellite instability-high (MSI-H) tumors are malignant tumors that, despite harboring a high mutational burden, often have intact TP53. One of the most frequent mutations in MSI-H tumors is a frameshift mutation in RPL22, a ribosomal protein. Here, we identified RPL22 as a modulator of MDM4 splicing through an alternative splicing switch in exon 6. RPL22 loss increases MDM4 exon 6 inclusion and cell proliferation and augments resistance to the MDM inhibitor Nutlin-3a. RPL22 represses the expression of its paralog, RPL22L1, by mediating the splicing of a cryptic exon corresponding to a truncated transcript. Therefore, damaging mutations in RPL22 drive oncogenic MDM4 induction and reveal a common splicing circuit in MSI-H tumors that may inform therapeutic targeting of the MDM4-p53 axis and oncogenic RPL22L1 induction.

Using a decision tree to predict the number of COVID cases: a tutorial for beginners.

This manuscript describes the development of a module that is part of a learning platform named "NIGMS Sandbox for Cloud-based Learning" https://github.com/NIGMS/NIGMS-Sandbox . The overall genesis of the Sandbox is described in the editorial NIGMS Sandbox at the beginning of this Supplement. This module delivers learning materials on machine learning and decision tree concepts in an interactive format that uses appropriate cloud resources for data access and analyses. Machine learning (ML) is an important tool in biomedical research and can lead to improvements in diagnosis, treatment, and prevention of diseases. During the COVID pandemic ML was used for predictions at the patient and community levels. Given its ubiquity, it is important that future doctors, researchers and teachers get acquainted with ML and its contributions to research. Our goal is to make it easier for everyone to learn about machine learning. The learning module we present here is based on a small COVID dataset, videos, annotated code and the use of Google Colab or the Google Cloud Platform (GCP). The benefit of these platforms is that students do not have to set up a programming environment on their computer which saves time and is also an important democratization factor. The module focuses on learning the basics of decision trees by applying them to COVID data. It introduces basic terminology used in supervised machine learning and its relevance to research. Our experience with biology students at San Francisco State University suggests that the material increases interest in ML.

Superficial mycosis, at the site or distant to the surgical site, appears to predispose patients to bacterial periprosthetic joint infections.

BACKGROUND: It is traditionally believed that presence of fungal infection in the nail or skin of patients is a risk factor for subsequent infection. The literature is devoid of any evidence to confirm or refute this belief. This study examined a possible relationship between the presence of superficial skin or nail mycoses and subsequent periprosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA). METHODS: This is a single-centre, retrospective study of patients who underwent primary TJA between 2000 and 2018. 55 patients with superficial mycoses of skin or nail, at the time of arthroplasty were identified and a variable number matching with up to a 1:5 ratio was performed with 182 patients undergoing TJA who had no superficial mycosis. The groups were further divided into knee and hip TJA. The outcome of TJA in the cohorts was compared. RESULTS: Preoperative demographics were similar between the 2 groups. The incidence of PJI in patients undergoing TKA within a year was significantly higher in patients with superficial mycosis at 8.6% (3/35) compared to 0% (0/120) in patients without mycosis. However, all infections were caused by bacterial species and none were fungal. Multiple regression analysis demonstrated that the presence of superficial mycosis had a strong correlation with development of PJI postoperatively in our TKA cohort. CONCLUSIONS: Identification of fungal infection (mycosis) of skin and nail in patients awaiting TJA is important. These patients appear to have a higher risk for developing bacterial PJI than those without fungal infections. Further study is needed to determine if treatment of these patients prior to arthroplasty stands to reverse the high risk for PJI that these patients carry.

Familial natural short sleep mutations reduce Alzheimer pathology in mice.

Although numerous studies have demonstrated that poor sleep increases the development of AD, direct evidence elucidating the benefits of good sleep on the AD pathogenesis is lacking. Familial Natural Short Sleepers (FNSS) are genetically wired to have lifelong reduction in nightly sleep duration without evident consequence on cognitive demise, implying that they may have better sleep quality. Here we investigated two FNSS mutations, DEC2-P384R and Npsr1-Y206H, on the development of tau and amyloid pathology in AD-like mouse models. We found that the development of tau pathology is attenuated in the hippocampus of tau mice carrying FNSS mutations. We also found that DEC2-P384R;5XFAD and female Npsr1-Y206H;5XFAD mice exhibit significantly less amyloid plaques than control mice at 6 months of age. Together, these results reveal that these two FNSS alleles are strong genetic modifiers of AD pathology and may confer resilience to the progression of tau pathology and amyloid plaque formation in neurodegeneration.

