Knowledge and preferences of substitution treatment of patients with chronic kidney disease

Several modalities of renal replacement therapy (RRT) are available for the treatment of end-stage renal disease (ESRD). Patients are likely to face complex medical decisions regarding the type of medical therapy they wish to pursue. A prospective, observational, descriptive and cross-sectional survey case series study was carried out in patients with grade 3-5 chronic kidney disease at the General Hospital ‘Dr. Miguel Silva’ without starting renal replacement therapy. We used descriptive statistics to evaluate the frequency of the categorical variables and measures of central tendency and dispersion for the quantitative variables. The total number of patients included was 20, with a mean age of 54.40±15.93 years and an age range between 24 and 78 years; 55% of the patients evaluated obtained a ‘good’ level of knowledge regarding the types of RRT (HD, PD and renal transplantation). All patients received pre-dialysis information before starting the survey. PD was the preferred RRT modality (45%), followed by kidney transplantation (35%) and finally HD (20%). The patient's level of knowledge regarding his chronic kidney disease allows him to make an informed decision about the choice of the ideal treatment. The most preferred renal replacement therapy for previously educated chronic kidney disease patients is peritoneal dialysis. The distance from the hemodialysis center to your home and work activity are important factors in choosing the type of RRT

Efecto de la hipnosis combinada con estimulación transcraniana de corriente continua en la percepción del dolor y en la función del sistema descendente en sujetos sanos : ensayo clínico randomizado ciego cruzado controlado con uso simulado

