Consentimiento informado en colonoscopia: un estudio comparativo de 2 modalidades

ResumenAntecedentesLa forma de obtener el consentimiento informado es variable, por lo que el objetivo de este trabajo fue evaluar el nivel de conocimientos sobre la colonoscopia comparando 2 modalidades de consentimiento.Materiales y métodosEstudio observacional, transversal y comparativo realizado en pacientes sometidos a colonoscopia en un hospital público (grupo A) y en un hospital privado (grupo B). El grupo A recibió información verbal por un médico e impresa y el grupo B solo impresa. Una o 2 semanas después se realizó una encuesta telefónica.ResultadosSe incluyó a 176 sujetos (grupo A n=55 y grupo B n=121). El 69.88% (n=123) de los pacientes tenían nivel educativo universitario, el 23.29% (n = 41) nivel educativo secundario, el 5.68% (n=10) nivel educativo primario completo y los restantes (n=2) no habían completado estudios. El 100% conocía las características y el 99.43% los beneficios del procedimiento. El 97.7% recibió información sobre complicaciones, el 93.7% nombró alguna y el 25% (n=44) recordó complicaciones mayores. Todos respondieron, recibieron y leyeron el consentimiento informado antes del estudio. No hubo diferencias entre los grupos en el conocimiento de las características, los beneficios, la recepción y la lectura del consentimiento. El grupo B respondió mejor sobre las complicaciones (p=0.0027) y el grupo A recordaba más las complicaciones mayores (p<0.0001). El grupo A tuvo mayor número de respuestas positivas (p<0.0001).ConclusionesLa combinación de información verbal y escrita logra mejor nivel de conocimientos por el paciente.AbstractBackgroundThe manner in which informed consent is obtained varies. The aim of this study is to evaluate the level of knowledge about colonoscopy and comparing 2 methods of obtaining informed consent.Materials and methodsA comparative, cross-sectional, observational study was conducted on patients that underwent colonoscopy in a public hospital (Group A) and in a private hospital (Group B). Group A received information verbally from a physician, as well as in the form of printed material, and Group B only received printed material. A telephone survey was carried out one or 2 weeks later.ResultsThe study included a total of 176 subjects (group A [n=55] and group B [n=121]). As regards education level, 69.88% (n=123) of the patients had completed university education, 23.29% (n= 41) secondary level, 5.68% (n=10) primary level, and the remaining subjects (n=2) had not completed any level of education. All (100%) of the subjects knew the characteristics of the procedure, and 99.43% were aware of its benefits. A total of 97.7% received information about complications, 93.7% named some of them, and 25% (n=44) remembered major complications. All the subjects received, read, and signed the informed consent statement before the study. There were no differences between the groups with respect to knowledge of the characteristics and benefits of the procedure, or the receipt and reading of the consent form. Group B responded better in relation to complications (P=.0027) and group A had a better recollection of the major complications (P<.0001). Group A had a higher number of affirmative answers (P<.0001).ConclusionsThe combination of verbal and written information provides the patient with a more comprehensive level of knowledge about the procedure

Tratamiento de regeneración endodóntica en pulpa vital y necrótica, utilizando fibrina rica en plaquetas y Biodentine: reporte de caso

