Necroptosis induced by ruthenium (II) complexes as mitochondrial disruptors.

Inducing necroptosis in cancer cells has emerged as an effective strategy to overcome drug resistance. However, while organic small molecules have been extensively studied for this purpose, metal-based compounds have received relatively little attention as triggers of necroptosis. The development of ruthenium (II) hybrid compounds, particularly those containing triazene (Ru-TRZ), highlights a novel avenue for modulating necroptotic cell death. Here we show that incorporating a methyltriazene moiety, a known alkylating warhead, confers superior mitochondrial-targeting properties and enhances cell death compared to amide-containing counterparts. Ru-hybrid TRZ2 exhibits also antitumor efficacy against in vivo drug-resistant cancer cells. Mechanistically, we demonstrate that Ru-TRZ hybrids induce apoptosis. In addition, by activating downstream RIPK3-driven cell death, TRZ2 proficiently restrains normal mitochondrial function and activity, leading to cancer cell necroptosis. Finally, TRZ2 synergizes anti-proliferative activity and cell death effects induced by conventional drugs. In conclusion, Ru-TRZ2 stands as a promising ruthenium-based chemotherapeutic agent inducing necroptosis in drug resistant cancer cells.

Augmented renal clearance. An unnoticed relevant event.

Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m2. Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5-58.5) versus 66 (63.5-68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients.

Time-to-Treatment in Oral Cancer: Causes and Implications for Survival.

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

La pobresa infantil I el pediatre. Ens ha de preocupar el futur proper? / No disponible

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Oral Lichen Planus and Dental Implants: Protocol and Systematic Review.

A systematic review was conducted to answer the following PICO question: "Can patients diagnosed with oral lichen planus (OLP) be rehabilitated with dental implants as successfully as patients without OLP?". A systematic review of the literature was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to gather available and current evidence of oral lichen planus and its relationship with dental implants. The synthesis of results was performed using a Binary Random-Effects Model meta-analysis. Summary measures were odds ratios (ORs), frequencies, and percentages comparing the survival rate of dental implants placed in patients with OLP vs. those in patients without OLP. The electronic search yielded 25 articles, after removing the duplicated ones, 24 articles were selected. Out of the 24 articles, only 15 fulfilled the inclusion criteria. According to the results of the meta-analysis, with a total sample of 48 patients with OLP and 49 patients without OLP, an odds ratio of 2.48 (95% CI 0.34-18.1) was established, with an I2 value of 0%. According to the Strength of Recommendation Taxonomy (SORT) criteria, level A can be established to conclude that patients with OLP can be rehabilitated with dental implants.

A Double Case: Socket Shield and Pontic Shield Techniques on Aesthetic Zone.

When a tooth is extracted, a bone remodeling of the alveolar process occurs irretrievably. Various techniques have emerged over time to maintain the thickness of the bone crest in fixed prosthetics on teeth and implants. The socket shield and pontic shield techniques are aimed at minimizing buccal bone remodeling, especially in the aesthetic area. We present a case of an aesthetic sector rehabilitated with partial fixed denture using the socket shield and pontic shield techniques.

Tatuatges i pírcings / No disponible

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Guided Bone Regeneration of an Atrophic Maxilla Using Heterologous Cortical Lamina.

Alloplastic dental implants are currently the best way to replace lost teeth. In order to achieve good function and prognosis of dental implants, having bone and soft tissue to support them is necessary. When the amount of bone left is not enough to ensure the outcome of the implant, techniques such as shorts implants, zygomatic implants, or guided bone regeneration have been used. Even though autologous bone is mostly the "gold standard," other biomaterials such as xenografts have led to the reduction of the morbidity of treatments and to the improvement of the regeneration technique outcomes. We present a clinical case of severe atrophy of the maxilla in which we used different types of biomaterials: heterologous cortical lamina, xenograft and autologous bone, and microscrews.

