Acute kidney injury secondary to a combination of renin-angiotensin system inhibitors, diuretics and NSAIDS: “The Triple Whammy”

AbstractBackgroundRenin-angiotensin system inhibitors (ACEI/ARB-II), diuretics and NSAIDs, a combination known as “Triple Whammy”, can result in decreased glomerular filtration rate (GFR) and acute kidney injury (AKI).ObjectivesTo describe the incidence of AKI for each drug type and their combinations. To define the profile of patients admitted for drug-related AKI secondary to Triple Whammy drugs (AKITW), with an assessment of costs and mortality.MethodsA retrospective observational 15-month study developed in three stages:–First: a cross-sectional stage to identify and describe hospitalizations due to AKITW.–Second: a follow-up stage of an outpatient cohort consuming these drugs (15,307 subjects).–Third: a cohort stage to assess costs and mortality, which compared 62 hospitalized patients with AKITW and 62 without AKI, paired by medical specialty, sex, age and comorbidity according to their Clinical Risk Groups.ResultsThere were 85 hospitalization episodes due to AKITW, and 78% of patients were over the age of 70. The incidence of AKITW in the population was 3.40 cases/1000 users/year (95% CI: 2.59–4.45). By categories, these were: NSAIDs + diuretics 8.99 (95% CI: 3.16–25.3);Triple Whammy 8.82 (95% CI: 4.4–17.3); ACEI/ARB-II + diuretics 6.87 (95% CI: 4.81–9.82); and monotherapy with diuretics 3.31 (95% CI: 1.39–7.85). Mean hospital stay was 7.6 days (SD 6.4), and mean avoidable costs were estimated at €214,604/100,000 inhabitants/year. Mortality during hospitalization and at 12 months was 11.3% and 38.7% respectively, and there were no significant differences when compared with the control group.ConclusionsTreatment with ACEI, ARB-II, diuretics and/or NSAIDs shows a high incidence of hospitalization episodes due to AKI; diuretics as monotherapy or dual and triple combination therapy cause the highest incidence. AKITW involves high health care costs and avoidable mortality

Novel Higgsino dark matter signal interpretation at the LHC

In the LHC searches for gluinos it is usually assumed that they decay predominantly into the lightest neutralino plus jets. In this work we perform a proof-of-concept collider analysis of a novel supersymmetric signal in which gluinos decay mostly into jets and the bino-like neutralino (χ 30), which in turn decays into the lightest Higgsino-like neutralino (χ 10), considered the dark matter candidate, together with the SM-like Higgs boson (h). This new physics signal then consists of an LHC final state made up by four light jets, four b-jets, and a large amount of missing transverse energy. We identify tt¯, V+jets (V=W, Z), and tt¯+X (X=W, Z, γ∗, h) productions as the most problematic backgrounds, and develop a search strategy for the high luminosity phase of the LHC, reaching signal significances at the evidence level for a luminosity of 1000 fb-1. The prospects for a luminosity of 3000 fb-1 are even more promising, with discovery-level significances.Fil: Arganda Carreras, Ernesto. Departamento de Fisica Teorica ; Facultad de Ciencias ; Universidad Autonoma de Madrid; . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Física La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Física La Plata; ArgentinaFil: Delgado de la Rosa, Juan Antonio. University of Notre Dame; Estados UnidosFil: Morales, Roberto Anibal. Departamento de Fisica Teorica ; Facultad de Ciencias ; Universidad Autonoma de Madrid; . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Física La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Física La Plata; ArgentinaFil: Quirós, Mariano. Institut de Física d’Altes Energies; Españ

Does surgency moderate the relationship betweenparenting and children's aggression in middlechildhood?

