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A complication of Kirschner (K) wire fixation is the migration of the wire. We report a patient who had undergone fixation of a right clavicle fracture associated with acromioclavicular joint (ACJ) dislocation 15 years ago. He presented with features of pain and dysaesthesia in the right ulnar nerve dermatome on the movement of the neck and shoulder. Radiographic investigations showed a broken K-wire that had migrated to the lower brachial plexus. He underwent surgical removal of the K-wire and recovered uneventfully. We summarise the literature on K-wire migration reported following clavicle and ACJ injuries. Level of Evidence: Level V (Therapeutic)

The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home.Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student's t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables.Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12; 95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81; 95% Confidence interval 1,32-12,10), respectively.Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.La pandemia de la COVID-19 ha tenido un efecto negativo en la salud mental de la población. Se desconoce si los distintos tipos de aislamiento de los pacientes afecta a estos por igual. El objetivo del estudio fue determinar si el efecto sobre el malestar psíquico originado por el aislamiento de la población con COVID-19 en un hotel supervisado por profesionales sanitarios fue diferente respecto al de las personas aisladas en su domicilio.Los sujetos a estudio fueron pacientes diagnosticados de la COVID-19 durante la primera ola pandémica en Barcelona, seleccionados consecutivamente de los listados de Atención Primaria. Se realizó una encuesta telefónica para recoger información sobre salud mental en los pacientes que fueron aislados en un hotel frente a los aislados en sus domicilios. Se realizó estadística descriptiva y las variables de estudio fueron analizadas mediante media y desviación estándar, contaje (porcentaje), test Chi-cuadrado y t-Student. Se llevaron a cabo modelos de regresión logística seleccionando frustración e ira/irritabilidad como variables respuesta.De los 89 pacientes incluidos, 45 (50,6%) fueron aislados en sus domicilios y 44 (49,4%) en el hotel. Se identificó frustración en el 48,3% e irritabilidad en el 29,2% de los pacientes. El sentimiento de frustración se concentraba principalmente en la franja de edad entre 45 y 65 años, mientras que el 50% de los que sentían irritabilidad eran todavía más jóvenes. Los modelos multivariados confirmaron que los pacientes en aislamiento domiciliario mostraron mayor riesgo de frustración (Odds ratio 4,12; 95% Intervalo de confianza 1,60-11,49) y de ira (Odds ratio 3,81; 95% Intervalo de confianza 1,32-12,10), respectivamente.Los pacientes con COVID-19 aislados en su domicilio tienen mayor riesgo de presentar sentimientos de frustración e ira que los aislados en hoteles supervisados por profesionales sanitarios.

Background Isolation of COVID-19 patients has been universally implemented to control transmission of the outbreak. Hotels and other facilities have been adapted to help appropriate isolation be achieved. Our study tested the efficacy of isolating patients in a reconditioned hotel versus isolation in their domiciles to reduce infection transmission. Methods Observational cohort study based on a survey to COVID-19 patients between April and June 2020. One cohort had been isolated in a hotel and the other in their domiciles. Multivariate regression models analyzed the factors related to the occurrence of COVID-19 infection among the household members. Results A total of 229 household members of COVID-19 patients were analyzed, 139 of them belonging to the group of hotel-isolated patients and 90 in the group of domicile-isolated ones. More than half of the household members became infected (53.7%). Higher risk of infection was found in the household members of domicile-isolated patients isolated and in those reporting overcrowding at home, (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.89–3.12) and (OR 1.44, 95% CI 0.81; 2.56), respectively. Conclusions The isolation of COVID-19 patients in community-supervised facilities may protect their household members from transmission of the disease. Overcrowded homes may contribute to the transmission of the infection.

In order to make constructive the theory of projective modules, stably free modules, Hermite rings and extended modules studied in the previous chapters, in the present and next chapters we will study the theory of Gobner bases of left (right) ideals and modules for bijective skew PBW extensions.

Skew PBW extensions include wellknown classes of Ore algebras, operator algebras and also a lot of quantum rings and algebras. The universal property that characterizes these objects and its existence will be studied.

As we saw in Section 8.7, and also at the beginning of Chapter 9, all rings and algebras presented in Chapter 2 are PSF.

In this chapter we will investigate the localization of skew PBW extensions with respect to different kinds of multiplicative subsets.

Serre’s Theorem for bijective skew PBW extensions (Theorem 8.2.3) says that if M is an f.g. projective module over a bijective skew PBW extension A of a left noetherian, left regular PSF ring R, then M is stably free.

