Algoritmo para la atención odontológica del paciente discapacitado

Fil: Messa, L. M.. Universidad Nacional de Cuyo. Facultad de Odontologí

A single cocaine administration alters dendritic spine morphology and impairs glutamate receptor synaptic retention in the medial prefrontal cortex of adolescent rats

The brain is still maturing during adolescence and interfering with such a vulnerable period may lead to structural and functional consequences. We investigated the effect of a single cocaine exposure on dendritic spine structure and glutamate dynamics in the medial prefrontal cortex (mPFC) of adolescent rats 7 days after a single cocaine administration. We found a reduced number of dendritic spines, suggesting that cocaine lowers the density of dendritic spines in the mPFC of adolescent rats. Since dendritic spines are postsynaptic glutamatergic protrusions, we investigated the main determinants of glutamate postsynaptic responsiveness. In the postsynaptic density, cocaine reduced the expression of the NMDA receptor subunits GluN1, GluN2A and GluN2B as well as of the AMPA GluA1 and GluA2 subunits. Cocaine also impaired their synaptic stability since the expression of the scaffolding proteins SAP102 and SAP97, critical for the anchoring of such receptors at the postsynaptic membrane, was reduced as well. The expression of PSD-95 and Arc/Arg3.1, which play structural and functional roles in glutamate neurons, was also similarly reduced. Such changes were not found in the whole homogenate, ruling out a translational effect of cocaine and implying, rather, an impaired synaptic retention at the active zones of the synapse. Notably, neither these critical glutamate determinants nor the density and morphology of the dendritic spines were altered in the mPFC of adult animals, suggesting that a single cocaine exposure selectively impairs the developmental trajectory of the glutamate synapse. These results indicate a dynamic impairment of mPFC glutamate homeostasis during a critical developmental window that persists for at least one week after a single cocaine administration. Our results identify dysfunctional glutamate synapse as a major contributor to the mechanisms that distinguish adolescent vs. adult outcomes of a single cocaine exposure

Produção e compreensão da ironia: Aproximações conceituais e empíricas entre a linguística e a análise do comportamento

O estudo da ironia verbal pela Análise do Comportamento imprescinde do conhecimento da teoria de Skinner sobre o comportamento verbal. Skinner cita a ironia como exemplo de comportamento verbal sem aprofundar sua definição e explicação. A ironia é comportamento operante e a explicação da sua função depende de variáveis ambientais específicas. O estudo da ironia pelo viés da Análise do Comportamento demonstra que a probabilidade de uma pessoa emitir ironias pode aumentar se parte da audiência já tenha liberado reforçadores para emissões anteriores e se o ambiente for similar ao ambiente em que a ironia emitida foi reforçada. A presente tese propõe a execução de quatro estudos, planejados para que seus achados se complementem para a defesa do argumento de que estímulos irônicos controlam comportamentos verbais de compreensão e comportamentos emocionais diferentes nos ouvintes, de acordo com as suas diferentes funções de audiência. O primeiro estudo é uma pesquisa teórico-conceitual. O procedimento de tratamento e análise de dados partiu das bases metodológicas de uma Análise Comportamental do Discurso. Trechos do discurso de Skinner no Verbal Behavior. Em um documento digitalizado do livro foram feitas buscas de ocorrências textuais que continham as palavras ironia, sarcasmo e zombaria, seguidas da interpretação da função do discurso do autor pela auto-observação do comportamento verbal de análise desse discurso. Foram localizadas e analisadas seis ocorrências nas quais Skinner impele no seu leitor a compreensão da ironia basicamente pela definição de dois elementos: controle múltiplo e do tato do contrário. No segundo estudo, visando à contribuição para uma análise funcional da ironia pela ótica da Análise do Comportamento, teve como objetivo, a partir de uma revisão sistemática, mapear as variáveis (ou indicadores de variáveis) que estão sendo estudadas pelas pesquisas empíricas sobre ironia. Foram realizadas buscas em bases de dados online com as palavras-chave: ironia, ironia verbal, sarcasmo, controle múltiplo, autoclíticos, irônico e comportamento verbal. O terceiro estudo é empírico e teve como objetivo analisar a produção da ironia por falantes irônicos profissionais que publicam constantemente produtos de seus comportamentos verbais em sites e redes sociais na rede mundial de computadores. Cinco produtores de ironia responderam questões descritivas dos elementos funcionais de sua produção irônica (sobre sexo, política e religião), em especial consequências sobre ouvintes e sentimentos correlatos a elas. O quarto estudo também é empírico e objetivou analisar a compreensão da ironia pelo ouvinte, a partir dos diferentes tipos de audiência, descrevendo os efeitos emocionais que ela pode produzir nele. Foram selecionadas cenas audiovisuais e formados quatro grupos de três participantes cada para responderem a questões sobre ironia tendo como Sd as cenas. As conclusões de cada estudo são que: a ironia é um comportamento verbal compreendido como a demonstração do contrário dos fatos reais e tem como característica essencial a audiência múltipla e o tato do contrário; a produção da ironia tem como motivador principal a crítica; audiências com características diferentes apresentam diferentes formas de compreensão da ironia. Com isso, espera-se que essa descrição de elementos conceituais e empíricos para uma análise funcional do comportamento verbal irônico contribua para o aprimoramento do conhecimento desse comportamento e para a execução de pesquisas experimentais sobre o tema na Análise do Comportamento. Palavras-chave: Ironia, Análise do Comportamento, Análise Funcional, Autoclítico, Produção, Compreensão, Linguística