Parenting and child temperament have both been linked to aggression among children. This study explores the moderating effects of children's surgency and sex and paternal/maternal parenting practices on aggressive behaviour in middle childhood. We analyse whether the moderating effects observed fit a Diathesis-Stress, Differential Susceptibility or Vantage Sensitivity model. Participants were 203 school children aged 7–8 years (M = 92.42 months, SD = 3.52) from southern Spain. Maternal inconsistency and coercion and paternal hostility and indulgence, had a direct effect on children's aggressive behaviour. The effects of maternal hostility and anticipatory problem solving on children's aggression were moderated by surgency (Diathesis-Stress), as was the effect of paternal coercion on aggression (Vantage Sensitivity). Children's sex was not found to moderate any effect. It therefore seems that not all children are equally sensitive to the influence of parenting on their aggression levels, and that this influence depends on their temperament

Unusual case of disseminated Langerhans cell histiocytosis in a young male, a case report

Background: Langerhans cell histiocytosis (LCH), is an uncommon hematological disorder characterized by uncontrolled stimulation and proliferation of normal antigen presenting cells, Langerhans cells. It’s estimated incidence in adults is approximately one to two cases per million. The purpose of this report is to describe the case of LCH in a 21-year-old male with multiple organ involvement including the brain, liver, bone; also, to discuss clinical, radiological, and histopathological features of LCH, and the role of internist in diagnosing and managing such disease. Case presentation: We describe the case of a 21-year-old Hispanic man with Langerhans cell histiocytosis involving his liver, skull, brain, and lungs. Initially patient presented to the hospital with upper GI bleeding. Upon review of his chart, it was found that the patient had previously a skull mass resection with immunohistochemistry confirming Langerhans cells which stain strongly positive for S100, CD 1a and langerin 3 year previous, and also a diagnosis of panhypopituitarism with a brain MRI with a 1 1.4 x 1.5 x 1.4 cm mass within the hypothalamus. Liver biopsy during current admission demonstrated a CD68 positive for histiocytes. Conclusions: This case report might contribute to a better understanding of the pathogenesis of LCH and will help to expand the knowledge of health professionals about this condition

A study on the reproducibility of cephalometric landmarks when undertaking a three-dimensional (3D) cephalometric analysis

Objectives: Cone Beam Computerized Tomography (CBCT) allows the possibility of modifying some of the diagnostic tools used in orthodontics, such as cephalometry. The first step must be to study the characteristics of these devices in terms of accuracy and reliability of the most commonly used landmarks. The aims were 1- To assess intra and inter-observer reliability in the location of anatomical landmarks belonging to hard tissues of the skull in images taken with a CBCT device, 2- To determine which of those landmarks are more vs. less reliable and 3- To introduce planes of reference so as to create cephalometric analyses appropriated to the 3D reality. Study design: Fifteen patients who had a CBCT (i-CAT®) as a diagnostic register were selected. To assess the reproducibility on landmark location and the differences in the measurements of two observers at different times, 41 landmarks were defined on the three spatial axes (X,Y,Z) and located. 3.690 measurements were taken and, as each determination has 3 coordinates, 11.070 data were processed with SPSS® statistical package. To discover the reproducibility of the method on landmark location, an ANOVA was undertaken using two variation factors: time (t1, t2 and t3) and observer (Ob1 and Ob2) for each axis (X, Y and Z) and landmark. The order of the CBCT scans submitted to the observers (Ob1, Ob2) at t1, t2, and t3, were different and randomly allocated. Multiple comparisons were undertaken using the Bonferroni test. The intra- and inter-examiner ICC ?s were calculated. Results: Intra- and inter-examiner reliability was high, both being ICC ? 0.99, with the best frequency on axis Z. Conclusions: The most reliable landmarks were: Nasion, Sella, Basion, left Porion, point A, anterior nasal spine, Pogonion, Gnathion, Menton, frontozygomatic sutures, first lower molars and upper and lower incisors. Those with less reliability were the supraorbitals, right zygion and posterior nasal spine

Influence of first and second premolar extraction or non-extraction treatments on mandibular third molar angulation and position. A comparative study