Prevalencia de malaria en Aguarico, comunidad de la Amazonía ecuatoriana / Malaria prevalence in Aguarico, a community in the Ecuadorian Amazon

Objetivo. Determinar el estado actual de la prevalencia de Plasmodium en pacientes febriles que acuden al Hospital Básico Franklin Tello Nuevo Rocafuerte, cantón Aguarico, comparando con los datos de otros estudios epidemiológicos de la misma zona y la frontera con el vecino país de Perú. Métodos. Se realizó un estudio observacional descriptivo, retrospectivo de prevalencia. Desde 2011-2015 se recogieron 2.668 muestras de sangre capilar correspondientes al 55,04% de la población total del cantón Aguarico. Se empleó la técnica Gota Gruesa y Frotis coloreados con Giemsa para determinar positividad de Plasmodium. Resultados. El rango de variación de la prevalencia en los pobladores de las comunidades investigadas osciló entre 2,38% y 28,57%, detectándose mayor prevalencia en el sexo masculino (50,56 %). Estos hallazgos son similares a los estudios previos realizados entre 1992-1995, en la misma región del Aguarico. El Riesgo Relativo es (RR) es de 1,36 y el Odds Ratio (OR) fue de 1,71, siendo mayor el riesgo a desarrollar la enfermedad en los positivos. Conclusiones. Los datos de la investigación confirman la presencia de un foco autóctono de malaria producida por Plasmodium vivax en la selva amazónica ecuatoriana, excepto 2 casos de P. falciparum importados de Perú. Los casos diagnosticados clínicamente y mediante la técnica de la Gota Gruesa, fueron tratados con medicación antipalúdica con excelente adherencia al medicamento.

Objective. To determine the status of the prevalence of Plasmodium in febrile patients who attend the Franklin Tello Nuevo Rocafuerte Basic Hospital, Aguarico town, comparing the results obtained with data from other epidemiological studies in the same area, and places near the border with Peru. Methods. A descriptive, retrospective, observational study of prevalence was carried out. From 2011-2015 2,668 capillary blood samples were collected corresponding to 55.04% of the total population of the Aguarico town. The Thick Drop and Giemsa-stained smear technique was used to determine Plasmodium positivity. Results. The range of variation of the prevalence in the inhabitants of the investigated communities ranged between 2.38% and 28.57%, detecting a higher prevalence in males (50.56%). These findings are like previous studies carried out between 1992-1995, in the same Aguarico region. The Relative Risk (RR) is 1.36 and the Odds Ratio (OR) was 1.71, with the risk of developing the disease being greater in the positives. Conclusions. The research data confirm the presence of an autochthonous focus of malaria produced by Plasmodium vivax in the Ecuadorian Amazon rainforest, except for 2 cases of P. falciparum imported from Peru. The cases diagnosed clinically and using the thick gout technique were treated with antimalarial medication with excellent adherence to the medication.

Development of paediatric critical care in northwestern Nigeria: Initial implementation with a needs assessment model.

INTRODUCTION: There is high paediatric morbidity and mortality in northwestern Nigeria, attributable in part to vaccine-preventable illnesses and lack of comprehensive training of medical and nursing staff in the healthcare delivery of paediatric critical care. Pediatric Universal Life-Saving Effort Inc. (PULSE), a New York-based nonprofit organisation with a mission to develop paediatric critical care in resource-limited settings, collaborated with Aminu Kano University Teaching Hospital to decrease the gaps in knowledge and skills of medical and nursing personnel. The joint effort also aims to address and remove barriers to the delivery of paediatric critical care in northwestern Nigeria. The primary objective was to perform a needs assessment for paediatric intensive care resources in northwestern Nigeria, identify barriers to delivering these services, and designate a hub for the development of paediatric critical care educational programs for healthcare professionals. METHODS: An anonymous survey was designed and distributed using SurveyMonkey® online software to medical and nursing staff from nine healthcare institutions in northwestern Nigeria. RESULTS: Analysis from 67 responses revealed that care delivered to critically ill paediatric patients was by anaesthesiologists (77%), pediatricians (26%), and adult intensive care specialists (10%). The acquisition of clinical skills was perceived to be an essential need (65%), followed by adequate staffing of critical care units (19%), continuing medical and nursing education (13%), and availability of medical equipment (3%). DISCUSSION: There is an identified need for paediatric critical care training and resources in northwestern Nigeria. CONCLUSION: The needs assessment conducted has provided important results that will form the basis for building staff capacity and training programs for paediatric critical care in northwestern Nigeria.