Introducción: El dolor es un problema de salud pública, asociado al sufrimiento y la incapacidad funcional. Sus consecuencias permanecen en la vida personal y social del paciente, llevando a cambios significativos en sus relaciones interpersonales, laborales, familiar y social, disminuyendo la capacidad para realizar las actividades diarias. Las técnicas farmacológicas tienes resultados parciales en los pacientes, muchos de ellos acaban por convertirse en pacientes polimedicados y refractarios al tratamiento. Las técnicas no farmacológicas son promisorias y tienen evidencia científica positivas en el efecto del dolor, teniendo mayores estudios en los últimos años con técnicas como electroacupuntura. estimulación magnética transcraneana, estimulación transcraneana de corriente continua, terapia cognitiva conductual y hipnosis. Entre las que se destacan es la estimulación transcraniana de corriente continua (ETCC) y la sugestion a la analgesia hipnótica. Considerando las limitaciones de las opciones farmacológicas en el tratamiento de dolores crónicos, nuevas investigaciones deben orientarse a propiciar el avance en el proceso y comprensión de los mecanismos del dolor y proporcionar nuevas posibilidades terapéuticas con el potencial de modificar los procesos de neuroplasticidad disfuncional asociados al dolor crónico. Objetivo: Los objetivos fueron dos: (I) Determinar si la sugerencia de analgesia hipnótica y la estimulación transcraniana de corriente continua (ETCC) tienen un efecto diferencial en la percepción del dolor. Planteamos la hipótesis de que la estimulación transcraniana de corriente continua sería más efectiva que la analgesia hipnótica para cambiar el sistema de modulación del dolor descendente, mientras que la sugestión hipnótica tendría un mayor efecto en las pruebas sensoriales cuantitativas. (ii) Pretende comprender el efecto combinado de la estimulación de corriente continua transcraneal (a-ETCC) y la sugerencia de analgesia hipnótica sobre la percepción del dolor y el sistema de modulación del dolor descendente (SMDD). Esta investigación también pretende determinar si el efecto de a-ETCC y la sugerencia de analgesia hipnótica en las medidas psicofísicas (CPM-task, HPT, HPTo y CPT) podría asociarse con el nivel sérico de BDNF. Planteamos la hipótesis de que la terapia combinada (a-ETCC / sugerencia hipnótica) presentaría más efectividad en la percepción del dolor y SMDD que las intervenciones individuales (a-ETCC o sugerencia hipnótica). Métodos: Se incluyeron mujeres sanas de 18 a 45 años, con una alta susceptibilidad a la hipnosis, según la Escala de susceptibilidad hipnótica de Waterloo-Stanford Group, Forma C . Los sujetos recibieron una estimulación de corriente continua transcraneal anodal (a-ETCC) sobre DLPFC izquierdo (2 mA durante 20 min) y analgesia hipnótica (20 min). En estudio I: Se incluyeron 24 mujeres aleatorizados y asignados en uno de los dos grupos de intervención con una distribución cruzada para uno del los grupos: (1) a-ETCC (2mA, 20min) e (2) Sugerencia hipnótica (20min). En estudio II: Se incluyeron 48 mujeres aleatorizados y asignados en uno de los cuatro grupos de intervención: (1) a-ETCC (2mA, 20min), (2) Sugerencia hipnótica (20min), (3) a-ETCC / Sugerencia hipnótica (2mA, 20min) o (4) s-ETCC / Sugerencia hipnótica (0mA, 20min). Después de la primera intervención, los participantes regresaron para una segunda sesión experimental para recibir una intervención alternativa. El grupo 1 pasó a recibir la intervención del grupo 2 y viceversa. Lo mismo se aplicó entre el grupo 3 y 4. Resultados: Los resultados del estudio I revelaron que solo la sugerencia hipnótica produjo cambios que son estadísticamente significativos desde antes de la intervención hasta después de la intervención en las siguientes medidas: umbral de dolor por calor, tolerancia al dolor por calor, prueba de presión en frío y factor Neurotrófico derivado del cerebro en suero. El análisis mostró un efecto principal significativo para el tratamiento (F = 4.32; P = 0.04) cuando comparamos la tarea delta- (Δ) de la modulación condicionada del dolor entre los grupos de estimulación transcraniana de corriente continua y de sugerencia hipnótica. Además, el cambio en el factor Neurotrófico derivado del cerebro se correlacionó positivamente con la tarea de modulación del dolor condicionada. Los resultados de estudio II demostraron que la sugerencia de hipnosis sola o combinada para a- o s-ETCC ha demostrado reducir la eficiencia del sistema de modulación del dolor descendente cuando se compara con a-ETCC solamente. El uso de a-ETCC mejoró el SMDD en un 53,70% en comparación con a-ETCC / Sugerencia hipnótica. La sugerencia hipnótica combinada con a-ETCC o s-ETCC aumentó el HPTo cuando se comparó con a-ETCC solo. Mientras que en s-ETCC / Sugerencia hipnótica aumentó HPTo casi 16 veces. La combinación de a-ETCC y la sugerencia hipnótica aumentó el CPT casi seis veces en comparación con a-ETCC solo y en un 156% en comparación con la sugerencia hipnótica solamente. Además, los niveles más altos de BDNF en la línea de base se correlacionaron positivamente con un cambio mayor en el valor de CPTo en el a-ETCC y en el CPT con a-ETCC / Sugerencia hipnótica. Conclusiones: Los resultados confirman un efecto diferencial entre la sugerencia hipnótica y la estimulación de corriente directa transcraneal en las medidas del dolor. Sugieren que el impacto de las intervenciones tiene mecanismos neurales diferenciales, ya que la sugerencia hipnótica mejoró la percepción del dolor, mientras