HBV vaccination with Fendrix is effective and safe in pre-dialysis CKD population

Background: Patients with chronic kidney disease have a poor response to hepatitis B vaccine due to the immunodeficiency conferred from chronic uremia. A recombinant HB vaccine containing an improved adjuvant system AS04 (HBV-AS04) has been manufactured but scarce evidence exists on HBV-AS04 use among patients with CKD. Aim: To assess efficacy and safety of an adjuvanted recombinant vaccine (HBV-AS04) in a large cohort of CKD patients at pre-dialysis stage (with susceptibility to HBV infection). Methods: Patients were prospectively enrolled to receive four 20-mcg doses of HBV-AS04 by intramuscular route (deltoid muscle) at months 1, 2, 3, and 4. Anti-HBs surface antibody concentrations were tested at intervals of 1, 2, 3, 4, and 12 months. Multivariate analyses were performed to assess the parameters, which predicted immunologic response to HBV-AS04 vaccine. Results: One hundred and seven patients were included and 102 completed the study. At completion of vaccine schedule, the frequency of responders (anti-HBs titers 65 10 mIU/mL) was 95% (97/102) (mean anti-HBs antibody titers, 688.9 \ub1 385 mIU/mL), according to per-protocol analysis. Serum haemoglobin levels were greater in responder than non- or low-responder patients to HBV-AS04 (P = 0.04) and this was confirmed by multivariate analysis. The seroprotection rate at month 50 was 88% (30/34) with lower anti-HBs antibody titers (218.5 \ub1 269.6 mIU/mL, P = 0.001). No major side effects were observed. Conclusions: Our prospective study performed in a real-world setting showed a high immunogenicity and safety of HBV-AS04 vaccine in patients with CKD not yet on maintenance dialysis. Studies provided with longer follow-ups are under way to assess the durability of seroprotection in responders

Native Hypovitaminosis D in CKD Patients : From Experimental Evidence to Clinical Practice

Native hypovitaminosis D (n-hVITD) is frequently found from the early stages of chronic kidney disease (CKD) and its prevalence increases with CKD progression. Even if the implications of n-hVITD in chronic kidney disease-mineral bone disorder (CKD-MBD) have been extensively characterized in the literature, there is a lot of debate nowadays about the so called "unconventional effects" of native vitamin D (25(OH)VitD) supplementation in CKD patients. In this review, highlights of the dimension of the problem of n-hVITD in CKD stages 2-5 ND patients will be presented. In addition, it will focus on the "unconventional effects" of 25(OH)VitD supplementation, the clinical impact of n-hVITD and the most significant interventional studies regarding 25(OH)VitD supplementation in CKD stages 2-5 ND

Urinary Citrate, Bone Resorption and Intestinal Alkali Absorption in Stone Formers with Fasting Hypercalciuria