Prolactin enhances T regulatory cell promotion of breast cancer through the long form prolactin receptor.

Previous work has shown systemic knockdown of the long form prolactin receptor (LFPRLR) in vivo markedly reduced metastasis in mouse models of breast cancer, but whether this translated to prolonged survival was unknown. Here we show that LFPRLR knockdown in the highly metastatic, immunocompetent 4T1 model prolonged survival and reduced recruitment of T regulatory cells (Tregs) to the tumor through effects on the production of CCL17. For the Tregs still recruited to the primary tumor, LFPRLR knockdown both directly and indirectly reduced their ability to promote tumor parenchymal epithelial to mesenchymal transition. Importantly, effects of prolactin on expression of mesenchymal genes by the tumor parenchyma were very different in the absence and presence of Tregs. While systemic knockdown of the LFPRLR downregulated transcripts important for immune synapse function in the remaining tumor Tregs, splenic Tregs seemed unaffected by LFPRLR knockdown, as demonstrated by their continued ability to suppress anti-CD3/CD28-stimulated effector cell proliferation at 1-5 months. These results demonstrate that knockdown of the LFPRLR achieves intra-tumor immunotherapeutic effects and suggest this occurs with reduced likelihood of peripheral inflammatory/autoimmune sequelae.

Sex Differences in the Immune System Become Evident in the Perinatal Period in the Four Core Genotypes Mouse.

We have used the four core genotypes (FCG) mouse model, which allows a distinction between effects of gonadal secretions and chromosomal complement, to determine when sex differences in the immune system first appear and what influences their development. Using splenic T cell number as a measure that could be applied to neonates with as yet immature immune responses, we found no differences among the four genotypes at postnatal day 1, but by day 7, clear sex differences were observed. These sex differences were unexpectedly independent of chromosomal complement and similar in degree to gonadectomized FCG adults: both neonatal and gonadectomized adult females (XX and XY) showed 2-fold the number of CD4+ and 7-fold the number of CD8+ T cells versus their male (XX and XY) counterparts. Appearance of this long-lived sex difference between days 1 and 7 suggested a role for the male-specific perinatal surge of testicular testosterone. Interference with the testosterone surge significantly de-masculinized the male CD4+, but not CD8+ splenic profile. Treatment of neonates demonstrated elevated testosterone limited mature cell egress from the thymus, whereas estradiol reduced splenic T cell seeding in females. Neonatal male splenic epithelium/stroma expressed aromatase mRNA, suggesting capacity for splenic conversion of perinatal testosterone into estradiol in males, which, similar to administration of estradiol in females, would result in reduced splenic T cell seeding. These sex steroid effects affected both CD4+ and CD8+ cells and yet interference with the testosterone surge only significantly de-masculinized the splenic content of CD4+ cells. For CD8+ cells, male cells in the thymus were also found to express one third the density of sphingosine-1-phosphate thymic egress receptors per cell compared to female, a male characteristic most likely an indirect result of Sry expression. Interestingly, the data also support a previously unrecognized role for non-gonadal estradiol in the promotion of intra-thymic cell proliferation in neonates of both sexes. Microarray analysis suggested the thymic epithelium/stroma as the source of this hormone. We conclude that some immune sex differences appear long before puberty and more than one mechanism contributes to differential numbers and distribution of T cells.

Survival in patients with carcinomas presenting with bone metastasis at diagnosis: a SEER population-based cohort study.