que la estimulación transcraniana de corriente continua aumentó la inhibición del sistema de modulación del dolor descendente. Mientras que el efecto combinado no mejoró la eficiencia de la inhibición en el SMDD.Pain is a public health problem, associated with suffering and functional disability. Its consequences remain in the personal and social life of the patient, leading to significant changes in their interpersonal, work, family and social relationships, decreasing the ability to perform daily activities. Pharmacological techniques present a poor therapeutic response in most patients, many of them end up becoming polymedicated and refractory to treatment. The nonpharmacological techniques are promising and have positive scientific evidence of its effects on pain, with an increase in the number of studies with neuromodulatory techniques such as acupuncture, electroacupuncture, TMS, tDCS and hypnosis. Among those that stand out most are the transcranial direct current stimulation (ETCC) and the hypnotic analgesia suggestion. Considering the limitations of pharmacological options in the treatment of chronic pain, new research should be oriented to promote progress in the process and understanding of the mechanism of pain, providing new therapeutic possibilities with the potential to modify the dysfunctional neuroplasticity processes associated with chronic pain, aiming at clinical improvement. Objectives: There were two objectives: (I) To determine whether the suggestion of hypnotic analgesia and the transcranial direct current stimulation (tDCS) have a differential effect on the perception of pain. We hypothesized that transcranial direct current stimulation would be more effective than hypnotic analgesia in changing the descending pain modulating system (DPMS), whereas hypnotic suggestion would have a greater effect on quantitative sensory tests. (ii) Understand the combined effect of transcranial direct current stimulation (a tDCS) and the hypnotic analgesia suggestion on pain perception and the descending pain modulating system. This research also aims to determine if the effect of a-tDCS and the suggestion of hypnotic analgesia in psychophysical measures (CPM-task, HPT, HPTo and CPT) could be associated with the serum level of BDNF. We hypothesized that the combined therapy (a-tDCS / hypnotic analgesia suggestion) would be more effective in pain perception and DPMS than individual interventions (a-tDCS or hypnotic analgesic suggestion). Methods: Healthy women aged 18 to 45 years were included, with a high susceptibility to hypnosis, according to the Waterloo-Stanford Group hypnotic susceptibility scale, Form C. Subjects received an anodal transcranial direct current stimulation (a-tDCS) on left DLPFC (2 mA for 20 min) and hypnotic analgesia (20 min). In study I: 24 randomized and assigned women were included in one of the two intervention groups with a cross-sectional distribution for one of the groups: (1) a-tDCS (2mA, 20min) or (2) Hypnotic suggestion (20min). In study II: 48 randomized and assigned women were included in one of the four intervention groups: (1) atDCS (2mA, 20min), (2) Hypnotic analgesia suggestion (20min), (3) a-tDCS / Hypnotic analgesia suggestion (2mA, 20min) or (4) s-tDCS / Hypnotic analgesia suggestion (0mA, 20min). After the first intervention, the participants returned for a second experimental session to receive an alternative intervention. Group 1 went on to receive group 2 intervention and vice versa. The same was applied between group 3 and 4. Results: The results of the study I revealed that only the hypnotic suggestion produced changes that are statistically significant from pre to pos intervention in the following measures: heat pain threshold, heat pain tolerance, cold pressure test and neurotrophic factor derived from the brain in serum. The analysis showed a significant main effect for the treatment (F = 4.32, P = 0.04) when we compared the delta (Δ) task of the conditioned pain modulation between the groups of transcranial direct current stimulation and hypnotic suggestion. In addition, the change in the neurotrophic factor derived from the brain correlated positively with the task of conditioned pain modulation. The results of study II demonstrated that hypnotic suggestion alone or combined with a- or s-tDCS has been shown to reduce the efficiency of the descending pain modulation system when compared to a-tDCS alone. The use of a-tDCS improved the DPMS by 53.70% compared to a-tDCS / Hypnotic suggestion. The hypnotic suggestion combined with a-TDCS or s-TDCS increased the HPTo when compared with a-TDCS alone. While in s-tDCS / Hypnotic suggestion HPTo increased almost 16 times. The combination of a-tDCS and the hypnotic suggestion increased the CPT by almost six times compared to a-tDCS alone and by 156% compared to the hypnotic suggestion alone. In addition, the highest levels of BDNF in the baseline correlated positively with a greater change in the CPTo value in the a-tDCS and in the CPT with a-tDCS / Hypnotic suggestion. Conclusions: The results confirm a differential effect between hypnotic suggestion and transcranial direct current stimulation in pain measurements. They suggest that the impact of the interventions has differential neural mechanisms, since the hypnotic suggestion improved the perception of pain, whereas the stimulation by transcranial direct current increased the inhibition of the descending pain modulating system. While the combined effect did not improve the efficiency of inhibition in the DPMS