In particular, we will investigate the regularity of these rings and Serre’s theorem on the stably freeness of every finitely generated projective module. Moreover, we will compute the Quillen’s K-groups for these extensions.

There are some classical and elementary applications of Grobner theory that we will study in this chapter. We will consider the membership problem, and we will compute the syzygy module, free resolutions of modules, the intersection and quotient of ideals and submodules, the matrix presentation of a finitely presented module, and the kernel and the image of homomorphism between modules.

In this chapter we will make some matrix computations over skew PBW extensions using Grobner bases.

In this chapter R is a commutative domain and A is an R-algebra. In some places R = K is a field, or R = Z, i.e., we will study also the Zariski problem for rings.

The results presented in this chapter are an easy generalization of those of the previous chapter, i.e., taking m = 1 we get the theory of Grobner bases for the left ideals of A.

Motivated by Theorem 18.5.13, Example 18.5.15 and Theorem 18.6.8 of the previous chapter, we will introduce semi-graded versions of Koszul and Artin{ Schelter regular algebras. We will classify many of the skew PBW extensions considered in the present monograph according to these two types of algebras.

In this first chapter of applications we study some algebraic and categorical topics of the noncommutative algebraic geometry of skew PBW extensions. For this task we will follow the approach presented by M. Artin and J.J. Zhang in [28], by A.B. Verevkin in [398], [399] and by D. Rogalski in [344].

Now we will compute the global, Krull, Goldie and Gelfand{Kirillov dimensions for bijective skew PBW extensions. All of these computations will be done also for the skew quantum polynomials.

We investigate the behavior of finitely generated projective modules over a down-up algebra. Specifically, we show that every noetherian down-up algebra $A(\alpha,\beta,\gamma)$ has a non-free, stably free right ideal. Further, we compute the stable rank of these algebras using Stafford's Stable Range Theorem and Kmax dimension., Comment: 14 pages

In this short paper we study the d-Hermite condition about stably free modules for skew $$\textit{PBW}$$ extensions. For this purpose, we estimate the stable rank of these non-commutative rings. In addition, and closely related with these questions, we will prove Kronecker’s theorem about the radical of finitely generated ideals for some particular types of skew $$\textit{PBW}$$ extensions.

Many rings and algebras arising in quantum mechanics, algebraic analysis, and non-commutative algebraic geometry can be interpreted as skew PBW (Poincare- Birkhoff Witt) extensions. In the present paper we study two aspects of these non-commutative rings: their finitely generated projective modules from a matrix-constructive approach, and the construction of the Gröbner theory for their left ideals and modules. These two topics have interesting applications in functional linear systems and in non-commutative geometry. Fil: Lezama Serrano, José Oswaldo. Universidad Nacional de Colombia; Colombia Fil: Gallego Joya, Claudia Milena. Universidad Nacional de Colombia; Colombia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Background Skin patch test is the gold standard method in diagnosing contact allergy. Although used for more than 100 years, the patch test procedure is performed with variability around the world. A number of factors can influence the test results, namely the quality of reagents used, the timing of the application, the patch test series (allergens/haptens) that have been used for testing, the appropriate interpretation of the skin reactions or the evaluation of the patient’s benefit.Methods We performed an Internet –based survey with 38 questions covering the educational background of respondents, patch test methods and interpretation. The questionnaire was distributed among all representatives of national member societies of the World Allergy Organization (WAO), and the WAO Junior Members Group.Results One hundred sixty-nine completed surveys were received from 47 countries. The majority of participants had more than 5 years of clinical practice (61 %) and routinely carried out patch tests (70 %). Both allergists and dermatologists were responsible for carrying out the patch tests. We could observe the use of many different guidelines regardless the geographical distribution. The use of home-made preparations was indicated by 47 % of participants and 73 % of the respondents performed 2 or 3 readings. Most of the responders indicated having patients with adverse reactions, including erythroderma (12 %); however, only 30 % of members completed a consent form before conducting the patch test.Discussion The heterogeneity of patch test practices may be influenced by the level of awareness of clinical guidelines, different training backgrounds, accessibility to various types of devices, the patch test series (allergens/haptens) used for testing, type of clinical practice (public or private practice, clinical or research-based institution), infrastructure availability, financial/commercial implications and regulations among others.Conclusion There is a lack of a worldwide homogeneity of patch test procedures, and this raises concerns about the need for standardization and harmonization of this important diagnostic procedure. Keywords: Allergy, Contact dermatitis, Sensitization, Skin patch test, Survey

As the case of free k -algebras and PBW algebras, given a bijective skew PBW extension A , we will show that it is possible transfer Grobner bases between A and its associated graded ring.