INTRODUCTION: Carcinoma metastasis to bone is a common reason for consultation to orthopedic surgeons. The presence of bone metastases (BM) is usually associated with poor prognosis which is worsened in the presence of synchronous metastases. The purpose of this study was to: (1) identify the most common carcinomas presenting with BM at diagnosis, to (2) analyze their survival, and (3) compare this against the survival of patients with additional synchronous metastasis based on a large population analysis. MATERIALS AND METHODS: Patients diagnosed with carcinoma between January 2010 and December 2015 were identified from the Surveillance, Epidemiology and End Results (SEER) database. The most common carcinomas presenting with BM at diagnosis were identified. Survival based on the presence of BM and synchronous metastases (lung, brain, liver, lymph nodes) was evaluated with Kaplan-Meier analysis. Five-year survival (%) stratified by carcinoma type was calculated. Hazard ratio (HR) for mortality comparing isolated BM to other synchronous metastases was performed. RESULTS: A total of 4.85% of patients (98,606/2,035,204) with carcinoma presented with BM at diagnosis, most commonly from a lung primary. Five-year survival with isolated BM was lowest in patients with pancreatic carcinoma (5.8%, 95% CI 3.0-9.9%), and highest in patients with breast carcinoma (41.1%, 95% CI 38.6-43.5%). Synchronous metastases increased significantly the risk of mortality within the majority of carcinomas. CONCLUSION: BM at diagnosis has a poor prognosis which is worsened if synchronous metastases are present; a fact to consider when planning orthopedic interventions. LEVEL OF EVIDENCE: Level III, prognostic study.

Occurrence of relevant mycotoxins in food commodities consumed in Chile.

The aims of this study were to analyse the occurrence of aflatoxins, aflatoxin M1 (AFM1), fumonisins, ochratoxin A (OTA), patulin (PAT), zearalenone (ZEN) and deoxynivalenol (DON) in foodstuffs consumed in Chile between 2008 and 2017 and to estimate the contribution of main contaminated foodstuff in human exposure by the probable daily intake (PDI) estimation. In 9 years of surveillance, 2020 food samples were analysed with an occurrence of 18.2% and with 2.7% of the samples being over the Chilean regulation. The occurrence of mycotoxins in food were 16% for aflatoxins, 6% for AFM1, 30% for OTA, 12% for DON, 7% for PAT, 21% for fumonisins and 2% for ZEN. The estimated median PDI of DON because of bread consumption was 129.2 ng/kg bw/day for children and 96.0 ng/kg bw/day in adults. Median PDI because of capsicum consumption was 0.006 ng/kg bw/day for OTA and 0.005 ng/kg bw/day for aflatoxins. Median PDI of aflatoxins was estimated at 0.02 ng/kg bw/day for spices and 0.04 ng/kg bw/day for nuts consumption. In children, the median PDI of AFM1 for dairy consumption was 0.07 ng/kg bw/day. The derived margin of exposure (MoE) values ranged from 1133 to 8500 suggested that aflatoxins would be of public health concern. The PDI of the other mycotoxins did not show a health risk. This is the first survey of mycotoxins in food made in Chile; further research is needed to improve surveillance and guidelines based on national risk assessments and considering sensitive population groups.

Neuro-2a cell-based assay for toxicity equivalency factor - proposal and evaluation in Chilean contaminated shellfish samples.

There are two official PSP detection methods (mouse bioassay and HLPC-FLD) and a number of alternative methods. Ethical considerations have led to regulations being adopted in some countries that limit or prohibit the application of mouse bioassay. Analytical methodologies (e.g. HPLC-FLD or LC-MSMS) have the disadvantages of not being able to detect new toxins or analogues or reflecting the overall toxicity of the sample. In addition, they require highly trained personnel and expensive equipment, which are not always available. In this work, we have evaluated a method based on the Neuro-2a cell-based assay to detect substances that inhibit voltage-dependent sodium channels (Manger's method). We tested PSP standards and natural samples contaminated with PSP. Here we demonstrate that the adapted Manger's method is suitable for calculating Toxicity Equivalency Factors (TEF) for STX-analogues. The method was shown to be useful for screening contaminated natural samples in concentrations above the regulatory limit for these toxins (80 µg STX equivalents/100 g shellfish). We were able to detect PSP in 19 natural mollusc samples from South Chile despite the presence of other marine toxins. These preliminary results suggest that the method could be used as a first step in screening programmes.

Matrix effects on a cell-based assay used for the detection of paralytic shellfish toxins in bivalve shellfish samples.