Reduced citrate in urine and increased fasting excretion of calcium are abnormalities frequently reported in stone forming (SF) patients. Increased dietary acid (or reduced alkali) introduction or absorption may be a potential cause of both these pathological findings. To test this hypothesis, we studied 64 SF patients {32 with fasting hypercalciuria (FH) and 32 without FH (NFH)}. After a basal evaluation for nephrolithiasis, while on a 500 mg calcium diet, they were evaluated for: (1) daily intestinal alkali absorption (IAA), by urinary electrolyte excretion; (2) basal concentrations of PTH, calcitonin (CT) and 1,25(OH)2-VitD; (3) oral calcium load for evaluation of changes in calcium and hydroxyproline urinary excretions; (4) intestinal calcium absorption (18 patients), with double curve analysis (stable Sr as tracer); and (S) changes in citrate excretion after an alkali load (50 mEq of a mixture of calcium gluconate, lactate and carbonate) in 10 patients. The results demonstrated: (1) FH stone formers had reduced citrate excretion and lower mean IAA levels than NFH stone formers; (2) FH stone formers also had higher bone resorption levels with lower PTH and higher CT levels; (3) IAA levels were related to both citrate excretion and bone turnover indices; and (4) the increases in citrate excretion after oral alkali load were strictly related to basal IAA values (index of alkali absorption and/or generation after oral load), demonstrating that a different absorptive capacity of alkali rather than a different dietary content may underlie these metabolic abnormalities

Um caso para competências: avaliar o valor do traço-baseado: Avaliação de desempenho para os funcionários não-faculdade da Universidade

A case study analyzed how supervisors at one university selected competencies, or trait-based skills, for non-faculty employees. This case study provides a valuable contribution by focusing on employees at one institution type–a large, public research university. While it has been documented that non-faculty employees provide important contributions to higher education, there is more to be discovered about this population of university employee, noted as more than 2 million U.S. employees in 2011. The research question guiding this study was: Within a university setting, how are employee competencies valued by job title within colleges and divisions? Multiple correspondence analysis evaluated supervisor competency selection for 1,836 non-supervisory and 565 supervisory employees using data from this university’s 2012 performance appraisal. For non-supervisory employees, the first dimension accounted for 65.11% of adjusted inertia, or explained variance. The second dimension accounted for 23.89% of adjusted inertia. For supervisory employees, the first dimension accounted for 86.57% of adjusted inertia. The second dimension accounted for 8.26% of adjusted inertia. The key study finding was that, despite the availability of other higher-education specific competency alternatives and best practices for competency use in the appraisal, this institution’s implementation of competencies was found to be mechanical. This study proposed best practices for this and similarly situated institutions as to how competencies can be used to develop employees and improve their performance.Un estudio de caso analizado cómo supervisores en una Universidad seleccionan las competencias o habilidades basadas en el rasgo, no Facultad empleados. Este estudio de caso proporciona una valiosa contribución al centrarse en los empleados en un tipo de institución, una Universidad de investigación grande, público. Mientras que se ha documentado que no Facultad empleados brindan importantes aportes a la educación superior, hay más por descubrir acerca de esta población de empleados de la Universidad, señaló como empleados de los Estados Unidos más de 2 millones en 2011. ¿Fue la pregunta de investigación que guía este estudio: dentro de un ámbito universitario, cómo son las competencias del empleado valoradas por título del trabajo en universidades y divisiones?  Análisis de correspondencia múltiple había evaluado supervisor competencias selección de 1.836 no supervisión y 565 empleados supervisión utilizando los datos de evaluación del desempeño de la Universidad 2012. Empleados sin supervisión, la primera dimensión representaron el 65.11% de inercia ajustada o explicó la varianza. La segunda dimensión 23.89% de inercia ajustada. Para los empleados de supervisión, la primera dimensión representaron 86.57% de inercia ajustada. La segunda dimensión 8.26% de inercia ajustada. El hallazgo clave del estudio fue a pesar de la disponibilidad de otras alternativas de la competencia específica de la educación superior y las mejores prácticas para el uso de competencias en la evaluación, implementación de esta institución de competencias fue encontrado para ser mecánico. Este estudio propone instituciones situación similar en cuanto a cómo las competencias se pueden utilizar para desarrollar a empleados y mejorar su desempeño y mejores prácticas para esto.Um estudo de caso analisado como supervisores numa Universidade selecionado competências ou habilidades baseadas em traço, para os empregados não-docente. Este estudo de caso fornece uma contribuição valiosa, centrando-se sobre os funcionários em um tipo de instituição – uma grande, pública, Universidade. Embora tem sido documentado que os funcionários não-faculdade fornecem importantes contribuições para o ensino superior, há mais a ser descoberto sobre esta população de funcionários da Universidade, observou-se como funcionários de Estados Unidos mais de 2 milhões em 2011. A pergunta de pesquisa orientar este estudo foi: dentro de um cenário de Universidade, como são competências do empregado valorizadas pelo cargo dentro de faculdades e divisões? Análise de correspondência múltipla avaliada seleção de competências de supervisor para 1.836 não-supervisão e 565 funcionários supervisão usando os dados de avaliação de desempenho de 2012 da Universidade. Para empregados não-supervisão, primeira dimensão representou 65.11% da inércia ajustada ou variância, explicou. A segunda dimensão representou 23.89% da inércia ajustada. Para funcionários de fiscalização, a primeira dimensão representou 86.57% de inércia ajustada. A segunda dimensão representaram 8.26% da inércia ajustada. A conclusão do estudo chave era que apesar da disponibilidade de outras alternativas de competência específica de ensino superior e as melhores práticas para uso de competência na avaliação, implementação desta instituição de competências foi encontrada para ser mecânico. Este estudo propõe-se similarmente situadas instituições quanto como competências podem ser usadas para desenvolver os funcionários e melhorar o seu desempenho e melhores práticas para isso

Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients : lessons from the first phase of the epidemics in Lombardy

Confronting the SARS-CoV-2 outbreak has allowed us to appreciate how efficiently highly-resourced settings can respond to crises. However even such settings are not prepared to deal with the situation, and lessons are only slowly being learnt. There is still an urgent need to accelerate protocols that lead to the implementation of rapid point-of-care diagnostic testing and effective antiviral therapies. In some high-risk populations, such as dialysis patients, where several individuals are treated at the same time in a limited space and overcrowded areas, our objective must be to ensure protection to patients, the healthcare team and the dialysis ward. The difficult Italian experience may help other countries to face the challenges. The experience of the Lombardy underlines the need for gathering and sharing our data to increase our knowledge and support common, initially experience-based, and as soon as possible evidence-based position to face this overwhelming crisis

Gut microbiota composition and frailty in elderly patients with Chronic Kidney Disease

Background Frailty is common in older patients affected by chronic kidney disease (CKD). Since gut microbiota (gMB) may contribute to frailty, we explored possible associations between gMB and frailty in CKD. Methods We studied 64 CKD patients (stage 3b-4), categorized as frail (F, 38) and not frail (NF, 26) according to Fried criteria, and 15 controls (C), all older than 65 years. In CKD we assessed serum C-reactive protein, blood neutrophil/lymphocyte ratio, Malnutrition-inflammation Score (MIS); gMB was studied by denaturing gel gradient electrophoresis (DGGE), high-throughput sequencing (16S r-RNA gene), and quantitative real-time PCR (RT-PCR). Results No differences in alpha diversity between CKD and C and between F and NF patients emerged, but high-throughput sequencing showed significantly higher abundance of potentially noxious bacteria (Citrobacter, Coprobacillus, etc) and lower abundance of saccharolytic and butyrate-producing bacteria (Prevotella spp., Faecalibacterium prausnitzii, Roseburia spp.), in CKD respect to C. Mogibacteriaceae family and Oscillospira genus abundance was positively related to inflammatory indices in the whole CKD cohort, while that of Akkermansia, Ruminococcus and Eubacterium genera was negatively related. Compared with NF, in F there was a higher abundance of some bacteria (Mogibacteriacee, Coriobacteriacee, Eggerthella, etc), many of which have been described as more abundant in other diseases. Conclusions These results suggest that inflammation and frailty could be associated to gMB modifications in CKD