Estudo comparativo de protocolos tomográficos na aquisição das imagens para confecção de modelos de prototipagem

Convenio realizado entre la Universidade Federal do Rio Grande do Sul y la Universidad de la República Oriental del Uruguay en el marco del Programa de Post-graduación en Odontología.A especialidade de Prótese Buco-Maxilo-Facial é responsável por reconstruções complexas da face e do crânio. Entretanto, com a utilização de impressões convencionais, é difícil se alcançar uma adequada adaptação clínica para a reabilitação do paciente. Assim, algumas vêzes, faz-se necessária a obtenção de modelos tridimensionais (3D) que reproduzam a realidade clínica. O objetivo deste estudo é comparar os protótipos obtidos com diferentes protocolos de aquisição de imagem provenientes de distintos aparelhos de tomografia computadorizada com relação à rugosidade superficial, área reconstruída e dose de exposição gerada, procurando estabelecer o mais adequado para a confecção de protótipos de crânio. Para isso, nove protótipos de um fragmento craniofacial seco foram confeccionados. A comparação entre os protótipos quanto à lisura superficial e à área reconstruída foi realizada por meio da Análise de Variância (ANOVA). Nos casos em que a avaliação indicou diferença significativa, foi aplicado como complemento o Teste de Comparações Múltiplas de Tukey. O nível de significância adotado foi de 5%. Em relação à análise de rugosidade as diferenças encontradas não demonstraram correlação com a área reconstruída. Já em relação aos diferentes protocolos, diferenças significativas foram observadas nos protótipos com respeito à área reconstruída e dose de radiação gerada. Pode-se concluir, frente aos resultados encontrados, que as imagens geradas pelos tomógrafos de feixe cônico e feixe em leque, utilizando os protocolos com as resoluções máximas estudadas, estão indicadas para a confecção de protótipos. Contudo, o que deve nortear a seleção do melhor protocolo tomográfico deve ser o propósito da indicação clínica correlacionado com o princípio ALARA (As Low As Reasonably Achievable).Oral-maxillo-facial prosthodontics is the study of complex face and skull reconstructions. In view of the insufficient degree of adjustment of conventional impression to enable proper clinical rehabilitation, among other reasons, practitioners increasingly resort to 3D models that accurately reproduce the clinical reality. The aim of this study is to determine the optimal selection of imaging device and protocol for use in skull prototyping. The surface roughness and reconstructed area of nine prototypes obtained from a dried craniofacial specimen using different image acquisition protocols and CT devices were measured, in addition to measurements of the radiation dose potentially received by the patient. ANOVA of the surface roughness, reconstructed area and radiation dose data enabled statistical comparisons among the prototypes. Where significant differences were found, Tukey’s multiple-comparison test was conducted, using a significance level of 5%. No correlation was found between surface roughness and reconstructed area. However, significant differences in reconstructed area and radiation dose were found among the different protocols. These results support the use of images generated by CBCT or fan beam CT for the construction of prototypes, using the protocols with the highest resolution. Nevertheless, the selection of the most appropriate TC protocol should be based on the particular clinical indication along with the ALARA (as low as reasonably achievable) principle

Effects of Zn Substitution in the Magnetic and Morphological Properties of Fe-Oxide-Based Core-Shell Nanoparticles Produced in a Single Chemical Synthesis