Detecting marine biotoxins such as paralytic shellfish toxins (PSTs) is essential to ensuring the safety of seafood. The mouse bioassay is the internationally accepted method for monitoring PSTs, but technical and ethical issues have led to a search for new detection methods. The mouse neuroblastoma cell-based assay (Neuro-2a CBA) using ouabain and veratridine (O/V) has proven useful for the detection of PSTs. However, CBAs are sensitive to shellfish-associated matrix interferences. As the extraction method highly influences matrix interferences, this study compared three extraction protocols: Association of Official Analytical Chemists (AOAC) 2005.06, AOAC 2011.02 and an alternative liquid-liquid method. These methods were used to assess the matrix effect of extracts from four commercially important bivalve species (Chilean mussel, Magellan mussel, clam and Pacific oyster) in Neuro-2a CBA. Extracts from all three protocols caused a toxic effect in Neuro-2a cells (without O/V) when tested at a concentration of 25 mg of tissue-equivalent (TE) ml(-1). The greatest toxicity was obtained through the AOAC 2011.02 protocol, especially for the Chilean mussel and Pacific oyster extracts. Similar toxicity levels (less than 15%) were observed in all extracts at 3.1 mg TE ml(-1). When assessed in Neuro-2a CBA, AOAC 2005.06 extracts presented the lowest matrix interferences, while the highest interferences were observed for AOAC 2011.02 in Magellan mussel and clam extracts. Finally, the AOAC 2005.06 and alternative protocols were compared using Chilean mussel samples fortified with 40 and 80 µg STX per 100 g meat. The AOAC 2005.06 method demonstrated better results. In conclusion, the AOAC 2005.06 extracts exhibited the fewest interferences in the Neuro-2a CBA. Therefore, this extraction method should be considered for the implementation of Neuro-2a CBA as a high-throughput screening methodology for PST detection.

Detección del alucinógeno 25C-NBOMe en orina por dos técnicas cromatográficas / Detection of hallucinogen 25C-NBOMe in urine by two chromatographic techniques / Detecção de alucinógeno 25C-NBOME na urina através de duas técnicas cromatográficas

El consumo de drogas de síntesis ha ido en aumento. Estos nuevos derivados sintéticos son análogos estructurales de la feniletilamina N-sustituida. Este grupo ha provocado severos casos de intoxicación e incluso probablemente la muerte de varios consumidores. El principal derivado es conocido como 25C-NBOMe y se consume en estampillas idénticas al LSD. En este trabajo se desarrolla una metodología analítica para la determinación de 25C-NBOMe mediante cromatografía planar instrumental (cromatografía en capa delgada de alta resolución) y cromatografía de gases con detector de masas (CG/EM) como técnicas alternativas de fácil manejo y costo. Estas metodologías demostraron ser robustas y confiables para el propósito previsto.

Consumption of synthetic drugs has increased. These new synthetic derivatives are structural analogs of N-substituted phenylethylamine, and this group has caused severe cases of poisoning and even probably the death of several users. The main derivative is known as 25C-NBOMe and it is consumed in blotters in the same manner as LSD. In this work, an analytical methodology for 25C-NBOMe determination by instrumental planar chromatography high-performance thin-layer chromatography (HPTLC) and gas chromatography with mass detector (GC/MS) were developed as alternative techniques; they are easy to use and low cost. These methods proved to be robust and reliable for the intended purpose.

O consumo de drogas sintéticas vem aumentando. Esses novos derivados sintéticos são análogos estruturais de feniletilamina N-substituída, este grupo tem causado casos graves de intoxicação e, até mesmo, provavelmente, a morte de vários consumidores. O principal derivado é conhecido como 25C-NBOMe e consumido em selos idênticos ao LSD. Neste trabalho é desenvolvida uma metodologia analítica para a determinação de 25C-NBOMe através de cromatografia planar instrumental (cromatografia em camada delgada de alta resolução) e cromatografia gasosa com detector de massas (CG/EM) como técnicas alternativas de fácil utilização e custo. Estas metodologias demonstraram serem robustas e fiáveis para a finalidade a que se destinam.

Anti-metastatic outcome of isoform-specific prolactin receptor targeting in breast cancer.