"El dia de l'antibiòtic": una eina per sensibilitzar sobre l'ús correcte d'antimicrobians / "El día del antibiótico": una herramienta para sensibilizar sobre el uso correcto de los antimicrobianos / "Antibiotic day": a tool for the correct use of antimicrobials

FONAMENT: El Pla de Salut de Catalunya 2016-2020 promou la implantació de projectes que disminueixin les resistències antibiòtiques. OBJECTIU: Valorar «El dia de l'antibiòtic» com una eina per fer control de qualitat I seguiment de l'ús dels antibiòtics. MÈTODE: Recollida de dades de pacients hospitalitzats en un centre pediàtric de segon nivell, per un membre del comitè d'infeccioses sense intervenció en la pràctica assistencial I amb desconeixement dels facultatius del centre. La recollida es fa aleatòriament dos dies a l'any durant 2016, 2017 I gener de 2018. S'obtenen: edat, pes, motiu I dies d'ingrés, antibiòtic, dosi, via, durada, cultius, tractament a l'ingrés I durant l'hospitalització, I compliment dels protocols interns. Es comuniquen els resultats als responsables dels pacients. S'avalua el cost que va representar la despesa d'antibiòtics durant els dos anys. RESULTATS: Al 2016, tres pacients ingressen amb una dosi incorrecta, dos amb una durada allargada I tres amb un espectre massa ample. Al 2017, dos pacients no segueixen el protocol, dos reben una dosi incorrecta I dos un antibiòtic d'espectre massa ample. Al 2018, un pacient rep antibiòtic amb un espectre massa ample. Tot això comporta un canvi en el protocol de la pneumònia adquirida a la comunitat (PAC). Es calcula una disminució de la despesa del 13,2%. CONCLUSIONS: La revisió anònima de la prescripció antibiòtica ha provocat un canvi en la mentalitat del pediatre per tal de emprar l'antibiòtic adient. El seguiment acurat de protocols interns ha fet que es modifiqui el protocol de PAC minvant l'espectre antibiòtic empíric. La despesa econòmica ha millorat un 13%

FUNDAMENTO: El Plan de Salud de Catalunya 2016-2020 promueve la implantación de proyectos que disminuyan las resistencias antibióticas. OBJETIVO: Valorar «El día del antibiótico» como herramienta para el control de la calidad y el seguimiento de la utilización de los antibióticos. MÉTODO: Recogida de datos de pacientes hospitalizados en un centro pediátrico de segundo nivel, por un miembro del comité de infecciones sin intervención asistencial y con desconocimiento de los facultativos asistenciales. La recogida se hace aleatoriamente dos días al año durante 2016, 2017 y enero de 2018. Se recoge: edad, peso, motivo y días de ingreso, antibiótico, dosis, vía, duración, cultivos, tratamiento al ingreso y durante la hospitalización, y cumplimiento de los protocolos internos. Se comunican los resultados a los responsables de los pacientes. Se evalúa el coste del gasto de antibióticos durante los dos años. RESULTADOS: En 2016, tres pacientes ingresan con dosis incorrectas, dos con duración alargada y tres con espectro demasiado amplio. En 2017, dos pacientes no siguen el protocolo, dos reciben dosis incorrectas y dos un antibiótico de espectro demasiado amplio. En 2017 se cambia el protocolo de neumonía adquirida en la comunidad (NAC). En 2018, un paciente recibe antibiótico con un espectro demasiado amplio. Se calcula una disminución de gastos del 13,2%. CONCLUSIONES: La revisión anónima de la prescripción antibiótica ha producido un cambio en la mentalidad del pediatra con el fin de utilizar el antibiótico adecuado. El seguimiento estricto de protocolos internos facilitó la modificación del protocolo de NAC disminuyendo el espectro antibiótico empírico. El gasto económico mejoró un 13%

BACKGROUND: The Catalonia Health Plan 2016-2020 promotes the implementation of projects that reduce antibiotic resistance in health centers. OBJECTIVE: To evaluate «Antibiotic Day» as a tool for quality control and monitoring of the use of antibiotics. METHOD: Collection of data from a second level pediatric hospital by a member of the infectious disease committee without intervention in clinical practice and without the prior knowledge of the hospital staff. Twice a year, with randomly selected dates for 2016, 2017 and January 2018, the following data were collected for patients receiving antibiotics: age, weight, cause and days of admission, antibiotic dose, route, days of treatment, cultures, treatment during hospitalization and upon discharge, and compliance with internal protocols. The results were communicated to the primary care providers. The antibiotic-associated cost for the two-year period was calculated. RESULTS: In 2016, three patients were admitted with an incorrect dose, two with prolonged duration and three received antibiotics of wider spectrum than indicated. In 2017, two patients did not follow the protocol, two received incorrect doses, and two received antibiotics of wider spectrum than required. In 2017, the Community Acquired Pneumonia Protocol (CAP) was modified. In 2018, one patient received an antibiotic of wider spectrum that indicated. Hospital expenses decreased by 13.2% during the study period. CONCLUSIONS: The implementation of "Antibiotic Day" resulted in a change in the antibiotic prescription practices with the use of antibiotics with narrower spectrum. The careful monitoring of internal protocols has led to the modification of the CAP protocol, which is used to reduce the empirical antibiotic spectrum. Economic waste has improved by 13%

