[Impact of cognitive biases in therapeutic inertia in arterial hypertension: Not everything is as it seems]. / Impacto de los sesgos cognitivos en la inercia terapéutica en hipertensión arterial: no todo es lo que parece.

Therapeutic inertia is defined as the failure to take therapeutic decisions, such as initiating, adding or increasing the dose of a drug during patient follow-up, despite there being an indication to do so. It is currently considered that therapeutic inertia is a considerable impediment to achieving adequate control of hypertension, and this has implications for the prognosis of the disease. Therapeutic inertia might be due to various factors involving physicians, patients and the health system. Many studies have attempted to find determinants for therapeutic inertia in hypertension and to explain the reasons why health professionals in charge of treatment are failing to make the appropriate modifications to therapy. The many reasons for therapeutic inertia on the part of physicians include the various cognitive and affective biases that influence clinical reasoning and decision-making during healthcare activity in doctors' surgeries. Identifying and recognising these cognitive and affective biases could be important for planning educational strategies for health professionals. This requires a multi-dimensional approach, including knowledge beyond that observed in terms of insufficient information and updating on the disease, and starting to analyse and consider other reasons. Preventing therapeutic inertia should be made a priority along with other important measures to control hypertension and minimise its consequences.

[Analysis of Argentine scientific production in MEDLINE in the area of hypertension]. / Análisis de la producción científica argentina en MEDLINE en el área hipertensión arterial.

INTRODUCTION: Argentine science has played an important role in the study of blood pressure. However, this scientific production has not been classified. We set out (1) to analyse the contribution of scientific publications indexed in MEDLINE of authors with Argentinean academic affiliation in the field of blood pressure and hypertension in the last 50 years and, (2) determine the characteristics of the scientific journals in which they were published. METHODS: The 831 indexed MEDLINE publications by authors from Argentina were analysed quantitatively and qualitatively (period 1966-2017). RESULTS: The number of publications has increased 5.4 times in the last 20 years. Eighty percent of the publications were original manuscripts and 15% reviews. Sixty-five percent of the publications addressed clinical research, 33% basic research. The average authors per paper was 6 (89% as first author), 74% belonged to public institutions. The research was published in journals published in the United States (36%), the United Kingdom (27%), the Netherlands (12%), Spain (6%) and Argentina (4%). Eighteen percent of the publications were in journals with impact factor >3.88 (first quartile). Only 5% accessed journals with a factor ≥10. The average SJR index was 1.66. CONCLUSIONS: Argentine scientific production in MEDLINE in the field of blood pressure and hypertension showed constant growth. The vast majority is original research, directed by researchers with affiliation to public institutions. Foreign journals are accessed in the main, with acceptable quality indexes.

White matter lesions in migraine and right-to-left shunt: a conventional and diffusion MRI study.

Subjects with migraine with aura (MA) have a high prevalence of white matter lesions (WMLs) on magnetic resonance imaging (MRI). Moreover, right-to-left shunt (RILES), mainly due to patent foramen ovale, is frequently associated with MA. The aim of this study was to clarify the relationship between RILES and WML in MA. We enrolled 87 consecutive subjects affected by MA. Patients were screened for migraine characteristics and cerebrovascular risk factors. Transcranial Doppler was used to diagnose RILES and MRI with T2-weighted and diffusion-weighted imaging (DWI) to evaluate presence, number and volume of WMLs. RILES was present in 45% of patients. We did not detect any DWI hyperintense lesion; WMLs were present in 61% of patients on T2-weighted images. Presence of WMLs did not correlate with any migraine clinical feature, whereas the presence, number and volume of WMLs increased with subjects' age. There was no significant difference in the total volume and number of WMLs in the group with and without RILES. In conclusion, RILES does not increase the likelihood of finding WMLs in migraineurs.

[Prevalence of metabolic syndrome in Argentina in the last 25 years: systematic review of population observational studies]. / Prevalencia del síndrome metabólico en Argentina en los últimos 25 años: revisión sistemática de estudios observacionales poblacionales.