Controversy exists concerning the role of the long prolactin receptor (PRLR) in the progression of breast cancer. By targeting pre-mRNA splicing, we succeeded in knocking down only the long PRLR in vivo, leaving the short forms unaffected. Using two orthotopic and highly-metastatic models of breast cancer, one of which was syngeneic (mouse 4T1) to allow assessment of tumor-immune interactions and one of which was endocrinologically humanized (human BT-474) to activate human PRLRs, we examined the effect of long PRLR knockdown on disease progression. In both models, knockdown dramatically inhibited metastatic spread to the lungs and liver and resulted in increased central death in the primary tumor. In the syngeneic model, immune infiltrates in metastatic sites were changed from innate inflammatory cells to lymphocytes, with an increase in the incidence of tumor-specific cytotoxic T cells. Long PRLR knockdown in three-dimensional culture induced apoptosis of tumor-initiating/cancer stem cells (death of 95% of cells displaying stem cell markers in 15 days). We conclude that the long PRLR plays an important role in breast cancer metastasis.

Ortopedia prequirúrgica en niños fisurados: Reporte de caso clínico / Presurgical orthopedics in children with cleft palate: Case Report

La fisura labiopalatina requiere ortopedia prequirúrgica para alinear los segmentos maxilares fisurados previo a la queiloplastía primaria. Caso Clínico. Recién nacido de género masculino atendido en el Hospital Regional de Concepción con diagnóstico de fisura labiopalatina bilateral completa, tratado con ortopedia prequirúrgica, siendo posible apreciar la evolución al término del primer año, las ventajas por el uso de la técnica de Grayson, así como la interacción del equipo multidisciplinario que participó del caso. Conclusión. La ortopedia prequirúrgica resulta eficaz en la rehabilitación de niños fisurados, al actuar como coadyuvante de la lactancia y alimentación del niño y permitiendo llevar tempranamente elementos óseos y partes blandas afectadas a una posición anatómica favorable, lo cual otorga mejores resultados quirúrgicos, tanto estéticos como funcionales. La queiloplastía primaria se ve favorecida por la reducción de la tensión en los tejidos blandos y del ancho de la fisura palatina y alveolar...

Cleft lip and palate requires presurgical orthopedics to achieve the normal alignment of the cleft maxillary segments prior to Primary Cheiloplasty. Clinical case A male newborn treated at the Hospital Regional of Concepción diagnosed with complete bilateral cleft lip and palate treated with presurgical orthopedics. Evolution was observed after the first year, as well as the advantages of the Grayson technique and the interaction of the participating multidisciplinary team. Conclusion. Preoperative orthopedic treatment is effective in the rehabilitation of cleft children, as it is a contributing factor to breastfeeding and child feeding. It also makes it possible to move the affected bony and soft tissue elements to a position which is anatomically favorable at an early stage. This results in better surgical outcomes: both aesthetic and functional. Primary cheiloplasty is thus facilitated by a reduction in the tension of soft tissues and of the width of the alveolar cleft palate...

Orientación inicial, calidad de consejería y forma de alimentación en niños fisurados / Initial guidance, counseling quality and feeding form in cleft children

La relevancia de la consejería radica en el trastorno y decepción que provoca el descubrimiento de cualquier malformación para los padres, requiriendo apoyo durante este periodo tan sensible, el cual es necesario para lograr la aceptación del niño.Se describe el tipo de fisura, orientación inicial y forma de alimentación en pacientes fisurados, mediante un estudio descriptivo transversal, con muestreo no aleatorio por accesibilidad entre los pacientes de odontopediatría y ortodoncia del Hospital Regional Guillermo Grant Benavente, Concepción, Chile. Se entrevistaron 36 padres; 69% evaluaron la calidad de información recibida como muy mala. La primera información acerca de la fisura fue entregada por: matrona (28%), pediatra (22%), neonatólogo (11%), cirujano infantil (11%) y ortodoncista (8%). Del 91% de los padres que reconoce haber recibido consejería posterior, el 11% provino de ortodoncistas.Sólo el 13% recibió leche materna exclusiva, aunque 96% de los padres consideran que la lactancia materna es esencial para su hijo. El 95% de los padres, no están vinculados a alguna organización de padres de niños fisurados.