Functional outcomes after glossectomies: Pilot study on use of a thrombin-fibrinogen biosponge (TachoSil).

OBJECTIVE: The aim of this study was to investigate whether the use of a thrombin-fibrinogen biosponge (TachoSil) has any advantage in tongue healing. STUDY DESIGN: A retrospective study with 30 patients treated with partial glossectomy (below half a tongue) was designed. We compared the results from a group using the biosponge (n =15 patients) and a control group (n = 15). Variables taken into consideration were bolus clearance, frenulum flexibility, and oral transit time. With these parameters, we formulated a "tongue remaining functional" (TRF) scale to assess tongue functionality after the surgery. We also evaluated long-term quality of life by using the Functional Intraoral Glasgow Scale (FIGS). RESULTS: In this study, TRF score, bolus clearance, oral transit time, and frenulum flexibility were significantly improved in the biosponge group. However, there were no differences between the 2 groups in the FIGS scores. CONCLUSIONS: The use of the biosponge in this pilot study showed positive long-term effects in lingual healing and functionality after partial glossectomies.

Autogenous teeth used for bone grafting: A systematic review

Background: Recently, bone graft materials using permanent teeth have come to light, and clinical and histological outcomes of this material have been confirmed by some studies. The aim of this systematic review was to evaluate the reliability of the autogenous tooth bone graft material applied to alveolar ridge augmentation procedures. Material and Methods: A systematic review of literature was conducted analyzing articles published between 2007 and 2017. The following four outcome variables were defined: a) implant stability b) post-operative complication c) evaluation of implant survival and failure rates, and d) histological analysis. A total of 108 articles were identified; 6 were selected for review. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with alveolar ridge deficiency be successfully treated with the autogenous teeth used as bone graft? Results: The mean primary stability of the placed implants was 67.3 ISQ and the mean secondary stability was 75.5 ISQ. The dehiscence of the wound was the most frequent complication with a rate of 29.1%. Of the 182 analyzed implants, the survival rate was 97.7% and the failure rate was 2.3%. In the histological analysis, most of studies reported bone formation (AU)

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Intraosseous Leiomyoma of the Jaw in an Adolescent.

Leiomyoma is a benign tumor of the smooth muscle that rarely occurs in the mouth as an intraosseous lesion. The purposes of this paper are to: (1) present a case of an intraosseous solid leiomyoma of the mandible in a 13-year-old child, who presented with a well-defined unilocular radiolucency in the right mandible incidentally discovered during a routine dental radiographic examination; and (2) conduct a review of the literature to describe clinicopathological features and management of intraosseous jaw leiomyoma (IJL). A total of 17 articles describing 18 cases of IJL satisfied the selection criteria; including the present patient, to date a total of 19 cases of IJL have been reported. IJL occurs mainly in young patients (36.8 percent), more often in boys (1:5:1 male-to-female ratio), and reaches a larger size in children than in adults. The treatment of choice for IJL is surgical excision, which should be as minimally invasive as possible, especially in children.