Endodontic regeneration is an inductive and reparative biological treatment indicated to replace cell damage at the level of the dentinopulp complex. The objective of this study is to report a case of Endodontic Regenerative Therapy, in young permanent first molars, in a 10-year-old patient, using platelet-rich fibrin and Biodentine, applying two different protocols for combined diagnoses of irreversible pulpitis and pulp necrosis. The patient attended consultation due to extensive carious lesions. Clinical and imaging evaluations (X-rays and Cone Beam) were performed. The protocol in the necrotic canal consisted of disinfection with a bi-antibiotic paste and placement of a second-generation autologous scaffold matrix, made of biodegradable platelet-rich fibrin which is also , biocompatible and therefore without risk of immune rejection. The protocol in the canals with irreversible pulpitis consisted in a complete pulpotomy and placement of Biodentine calcium silicate cement, a material considered as first choice for pulp-conserving treatments, with properties similar to dentin. Eight weeks after the end of the treatment, a clinical control was conducted revealing an asymptomatic chart and negative palpation without the presence of fistula or abscess. This result indicated regeneration of the pulp tissues and success of the applied protocols. Controls will be carried out at 6, 12 and 18 months. Conclusion: The application of endodontic regenerative treatments, as performed in this reported case, is a favorable and innovative option to preserve, restore or replace the dental pulp. In comparison with conventional treatments, this procedure allows to return pulp functionality, complete development of the root, thickening of the dentinal walls and closure of the apical foramen of young permanent teeth affected by pulp pathologies. It is important that regenerative therapies are publicized and applied by dental professionalsLa regeneración endodóntica es un tratamiento inductivo y reparativo con bases biológicas, indicado para reemplazar los daños celulares a nivel del complejo dentinopulpar. El objetivo de este estudio es reportar un caso de Terapia Regenerativa Endodóntica, en primeros molares permanentes jóvenes, en un paciente de 10 años, a través del uso de fibrina rica en plaquetas y Biodentine, se aplicaron dos protocolos diferentes por diagnósticos combinados de pulpitis irreversible y necrosis pulpar. El paciente acude a consulta por presentar lesiones cariosas extensas; se realizaron evaluaciones clínicas e imagenológicas (radiografías y Cone Beam), el protocolo en el conducto necrótico consistió en la desinfección con pasta biantibiótica y la colocación de una matriz de andamiaje autóloga de segunda generación, elaborada de fibrina rica en plaquetas que es biodegradable, biocompatible y no existe riesgo de rechazo inmunológico. El protocolo en los conductos con pulpitis irreversibles consistió en pulpotomía total y colocación de cemento de silicato de calcio Biodentine, el cual se considera el material de primera elección para los tratamientos conservadores de la pulpa, con propiedades similares a la dentina. A 8 semanas de finalizado el tratamiento se realizó control clínico y el paciente mostró un cuadro asintomático, palpación negativa sin presencia de fístula o absceso lo que podría indicar regeneración de los tejidos pulpares y éxito de los protocolos aplicados. Los siguientes controles se realizán a los 6, 12 y 18 meses. Conclusión: la aplicación de los tratamientos regenerativos endodónticos como se realizó en el caso reportado, es una opción favorable e innovadora para preservar, restaurar o sustituir la pulpa dental, que en comparación con los tratamientos convencionales nos permiten devolver la funcionalidad pulpar, finalizar el desarrollo radicular, engrosamiento de las paredes dentinales y cierre del foramen apical de dientes permanentes jóvenes que han sido afectados por patologías pulpares. Es importante que las terapias regenerativas sean divulgadas y aplicadas por los profesionale

Identification of quantitative trait loci for resistance against soybean sudden death syndrome caused by Fusarium tucumaniae

The objective of this work was to identify genomic regions that underlie resistance to Fusarium tucumaniae sp. nov., the causing agent of sudden death syndrome (SDS) in soybean in South America, using a population with a genetic background different from that previously reported for Fusarium virguliforme sp. nov. (F. solani f. sp. glycines), also responsible for SDS in soybean. Although major genes and quantitative trait loci (QTL) for SDS resistance have been identified, little is known about the same disease caused by Fusarium tucumaniae sp. nov., in South America. To identify genetic factors related to resistance to F. tucumaniae and DNA markers associated with them, a QTL analysis was performed using recombinant inbred lines. The map locations of the four loci, here identified, differed from those SDS resistance QTL previously described. It was screened a residual heterozygous line (RHL), which was heterozygous around the most effective QTL, RSDS1, and homozygous for the other genomic regions. The genetic effect of RSDS1 was confirmed using near-isogenic lines (NIL) derived from the RHL. The line which was homozygous for the Misuzudaizu genotype showed resistance levels comparable with that of the line homozygous for the Moshidou Gong 503 genotype

Metal-THINGS: On the Metallicity and Ionization of ULX Sources in NGC 925

Galaxie

Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry.

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P&lt;0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes

Seasonal drought limits tree species across the Neotropics

Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This process implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions it predicts a nested pattern of taxa distribution from wet to dry areas. However, this ‘dry-tolerance’ hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the Western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the ‘dry tolerance’ hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true