The McGill Quality of Life Questionnaire-Revised (MQOL-R) : psychometric properties and validation of a Brazilian version on palliative care patients : a cross-sectional study

Background: To assess the psychometric properties, including internal consistency, construct validity, criterion validity, criterion-group validity, and responsiveness, the Reviewed McGill Quality of Life Questionnaire (MQOL-R), into Brazilian Portuguese-(BrP). Also, to analyze the relationship of the BrP-MQOL-R with the scores on the Karnofsky Performance Scale (KPS) and on the Numerical Pain Scale (NPS 0–10). Methods: The BrP-MQOL-R was administered to a sample of 146 adults (men=78). A team of experts translated the MQOL-R according to international guidelines. Convergent validity and Confrmatory factor analysis (CFA) was performed. Results: The BrP-MQOL-R Cronbach’s alpha was 0.85. CFA supported the original four-factor structure, with the following revised model ft-indices: PCLOSE=0.131, Tucker-Lewis Index (TLI) rho 2=0.918, incremental ft index (IFI) delta 2=0.936. The convergence validity is supported by a signifcant correlation between BrP-MQOL-R total scores and their subscales with KPS and with the single item related to the quality of life. And by a converse correlation with the pain scores in the NPS (0–10). Receiver operator characteristics (ROC) analysis showed subjects with KPS equal to or lower than 30% could be discriminated from those with scores on KPS higher than 30% by an area under the curve (AUC)=0.71, sensitivity=97%, and specifcity=92%). Conclusion: The BrP-MQOL-R proves to be a reliable instrument for assessing the quality of life (QOL) in palliative care (PC), with primary evidence of validity. BrP-MQOL-R presented adequate discriminate properties to identify distinct conditions that impact the QOL in PC

Tuneable endogenous mammalian target complementation via multiplexed plasmidbased recombineering

Understanding the quantitative functional consequences of human disease mutations requires silencing of endogenous genes and expression of mutants at close to physiological levels. Changing protein levels above or below these levels is also important for system perturbation and modelling. Fast design optimization demands flexible interchangeable cassettes for endogenous gene silencing and tuneable expression. Here, we introduce ‘TEMTAC’, a multigene recombineering and delivery system for simultaneous siRNA-based knockdown and regulated mutant (or other variant) expression with different dynamic ranges. We show its applicability by confirming known phenotypic effects for selected mutations for BRAF, HRAS, and SHP2

Accidental Injection of Chlorhexidine during Endodontic Therapy

The use of chlorhexidine gluconate (CHX) as an irrigating solution in an anesthesia cartridge is a wrong procedure commonly performed in daily clinical practice. Being an invasive procedure, it is invariably associated with complications. A 47-year-old healthy woman was injected accidentally with 2% CHX in the buccal vestibular area instead of an anesthetic solution during a root canal treatment. After the injection, the patient experienced local side effects, such as a burning sensation on the right cheek area, also a discomfort perception at the injection site and a slight inflammation with a mild extraoral redness especially on the right side cheek. The patient was prescribed with antibiotics and anti-inflammatories to reduce pain and inflammation. The patient complained of upper lip numbness by the second day of the accident. The extraoral swelling reduced gradually and the redness diminished considerably over a period of 6 days. At day 60 of follow-up, the patient recovered satisfactorily from extraoral inflammation but still presented a slight numbness of the upper lip. As a conclusion, we can claim that anesthesia cartridges with irrigant solutions should never be used to irrigate the root canals, and accidental injection of CHX should be carefully assessed by the clinician

Identification of new, very long-chain polyunsaturated fatty acids in fish by gas chromatography coupled to quadrupole/time-of-flight mass spectrometry with atmospheric pressure chemical ionization