In this article, we introduce the σ-PWB extensions and construct the theory of Grobner bases for the left ideals of them. We prove the Hilbert's basis theorem and the division algorithm for this more general class of Poincare–Birkhoff–Witt extensions. For the particular case of bijective and quasi-commutative σ-PWB extensions, we implement the Buchberger's algorithm for computing Grobner bases of left ideals.

Background Mastocytosis is a disorder characterized by an abnormal proliferation of mast cells and release of cell mediators. The incidence is 1 per 1000 skin diseases attending in dermatology services. Mastocytosis can be divided into 3 different clinical variants: cutaneous, systemic and malign mastocytosis. Urticaria pigmentosa is the most common variety (70–90%) of mastocytosis. Of all cases 55% ocurr during the first 2 years of life. When the bone marrow, lymph nodes, liver and spleen are affected the disorder is called systemic mastocytosis. Methods Case 1: A 20 month old male with history of penicillin and erythromycin allergy, as well atopic family history. Began at 4 months with itchy brown-marrow papules in the back, then generalizated except palms and soles. The lesions were exacerbated by heat and rubbing. There was no fever, weight loss, or any other systemic symptoms in the history. Blood count and biochemical laboratories were normal. Skin biopsy reported the presence of mast cells, confirming urticaria pigmentosa diagnosis. The management included antihistamines, restricted diet and emollients with improved of symptoms. Case 2: A 9 month old male with no history of atopy. At the first visit he had 4 months with skin lesions characterized by hyperpigmented maculopapular eruption, scattered on head, over trunk and extremities. Darier´s sign was positive. Skin biopsy is performed with confirming the diagnosis of mastocytosis. Conclusions The urticaria pigmentosa diagnosis is mainly clinical, with emphasis on the Darier´s sign, which is pathognomonic and positive in 90% of cases. In some cases a skin biopsy is required to confirm the diagnosis. Antihistamines are the first line of treatment. Symptoms relieve spontaneously before adolescence in 50% of pediatric patients. In some cases, a malignant transformation of mastocytosis could occur, condition that is called “mast cell leukemia”.

Background The risk of anaphylaxis ranges from 0.2 to 0.7%. The objective of this study was to describe the causes, clinical features and complications of patients with anaphylaxis treated in the emergency department of our hospital. Materials and Methods A prospective, observational and descriptive survey was conducted for assessing adult patients with a diagnosis of anaphylaxis from March 2005 to 2010. Information was obtained from the medical records and from a questionnaire was that completed for the patients and a relative. The information included, triggers, demographics, allergy history and clinical characteristics of the current episode. All the cases were followed to their outcome. Results We documented 45 cases of anaphylaxis. 26 patients (58%) were male. The most common causes of anaphylaxis were: drug (49%) food (20%) and poison hymenoptera venom (16%). The most common clinical signs ando symptoms included: dyspnea (69%), nausea (58%) and hypotension (56%). 44% of patients came to emergency departments in the course of 30 minutes after onset of symptoms while the 29% took 30 minutes to 1 hour and 27% more than 1 hour. Among the associated diseases, hypertension was 13% and rhinitis (11%). In 85% of the cases, patients remained under observation for 3 to 12 hours were the most frequent discharged. 7 patients were hospitalized and 4 sent to intensive care later were discharged without complications. Conclusions Anaphylaxis is not uncommon in our environment. Drugs are the most common cause as reported in the literature. The most frequent clinical manifestations are respiratory and gastrointestinal.

Background Among the more than 150 different forms of Primary Immunodeficiency Diseases (PID) the CVID is the most common symptomatic primary immunodeficiency, present mainly in adults. There is a failure of B cells to develop and differentiate into plasma cells; at consequent a reduction of the production of one or more isotypes of antibody can also affected Cell-mediated immunity. Common manifestations included recurrent bacterial infections, that typically involve the upper and lower respiratory tract. Some patients are highly prone to autoimmune manifestations, lymphoid hyperplasia, and tumors. Methods We presented 3 cases of CVID with a variety of clinical presentation, evolution and complications related to delayed diagnosis. Results A 34 year old male presented chronic diarrhea, weight loss, malnutrition and recurrent upper respiratory infections; digestive tract endoscopy and biopsy was reported with villous atrophy, chronic inflammation and low grade non-Hodgkin's lymphoma B cell. Unfortunately this patient refused the use of gamma globulin treatment, had a high morbidity, and finally the patient died. The case of a nurse with clinical manifestation of recurrent rinosinusitis and pneumonia, which was diagnosed as IDCV 17 years later, after she developed pulmonary bronchiectasis. Fortunately the disease is under control and she is actually under treatment with intravenous immunoglobulin. Finally, the case of a 44 year old female, who suffered from recurrent upper respiratory infections, additionally had a thyroid gland tumor associated which affecting the thyroid function. Conclusions In the 3 cases had low levels of all immunoglobulin as a hallmark. The clinician must be suspecting this condition in all adults with recurrent infectious disease who have gastrointestinal symptoms or who are detected a malignant disease. Early diagnosis and correct treatment are critical in preventing tissue damage, long-term sequelae and death. Replacement with intravenous gamma globulin and antibiotics are the mainstays in the management of these patients.