Magnetic, compositional, and morphological properties of Zn-Fe-oxide core-shell bimagnetic nanoparticles were studied for three samples with 0.00, 0.06, and 0.10 Zn/Fe ratios, as obtained from particle-induced X-ray emission analysis. The bimagnetic nanoparticles were produced in a one-step synthesis by the thermal decomposition of the respective acetylacetonates. The nanoparticles present an average particle size between 25 and 30 nm as inferred from transmission electron microscopy (TEM). High-resolution TEM images clearly show core-shell morphology for the particles in all samples. The core is composed by an antiferromagnetic (AFM) phase with a Wüstite (Fe 1-y O) structure, whereas the shell is composed by a Zn x Fe 3-x O 4 ferrimagnetic (FiM) spinel phase. Despite the low solubility of Zn in the Wüstite, electron energy-loss spectroscopy analysis indicates that Zn is distributed almost homogeneously in the whole nanoparticle. This result gives information on the formation mechanisms of the particle, indicating that the Wüstite is formed first, and the superficial oxidation results in the FiM ferrite phase with similar Zn concentration than the core. Magnetization and in-field Mössbauer spectroscopy of the Zn-richest nanoparticles indicate that the AFM phase is strongly coupled to the FiM structure of the ferrite shell, resulting in a bias field (H EB ) appearing below TN FeO , with H EB values that depend on the core-shell relative proportion. Magnetic characterization also indicates a strong magnetic frustration for the samples with higher Zn concentration, even at low temperatures.Fil: Lohr, Javier Hernán. Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física. Laboratorio de Resonancias Magnéticas; ArgentinaFil: de Almeida, Adriele Aparecida. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física. Laboratorio de Resonancias Magnéticas; ArgentinaFil: Moreno, Mario Sergio Jesus. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Troiani, Horacio Esteban. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física. Laboratorio de Resonancias Magnéticas; ArgentinaFil: Goya, Gerardo Fabian. Universidad de Zaragoza; EspañaFil: Torres Molina, Teobaldo Enrique. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física. Laboratorio de Resonancias Magnéticas; Argentina. Universidad de Zaragoza; EspañaFil: Fernandez Pacheco, Rodrigo. Universidad de Zaragoza; EspañaFil: Winkler, Elin Lilian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Vasquez Mansilla, Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Cohen, Renato. Universidade de Sao Paulo; BrasilFil: Nagamine, Luiz C. C. M.. Universidade de Sao Paulo; BrasilFil: Rodriguez, Luis Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Fregenal, Daniel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Zysler, Roberto Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; ArgentinaFil: Lima, Enio Junior. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche | Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología - Nodo Bariloche; Argentin

Prognostic factors of Infective Endocarditis in Patients on Hemodialysis: A Case Series from a National Multicenter Registry.

Background: Infective endocarditis (IE) is a severe complication associated with high mortality. Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD. Methods: From January 2008 to April 2015, 2,488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD. Results: A total of 126 patients (63% male, median age: 66 years; IQR: 54-74 years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1,177 patients, 50%; p 70 years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization. Conclusions. HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.pre-print714 K

Comportamiento epidemiológico de los factores de riesgo asociados a enfermedades crónicas no transmisibles en estudiantes universitarios

Describir el comportamiento epidemiológico de los factores de riesgo relacionados a enfermedades crónicas no transmisibles asociados a hipertrigliceridemia presentes en los estudiantes del primer año de la carrera de Médico y Cirujano de la Universidad de San Carlos de Guatemala. Estudio descriptivo transversal realizado en 1097 estudiantes, en los cuales se aplicó el cuestionario del método paso a paso para la vigilancia de factores de riesgo de enfermedades crónicas (STEPS) modificado. Se encontró 610 (56%) estudiantes sexo femenino, la media de edad fue de 19 años (±1.56); en relación a los factores de riesgo modificables: 219 (20%) consumen cigarrillo, 274 (25%) consumen alcohol nocivamente, 838 (76%) se alimentan de forma inadecuada, 887 (81%) no practica actividad física significativa; se identificó que 405 (37%) presentaron un índice cintura – cadera considerado de riesgo. En cuanto a los factores asociados a la presencia de hipertrigliceridemia: obesidad se identificó en 147 (13%) estudiantes (X2 de 104.98 y OR de 7), obesidad central en 204 (19%) (X2 de 55.74 y OR de 3), el sobrepeso en 330 (30%) (X2 de 53.4727 y OR de 3), presión arterial alta en 397 (36%) (X2 de 18.63 y OR de 2), y glucemia alterada en ayunas alta en 198 (18%) (X2 de 8.3 y OR de 2). La hipertrigliceridemia se presentó en 411 estudiantes (37%), siendo la edad más afectada la de 19 años. La mayoría de estudiantes estudiados es de sexo femenino. Existe una alta prevalencia de factores de riesgo modificables asociados a enfermedades crónicas no transmisibles, de estos se identificó que factores como obesidad, obesidad central, sobrepeso, presión arterial alta y glucemia alterada en ayunas alta tienen una significativa asociación al desarrollo de hipertrigliceridemia, con un aumento del riesgo de 7, 3, 3, 2 y 2, respectivamente

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study.

BACKGROUND: Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru. METHODS: Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS: From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP. INTERPRETATION: Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP. FUNDING: Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru. TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section

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