This is a pre-print of an article published in Analytical and Bioanalytical Chemistry. The final authenticated version is available online at: https://doi.org/10.1007/s00216-020-03062-0The characterization of very long-chain (>C24) polyunsaturated fatty acids (VLC-PUFAs), which are essential in the vision, neural function, and reproduction of vertebrates, is challenging because of the lack of reference standards and their very low concentrations in certain lipid classes. In this research, we have developed a new methodology for VLC-PUFA identification based on gas chromatography coupled to quadrupole/time-of-flight mass spectrometry with an atmospheric pressure chemical ionization source (GC-APCI-QTOF MS). The mass accuracy attainable with the innovative QTOF instrument, together with the soft ionization of the APCI source, provides valuable information on the intact molecule, traditionally lost with electron ionization sources due to the extensive fragmentation suffered. We have identified, for the first time, VLC-PUFAs with chains up to 44 carbons in eyes, brain, and gonads of gilthead sea bream, a commercially important fish in the Mediterranean. The added value of ion mobility-mass spectrometry (IMS), recently developed in combination with GC-QTOF MS, and the contribution of the collisional cross section (CCS) parameter in the characterization of novel VLC-PUFAs (for which reference standards are not available) have been also evaluated. The methodology developed has allowed assessing qualitative differences between farmed and wild fish, and opens new perspectives in a still scarcely known field of research

Seguridad y eficiacia de una nueva pauta de suplementación en pacientes con fibrosis quística e insuficiencia de vitamina D

Cystic fibrosis; Vitamin D; Multicentre studyFibrosis quística; Vitamina D; Estudio multicéntricoFibrosi quística; Vitamina D; Estudi multicèntricObjectives Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. Material and methods Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. Statistical analysis: t test for paired data and multivariate logistic regression analysis. Results Thirty patients aged 1–39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6−10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. Conclusions The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.Objetivos Basándonos en los documentos de consenso europeo y americano de Fibrosis Quística (FQ) se propone un incremento de la suplementación de vitamina D (VD) en pacientes con FQ y niveles insuficientes. El objetivo de nuestro estudio fue conocer la seguridad y la eficacia de este nuevo protocolo. Material y métodos Estudio multicéntrico, experimental no aleatorizado ni controlado. A los pacientes con niveles insuficientes (<30 ng/mL) se les administró dosis crecientes de VD (entre 800 y 10000 UI/día). Se realizó seguimiento durante 12 meses analizando estatus vitamínico, nutricional, función pulmonar y metabolismo fosfo-cálcico. Análisis estadístico: pruebas t para datos apareados y regresión logística con análisis multivariable. Resultados 30 pacientes entre 1 y 39 años (mediana 9,1) completaron el estudio. Se retiraron 2 por niveles de 25 OH VD > 100 ng/mL a los 3 meses sin encontrarse signos clínicos ni analíticos de hipercalcemia. Tras 12 meses se observó un incremento de 7,6 ng/mL (IC 95% 4,6−10 ng/mL) de los niveles medios de 25 OH VD. El 37% alcanzaron niveles ≥30 ng/mL, un 13% <20 ng/mL y un 50% entre 20 y 30 ng/mL. No se observó asociación de la mejoría de los niveles de VD con la función pulmonar. Conclusiones Con el protocolo propuesto se consigue un incremento de los niveles séricos de VD y una disminución del porcentaje de pacientes con insuficiencia de la misma, aunque todavía muy lejos de alcanzar los porcentajes de suficiencia recomendados para esta entidad.This study received funding from the Fundación Ernesto Sánchez Villares (05/2015) and the Fundación Nutrición y Crecimiento

Bezoars: diagnosis, management, and potential complications in patients with psychiatric disorders

Word "bezoar" comes from Persian "pâdzahr," which means "antidote," since, in ancient times, it was believed that bezoar could cure and nullify effects of all poisons. In medical context, bezoar is the term used for conglomerates of undigested material that accumulate in de gastrointestinal tract. Case of 60-year-old female patient with repeated episodes of intestinal obstruction associated with digestive tract bleeding. She presented to emergency department with severe abdominal pain and intolerance to oral route. Computed tomography identified hypodense image suggestive of a oreign body in the small bowel  lumen. During laparotomy, stone-like mass of approximately 3×5 cm was found at level of jejuno-ileal junction, 80 cm from Treitz ligament, with presence of an intestinal flange that conditions rotation of the intestinal loop on its axis. Intestinal obstruction due to bezoar is uncommon in adult patients, and symptoms are usually non-specific. It requires a high index of suspicion and effective screening for trichotillomania. In such cases, imaging studies such as tomography help to establish the diagnosis.