En la actualidad la demanda de estética en odontología ha aumentado considerablemente, el blanqueamiento dentario hoy en día es una práctica considerada rutinaria dentro y fuera de los consultorios odontológicos. Diferentes trabajos de investigación marcan controversias en cuanto a los efectos de los peróxidos, utilizados para realizar la aclaración dentaria, sobre los tejidos duros y blandos orales como así también el efecto por derivación en la adhesión de resinas compuestas a la estructura dentaria blanqueada.En el artículo se presenta una revisión de literatura sobre las desventajas que produce el blanqueamiento sobre el esmalte dentario. Se describen consideraciones a tener en cuenta por parte de los profesionales cuando programan realizar tratamientos restaurativos con técnicas adhesivas posteriores a técnicas de blanqueamiento dentario.

Methods We included patients at age of 7 years or more, with diagnosis of moderateto severe persistent allergic rhinitis that were evaluated between march of 2010 and june of 2011 at our Regional Center. All patient werw submitted to an spirometry, nasal cytology and a quantitatively nasal eosinophilia measured by optical microscopy. Study design: one center, observational, descriptive and transversal.

Children with allergic rhinitis were phenotypically characterized by rings (92%, p= 0.03), vertical facial plane growth (25%, p = 0.016), nasal fold (78%, p = 0.00) and retrognathia (17%, p = 0.057). In risk analysis found that mouth breathing increased 47.5 times the risk of allergic rhinitis. Children with persistent rhinitis and asthma had more mouth breading, snoring and jaw compression than children only with rhinitis. Conclusions Children with allergic rhinitis had higher prevalence of facial, tooth and jaw disorders than children without rhinitis. We recommend a multidisciplinary assessment to identify dentomaxilofacial alterations in this high risk groups and provide early treatment.

La anodoncia parcial forma parte de la realidad social de nuestro medio, una PPR bien diseñada puede actuar funcionalmente, son estéticamente aceptables, de larga duración sin dañar las estructuras de soporte. Tiene un costo razonable, ofrece restauraciones cómodas, eficientes y manteniendo el contacto oclusal, conservando los pilares libres de caries y enfermedad periodontal. Se verifica el buen funcionamiento a través de controles a distancia para evitar problemas que surgen del uso incorrecto, de un mal mantenimiento y del inadecuado mantenimiento de las conductas higiénicas. La importancia de implementar los controles posteriores a la instalación permite proteger los dientes remanentes y el estado periodontal, evaluar la integridad y buen funcionamiento de todos los componentes que forman la PPR.

Background Sneezing is a coordinated protective respiratory reflex which occurs due to stimulation of the upper respiratory tract, and frequently accompanies allergic or nonallergic rhinitis. Sneezing can also arise due to bright light or sun (ACHOO syndrome), physical stimulants of the trigeminal nerve, psychogenic or central nervous system pathologies, sexual ideation and psychogenic sneezing. There are few case reports in the literature of patients with psychogenic sneezing. Methods 14-year-old girl who had incessant sneezing for over 4 days. The patient was initially seen in a rural hospital, were it was prescribed prednisone and antihistamines but the patient did not show any improvement. She was refered to 3rd level Hospital and treated with nasal steroids, antihistamines, and isotonic sodium chloride solution nasal spray; sneezing remitted in 2 hours. During a follow up visit nasal endoscopy was normal. Had a similar episode a month after that, and was referred to our service. She didn´t have either personal or family history of allergies. Results There were not abnormalities in physical examination but obesity; nasal cytology and skin tests to aeroallergens were negatives. Received the same management with isotonic sodium chloride solution nasal and the symptoms remitted. Consultation with psychiatry is requested by probable psychogenic sneezing. The interrogation relates to the loss of father 3 years also suffered from bullying for obesity. Combined treatment was initiated by psychiatry and psychology. Conclusions Psychogenic Sneezing is a rare disorder, but should be considered in the differential diagnosis of sneezing. May have suspect if inspiratory phase is quite short and the amount of nasal mucosal secretion expelled very low. Eyes may remain open during sneezing. It usually develops due to psychogenic factors and is refractory to medical treatment. It is important to assess the patient in a holistic manner through a medical history and physical examination. Psychosocial environmental conditions should be investigated, and once identified the trigger requires a multidisciplinary treatment.