No impact of surviving sepsis campaign care bundles in reducing sepsis-associated acute kidney injury
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BACKGROUND: The impact of Surviving Sepsis Campaign (SSC) care bundles in reducing sepsis-associated acute kidney injury (SA-AKI) was evaluated. METHODS: We conducted an observational single-center cohort study. Accomplishment of SSC care bundles was registered in all patients with severe sepsis admitted to the critical care department of a university hospital during three different periods. The main outcome measured was SA-AKI incidence defined as any worsening of AKI stage within the first 7 days from onset of sepsis. RESULTS: Among 260 patients with severe sepsis or septic shock finally meeting inclusion criteria, 82 (31.5%) patients developed SA-AKI. None of the SSC care tasks significantly decreased SA-AKI incidence, although a trend was observed with an initial better blood glucose control as well as with a more protective ventilation strategy. Hypotension requiring fluid challenge (hazard ratio (HR), 2.3; 95% confidence interval (CI), 1.2 - 4.2) and the presence of an abdominal sepsis etiology (HR, 1.8; 95% CI, 1.1 - 3.1) were independently associated with SA-AKI. Patients who developed SA-AKI had a higher 90-day mortality rate (62.2 vs. 40.4%). CONCLUSION: In a cohort of septic patients, none of the SSC care tasks significantly decreased SA-AKI incidence within the first week after onset of sepsis.
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Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy.

PURPOSE: Identify clinical variables associated with mortality in patients with sepsis-associated acute kidney injury (SA-AKI) receiving continuous renal replacement therapy (CRRT) and examine timing of initiation of CRRT in reference to those variables identified. METHODS: Retrospective study conducted at two tertiary care hospitals including 939 septic shock patients with SA-AKI who received CRRT in the intensive care unit (ICU). Cox regression models were used to identify variables associated with 90-day mortality. Timing of CRRT initiation was assessed in relationship to significant clinical variables identified. RESULTS: Overall 90-day mortality was 62.9%. Variables prior to CRRT associated with 90-day mortality included: age (aHR, 1.02; 95%CI, 1.01-1.02, p<000.1), APS-III score (1.01, 1.0-1.0, p<0.048), days from hospital admission to CRRT initiation (1.01, 1.0-1.0, p<0.01), blood urea nitrogen (1.01, 1.0-1.0, p<0.04), medical admission (1.76, 1.5-2.1, p<0.0001), creatinine (0.99, 0.9-1.0, p<0.001), and urine output (0.77, 0.6-0.9, p=0.049). In patients with advanced SA-AKI at ICU admission receiving CRRT within the first 5days (n=433), urine output during the 24h prior to CRRT initiation was a strong predictor of survival (2.6, 1.6-4.3, p<0.001). CONCLUSIONS: In patients with SA-AKI, survival is lower when CRRT is started in the setting of low urine output.

Inflammatory papillary hyperplasia: A systematic review

INTRODUCTION: Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use. OBJECTIVES: The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated. MATERIAL AND METHODS: A search was carried out in PubMed (January 2005 to October 2015) with the key words «inflammatory papillary hyperplasia», «denture stomatitis», «granular stomatitis» and «Newton's type III» The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies. RESULTS: Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH. CONCLUSIONS: IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among nondenture-wearers is extremely unusual

El Servei de Pediatria en un hospital centenari. La patologia infecciosa, referència del Servei / No disponible

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Brots d'una malaltia neurològica inexplicable. Muzaffarpur, Índia, 2013-2014 / Outbreaks of unexplained neurologic illness-Muzaffarpur. India, 2013-2014

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Coronectomy versus surgical removal of the lower third molars with a high risk of injury to the inferior alveolar nerve. A bibliographical review.

BACKGROUND: Coronectomy is the surgical removal of the crown of the tooth deliberately leaving part of its roots. This is done with the hope of eliminating the pathology caused, and since the roots are still intact, the integrity of the inferior alveolar nerve is preserved. OBJECTIVE: The aim is to carry out a systematic review in order to be able to provide results and conclusions with the greatest scientific evidence possible. MATERIAL AND METHODS: A literature review is carried out through the following search engines: Pubmed MEDLINE, Scielo, Cochrane library and EMI. The level of evidence criteria from the Agency for Healthcare Research and Quality was applied, and the clinical trials' level of quality was analyzed by means of the JADAD criteria. RESULTS: The following articles were obtained which represents a total of 17: 1 systematic review, 2 randomized clinical trials and 2 non-randomized clinical trials, 3 cohort studies, 2 retrospective studies, 3 case studies and 4 literature reviews. CONCLUSIONS: Coronectomy is an adequate preventative technique in protecting the inferior alveolar nerve, which is an alternative to the conventional extraction of third molars, which unlike the former technique, presents a high risk of injury to the inferior alveolar nerve. However, there is a need for new clinical studies, with a greater number of samples and with a longer follow-up period in order to detect potential adverse effects of the retained roots.