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Kid's Rough-and-Tumble Play inside a Encouraging Early Child years Education and learning along with Proper care Environment.
OBJECTIVE Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT). MATERIAL AND METHODS Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χ2 test or Student t test. Significance level was set at P less then .05. RESULTS The mean Hb (standaith some degree of graft failure at 12 months. BACKGROUND Computed tomography (CT) volumetry and magnetic resonance cholangiopancreatography (MRCP) are mandatory steps for the evaluation of potential donors in living donor liver transplantation. The aim of this study is to compare the preoperative CT volumetry and biliary orifices of the donor graft to the actual operative findings. METHODS Between December 2013 and December 2017, 45 donors (27 men and 18 women) with a mean age of 27.3 years (range, 19-41 years) were evaluated preoperatively by CT volumetry and MRCP at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt. Of the donors, 43 out of 45 underwent intraoperative cholangiography before and after bile duct division. The right hepatectomies for all donors, as well as the actual weight and apparent biliary orifices in the graft, were documented. RESULTS The mean estimated graft volume (EGV) preoperatively by CT volumetry was 894.9 ± 184.2 mL (range, 480-1687 mL), whereas the actual graft weight (AGW) intraoperatively after washout was 862.6 ± 124.4 g (range, 676-1110 g). The correlation coefficient between the EGV and AGW was significantly linear (Y = 0.96X, r2 = 0.72, slope 0.96, P less then .001). The accuracy of the MRCP in preoperative biliary mapping was 76.7% whereas the accuracy of the MRCP in predicting the number of graft biliary orifices was 74.4% compared with the intraoperative cholangiography (IOC), which was 95.3% (P less then .001). CONCLUSION The weight of the right lobe of the liver graft in living donor liver transplants (LDLTs) can be accurately predicted preoperatively by multiplying the EGV by 0.96. Also, the IOC is an essential technique for LDLT. BACKGROUND Idiopathic focal segmental glomerulosclerosis (FSGS) commonly recurs in the early post-transplant period. The treatment protocols and results are conflictive in recurrent FSGS. We aimed to present the results of our treatment protocol and basic approach to the disease recurrences. METHODS This prospective, single-center study was conducted between the years 2015 and 2018. Twelve patients who fit completely the diagnosis of idiopathic FSGS by clinical, laboratory, and biopsy findings were included. A specific treatment protocol which consists of plasma exchange and high dose intravenous cyclosporine was delivered to the patients independently of induction protocols. Twenty-four months of outcomes of graft functions were evaluated. RESULTS Nine patients completed the treatment protocol and were documented for evaluation. All patients achieved a complete or partial remission in an average 24 months of follow-up period. CONCLUSION Idiopathic FSGS is more commonly recurrent than thought to be. The early detection of proteinuria is crucial because the administration of a plasma exchange-based treatment protocol can reverse proteinuria. We think our treatment protocol is a well-established, efficient, and safe choice for post-transplant recurrent FSGS in adults. OBJECTIVE To analyze evidence capable of supporting best practices available in the literature to create dialogues about organ and tissue donation with parents of deceased children and adolescents. METHODS An integrative literature review performed using Scopus, Cochrane, PsycINFO, PubMed/MEDLINE, Web of Science database, and SciELo electronic libraries from November of 2013 to November of 2018, using keyword syntax for each database. The categories were developed using the Alicante model. RESULTS A total of 745 articles were identified, with 7 selected for analysis. The information obtained was grouped into 3 categories death communication, which indicates the importance of using simple and clear words; emotional support, which reveals the need to respect family time and the importance of empathy and compassion; and donation information, which punctuates the importance of dissociating communication about the death from that regarding organ donation. CONCLUSIONS Evidence shows that best practices are the use of simple language, respect for the family during the grieving process, and the importance of establishing different situations in which to communicate about the death and the donation process. BL-918 BACKGROUND Liver retransplantation can be classified as urgent (when performed in the first week after the transplantation) or elective, which may be considered as early (first month post-transplantation) or late (after the first month). The time in which retransplantation takes place is determined by the cause that makes it necessary. The goal of this study is to analyze the causes and results of early retransplantation in our center. METHODS A retrospective analysis of liver retransplantations performed within the first month after the original transplantation in our center between 2007 and 2017 was carried out. The variables analyzed were demographic, causes of the first transplant and retransplantation, and the complications and mortality resulting from the latter. RESULTS A total of 698 liver transplants were performed, including 67 patients who required retransplantation (8.9%). Among these, 37 were late elective retransplantations and 30 were early