The mandibular third molar (3M) is the tooth that is most often impacted, with lack of space being one of the reasons. In some orthodontic treatments, premolars are extracted in order to create space. The aims of our study are: firstly, to assess the changes in the angulation and position of the 3M in cases treated either with or without extraction of the first or second premolars; secondly, to analyse the variation in the gonial angle and the degree of inclusion of the 3M; and lastly, to establish a predictive impaction model for 3M. This study included 88 patients: 28 patients treated with extractions of first premolars, 30 with second premolars and 30 without. The initial and final orthopantomography was analysed and the angulation of the 3M was measured, a new variable being created to determine the degree of 3M inclusion in the mandibular ramus. The results show that the angulation of 3M improves with time, regardless of treatment, and presents a greater disinclusion in cases treated with extractions. The gonial angle tends to diminish with age in all cases. The conclusions suggest that other factors may influence the angulation and position of 3M and that it is not possible to establish a predictive impaction model

Tractament nutricional de pacients amb insuficiència cardíaca i desnutrició: revisió de l’evidència

Desnutrició; Insuficiència cardíaca; Tractament nutricional mèdicDesnutrición; Insuficiencia cardíaca; Tratamiento nutricional médicoMalnutrition; Heart failure; Medical nutritional treatmentAquest article té com a objectiu avaluar la seguretat i l’eficàcia/efectivitat del tractament nutricional (SNO i NE) en pacients amb IC i desnutrició

Spontaneously Reported Adverse Drug Reactions and Their Description in Hospital Discharge Reports: A Retrospective Study

Reacció adversa al fàrmac; Informe d'alta hospitalària; FarmacovigilànciaReacción adversa al medicamento; Informe de alta hospitalaria; FarmacovigilanciaAdverse drug reaction; Hospital discharge report; PharmacovigilanceThe inclusion of spontaneously reported adverse drug reactions (ADRs) in hospital discharge reports was examined, in addition to the factors associated with their inclusion, the resulting therapeutic decisions, and any recommendations made upon patient discharge regarding the suspected offending drugs. ADRs that were spontaneously reported during 2017 and 2018 to the pharmacovigilance program were retrospectively analyzed. Information regarding patient characteristics, drug treatments, and ADRs was collected from the ADR notifications and from patient electronic medical records. The dependent variable was the mentioning of ADRs in the discharge reports, while characteristics of the ADRs, pharmacovigilance causality algorithms, and some of the suspected drugs themselves were the independent variables during bivariant analysis. A total of 286 reports of suspected ADRs from 271 patients (50.2% female; 77% adults) were included. Information regarding the ADRs was present in the discharge reports for 238 reports (83.2%); the ADR seriousness and the lack of potential alternative causes were the only associated factors. Withdrawal or withdrawal and substitution by an alternative drug were the most common therapeutic decisions, although often no recommendation was made. Overall, there is still room for improvement in terms of including information related to ADRs in hospital discharge reports.This research received no external funding

Evaluation of the validity of the Bolton Index using cone-beam computed tomography (CBCT)

Aims: To evaluate the reliability and reproducibility of calculating the Bolton Index using cone-beam computed tomography (CBCT), and to compare this with measurements obtained using the 2D Digital Method. Material and Methods: Traditional study models were obtained from 50 patients, which were then digitized in order to be able to measure them using the Digital Method. Likewise, CBCTs of those same patients were undertaken using the Dental Picasso Master 3D® and the images obtained were then analysed using the InVivoDental programme. Results: By determining the regression lines for both measurement methods, as well as the difference between both of their values, the two methods are shown to be comparable, despite the fact that the measurements analysed presented statistically significant differences. Conclusions: The three-dimensional models obtained from the CBCT are as accurate and reproducible as the digital models obtained from the plaster study casts for calculating the Bolton Index. The differences existing between both methods were clinically acceptabl