The relevance of counseling is based on the fact that the diagnosis of any malformation in children represents a burden and disappointment to their parents. Extra support is required during this sensitive period, which is necessary for children to accept their condition. We describe the type of cleft, the initial orientation, and the quality and practice of nutrition counseling in cleft patients, using a cross-sectional study with non-random sampling among patients in dental service at the Guillermo Grant Benavente regional hospital, Concepción, Chile. We interviewed 36 parents, and 69% of them assessed the quality of information they received as very poor. The information given to the parents, was first provided by the midwives (28%), secondly by the pediatricians (22%), followed by neonatologists, pediatric surgeons (11% each one) and orthodontists (8%). Parents (91%) acknowledged they had received later counseling from orthodontists (11%). Only 13% were exclusively breastfed, while parents (98%) believe that breastfeeding is essential for their children. Parents (95%) are not bound to any parent’s organization of cleft children.

Estado de salud bucal en preescolares con sobrepeso de Concepción, Chile / Oral health condition in overweight preschoolers Concepción, Chile

La obesidad es un problema de salud pública en nuestro país, con una tendencia que ha ido en aumento en los últimos años; la malnutrición por exceso incluye a niños con sobrepeso y obesos y debido a la relación causal entre consumo de carbohidratos refinados y caries, se plantea que la malnutrición por exceso podría ser un indicador para caries en preescolares. El propósito de esta investigación fue evaluar el estado de salud bucal en preescolares con diagnóstico de malnutrición por exceso, determinando índices ceo e higiene oral, según género; analizando frecuencia de cepillado y dieta. La muestra fue 20 niños perteneciente al CESFAM Víctor Manuel Fernández de la ciudad de Concepción, Chile, con diagnóstico de sobrepeso u obesidad. Se realizó un examen oral, con revelado de placa bacteriana, encuesta dietética y registro de frecuencia de cepillado. El análisis estadístico se efectuó con la prueba no paramétrica U de Mann-Whitney. El índice ceo fue de 2,67 (D.S. +/- 1,87) para los niños y de 5,1 (D.S. +/- 2,64) para las niñas, revelando una diferencia estadísticamente significativa para la muestra. El Índice de higiene oral no presentó diferencias significativas, con promedios de 1,83 (D.S. +/- 0,5) para los varones y de 1,98 (D.S. +/- 0,36) en las niñas. Al analizar dieta y +/-frecuencia de cepillado no hubo diferencias significativas.

Obesity is a public health problem in Chile nowadays. Excess malnutrition includes children that are overweight and obese. There is a causal relationship between refined carbohydrate consumption and cavities. We propose that excess malnutrition could be an indicator for cavities. The purpose of this study was to evaluate oral health in preschool children with excess malnutition diagnosis, determining ceo indexes and oral hygene, gender, and analyzing frecuency of tooth brushing and diet. Data from 20 children from CESFAM Víctor Manuel Fernández in Concepción, Chile were collected. Oral examination was performend on all children, with plaque revelation, diet survey and registration of tooth brushing frequency. Statistic analysis was done by the U de Mann-Witney non parametric test. Ceo index was 2.67 (SD +/- 1.87) for boys, and 5,1 (SD +/-2.64) for girls, showing significant statistic difference in oral hygiene index, dietary habits and tooth brushing frequency showed no significant differences between groups.

Dientes natales: revisión bibliográfica y caso clínico / Natal teeth: case report and review

Los dientes natales y neonatales deben valorarse con mucho cuidado; estimando su movilidad, integridad y la presencia de una úlcera (Riga Fede) en la superficie ventral de la lengua causada por su roce con el diente. Los dientes natales podrían parecerse a la dentición temporal normal en tamaño y forma, sin embargo, también pueden presentarse más pequeños, cónicos, con esmalte y dentina hipoplásicos, con poca formación o ausencia de sus raíces. La mayoría de estos dientes no son supernumerarios y no se requieren extracciones en todos los casos. Es de fundamental importancia el seguimiento periódico de un odontopediatra. En este artículo se presenta un caso clínico y se revisa la epidemiología, etiología, presentación clínica, diagnóstico diferencial, así como, el manejo de los dientes natales.

Natal and neonatal teeth should be evaluated carefully, considering their mobility, integrity and the presence of an ulcer (Riga Fede) on the ventral surface of the tongue caused by his brush with the tooth. Natal teeth may resemble normal primary dentition in size and shape, however, may also smaller, conical, with hypoplasic enamel and dentin, with little development or absence from their roots. Most of these teeth are not temporary and does not require removal in all cases. It is essential periodic monitoring of a pediatric dentist. This article presents a case report and review the epidemiology, etiology, clinical presentation, differential diagnosis and the management of natal teeth.