retransplantations. Regarding the latter, the causes that led to the first transplant were hepatocellular carcinoma (46.7%) and noncholestatic cirrhosis (30%). On the other hand, the main precipitants of the retransplantation were hepatic artery thrombosis (60%) and primary graft failure (13.3%). The reoperation rate was 16.7%, and the perioperative mortality rate was 16.7%. The 1-, 2-, and 5-year survival rates were 83.3%, 76.7% and 59.9%, respectively. CONCLUSION Despite the high perioperative morbidity of liver retransplantation, its results in terms of survival are similar to those of the global series of liver transplantation. STATEMENT OF PROBLEM The number of implants required for the rehabilitation of completely edentulous mandibles has been controversial. The use of a greater number of implants can produce favorable biomechanical outcomes. However, this will lead to high costs and may require complex surgical procedures. Therefore, the minimum number of implants that can produce desirable outcomes should be used. PURPOSE The purpose of this 3D finite element study was to compare the biomechanics of mandibular 3-implant-supported to 4-implant-supported prostheses. The opposing occlusion was a maxillary complete denture or natural dentition. MATERIAL AND METHODS Two finite element analysis mandibular anatomic models were created. Implants were virtually placed in the mandibular lateral incisor and second premolar region bilaterally in the 4-implant-supported prosthesis model. For the 3-implant-supported model, they were placed in the midline and bilaterally in the second premolar region. Screw-retained polymethyl methacrylate pro less than the highest reported threshold limit for bone resorption (6.6×103 με) in contrast with other reported threshold limits (3×103, 3.6×103 με). In both designs irrespective of the magnitude and direction of loading, the maximum recorded von Mises stresses of the implants (126 MPa) and denture displacement (3.24×102 μm) were less than titanium's yield strength of (960 to 1180 MPa) and the displacement values (5.2×103 to 8.8×103 μm) reported in the literature. CONCLUSIONS When opposed by a complete denture, recorded biomechanical outcomes for the 3- and 4-implant-supported designs were within physiologic limits. When opposed by a natural dentition, the von Mises stresses of the implants and denture displacement values for both designs were within a favorable mechanical range, whereas peri-implant stresses and strain exceeded most reported physiologic tolerance levels of bone except for the 6.6×103 με threshold limit for the bone resorption reported. This article describes a completely digital workflow for the diagnostic phase, surgical and prosthetic planning, extraction, immediate single implant placement by guided surgery, and interim implant-supported crown. From a virtual impression, zirconia abutments and a polymethylmethacrylate (PMMA) interim crown was planned in a computer-aided design (CAD) software program. This workflow shortened the time required for chairside placement of an interim restoration with enhanced function and esthetics while restoring an anterior mandibular tooth lost after trauma. Cysts, a common occurrence in the jaws, are managed with different conservative and radical approaches. Although surgical excision is usually the treatment of choice, it can result in an open defect that compromises the oronasal seal and affects the patient's quality of life by interfering with daily intake of nutrition. These defects vary in anatomic geometry and extent depending upon etiology and require a prosthodontic intervention in the intermediate phase until a definitive closure is executed. An unconventional obturator design with a helical spring incorporated into a flexible obturator is described to manage 2 patients with challenging anterior maxillary cysts. STATEMENT OF PROBLEM Yttria-stabilized zirconia polycrystal (Y-TZP) materials of different formulations (3Y-TZP, 4Y-TZP, and 5Y-TZP) can be colored by using color liquids. However, practically and clinically relevant factors such as modifications of sintering protocols and hydrothermal aging might affect the extent of light transmittance and flexural strength of zirconia materials of different formulations; studies on these outcomes, however, are lacking. PURPOSE The purpose of this in vitro study was to test the impact of hydrothermal aging on the light transmittance and flexural strength of colored zirconia materials compared with a lithium-disilicate (LiSi2) ceramic. MATERIAL AND METHODS A total of 210 specimens were prepared from 3Y-TZP0.25 (n=30), 3Y-TZP0.05 (n=30), 5Y-TZP (n=30), 4Y-TZP (n=60), pre4Y-TZP (preshaded, n=30), and LiSi2 (n=30). All specimens, except for pre4Y-TZP and LiSi2, were manually colored, predried, and either conventionally sintered at 1450 °C (3Y-TZP0.25, 3Y-TZP0.05, 5Y-TZP, and hangth. Hydrothermal aging increased biaxial flexural strength for 3Y-TZP0.25 and 3Y-TZP0.05 (P less then .001) but decreased it for 5Y-TZP (P=.005) and pre4Y-TZPspeed (P less then .001). After aging, 4Y-TZPspeed showed comparable values of flexural strength with 4Y-TZP (P=.06) and higher values than pre4Y-TZPspeed after aging (P=.019). CONCLUSIONS Manually colored, conventionally sintered 4Y-TZP was resistant to hydrothermal aging regarding flexural strength. High-speed sintering inhibited color development for manually colored 4Y-TZP but did not affect the resistance to hydrothermal aging. The findings were reversed for industrially preshaded 4Y-TZP.
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