Background Allergic reactions to insects are a global problem. The objective of this study was to assess the efficacy of immunotherapy with allergenic extract of Aedes aegypti for the treatment of large local reactions (LLR) to mosquito bites in children. Methods Experimental, comparative, prospective, longitudinal and randomized none blinded study was conducted. We included 2 to 15 year old children with a history of large local reactions to mosquito bites. Sensitization was confirmed by a positive prick test. One group was treated with subcutaneous immunotherapy with extract of Aedes aegypti during 5 months and a second group received only antihistamine as needed. Diary symptoms and medication use were recorded in each case. The presence of adverse reactions to immunotherapy was also documented. Results A total of 35 patients from August 2009 to September 2010. Twenty-eight patients completed the study (16 male were included, with mean 7 ± 2.5 years) 15 in the immunotherapy group and 13 in the control group. The immunotherapy group showed a decrease in the diameter of the wheal and flare as well as the duration of the reaction and the use of drugs, from the third month of treatment, compared with the control group (P < 0.001). Conclusions Our results suggest that immunotherapy with extract of Aedes aegypti, could modify the natural history of LLR to mosquito bites in children. Additional studies are needed to determine the optimal length treatment of the scheme and its long-term effects.

Background Rhinitis is characterized clinical by chronic runny nose, sneezing, nasal itching, congestion and postnasal discharge, among other symptoms. It´s classified as allergic and non allergic. Skin prick testing is the principal diagnosis method for allergic rhinits. However, there is a group of patients with chronic rhinopathy that have negative skin tests, the objective of this study was to determine the cutaneous response to patch tests with Dermatophagoides farinae and Dermatophagoides pteronyssinus in patients with chronic rhinitis. Methods It was a cross-sectional, observational and descriptive study. We included patients over 18 years old. They were divided into 3 groups; Group A patients who came for the first time with a history of chronic rhinopathy over 18 months of evolution and positive skin tests for aeroallergens; group B patients with chronic rhinitis with at least one year of evolution and negative skin tests; group C healthy volunteers. Patch test with farinae and pteronisyinnus were done in the subjects of all 3 groups, with readings at 48 and 72 hours. Results A total of 37 patients were studied, mean age 26.1 years. Twenty two were male subjects (60%). The mean lenghtof chronic rhinophaty was 10.8 years. Six patients had positive patch test to any of the mites tested; 2 (33%) in group A, 2 (33%) in group B and 2 (33%) of the control group, but it was not statistically significant (P > 0.05). Conclusions Although the results were not statistically significant, there were patients with chronic rhinitis wich had positive patch test for mites. This sensitization could be clinically significant for those patients.

Background Hereditary angioedema (HAE) was first described by Quincke in 1882 and appointed by Osler in 1888, is a rare disease caused by deficiency of gene esterase inhibitor C1 (C1 INH). Prevalence varies from 1:10,000 to 1:150,000. The attacks are usually sporadic and often associated with traumatic or stressful events. Treatment included management of acute attacks and prophylactic therapy in specific situations where attacks may occur. Methods A 40-year-old male with a family history of father facial angioedema. He had experienced 15 episodes of angioedema during the previous 5 years. During these events than lasted 3 to 5 days edema affected his eyelids, lips, hands, feet and testicles. And sometimes was associated to abdominal pain and shortness of breath. He went several times to medical office and emergency room, where he received treatment with antihistamines without improvement. Results The laboratory evaluation of complement components showed C4 2s0.8 (NV 20–50), CH50 10.1 (NV 20–50), C1 inhibitor quantitative 10.7), and C1 esterase inhibitor functional 104% (NV > 67%), once the diagnosis of type I hereditary angioedema was done, we started danazol therapy that has prevented recurrence of symptoms. Conclusions It is important to do a detailed history for the diagnosis and treatment in cases of angioedema. Most patients improve when receiving the right treatment. Recurrent angioedema events even with treatment, the physician must search for malignity and/or autoimmunity disease.