INTRODUCTION AND AIM: Metabolic syndrome (MS) comprises a set of risk factors for cardiovascular disease and diabetes. Argentina has numerous epidemiological studies on MS, however, there has been no systematic analysis of the prevalence of MS in our population. To estimate the prevalence of MS in the Argentine Republic, a systematic review of observational studies published during the period 1988-2014 was carried out. SEARCH STRATEGY: A bibliographic search was conducted in the MEDLINE (National Library of Medicine), SciELO (Scientific Electronic Library Online) and LILACS (Latin American and Caribbean Health Sciences Literature) databases on studies conducted in Argentina between January 1989 and December 2014. The following search terms were combined in English, Spanish and Portuguese: 'metabolic syndrome', 'insulin resistance', 'dysmetabolic syndrome', 'prevalence', 'epidemiology', and 'Argentina'. SELECTION OF STUDIES: Epidemiological studies based on the adult population of Argentina with specific report of the prevalence of MS (according to the WHO, ATP III or IDF criteria) were included in the analysis. SYNTHESIS RESULTS: In the initial bibliographic search, 400 publications were identified. In the second phase of search, 296 titles and abstracts were excluded. In the third phase, the full text of 104 studies was analyzed. Finally, 6 publications were included in the analysis that reported the prevalence of MS in a total of 10,191 subjects (39.6% male). The average age of the population was 45.2 years. The prevalence of MS (random effects model) was 27.5% (95% CI: 21.3%-34.1%). The prevalence of MS was higher in men than in women (29.4% vs. 27.4%, respectively, P=.02). In order of frequency, the most common components of MS were dyslipidaemia (38.3%), hypertension (33.4%), obesity (32.1%) and diabetes (7.5%). CONCLUSIONS: Our data show that the prevalence of MS is high, which represents a very important public health problem in Argentina.

Effect of copolymer-1 on serial gadolinium-enhanced MRI in relapsing remitting multiple sclerosis.

We examined the effect of Copolymer-1 (Cop1) on magnetic resonance (MR) imaging changes in 10 patients with relapsing-remitting multiple sclerosis (RRMS). Monthly gadolinium (Gd)-enhanced MR imaging was performed for 9 to 27 months in the pretreatment period followed by 10 to 14 additional months during Cop1 treatment. MR images were evaluated by two radiologists (F.S. and R.C.P.) masked to the scan date. We found a 57% decrease in the frequency of new Gd-enhancing lesions and in the mean area/month of new Gd-enhancing lesions in the Cop1 treatment period compared with the pretreatment period (0.92 versus 2.20 lesions per month and 22 mm2 versus 43 mm2 area/month; p = 0.1, Wilcoxon signed rank test). Percentage change in lesion load area on T2-weighted images showed a decrease in the accumulation of lesion area during treatment, which was significant for the patient group with a longer pretreatment period (p = 0.05, Friedman test). These results demonstrate a reduction in the number of new Gd-enhancing lesions and in the lesion load during Cop1 treatment compared with the preceding period without therapy and are suggestive of an effect of Cop1 on MR abnormalities observed in multiple sclerosis.

Application of slow-resorbing collagen membrane to periodontal and peri-implant guided tissue regeneration.

The utilization of resorbable membranes in the guided tissue regeneration technique allows unquestionable advantages for both the dentist and patient. Collagen is an important constitutive element of the human body and therefore is biodegradable. This study deals with a new slow-resorbing collagen membrane that, when used in conjunction with hydroxyapatite, brings about very interesting results for the treatment of periodontal and peri-implant defects.

The use of a slowly resorbable collagen barrier in the regeneration of bone in deep wide defects: a case report.

This paper presents a case in which a resorbable collagen membrane and a collagen-based spacemaker and root surface conditioning were used in a guided tissue regeneration procedure. There was no need to disturb the healing potential of the underlying selected cells with an early reentry procedure. Clinical postoperative findings at the time of surgery and in an 18-month follow-up and the differences in density of the mineralized tissues, as detected by standardized series of juxtagingival radiographs and during surgical reentry, showed encouraging results in bone regeneration and soft tissue management.

Implant placement in large edentulous ridges expanded by GBR using a bioresorbable collagen membrane.

The purpose of this study is to evaluate the possibility of expanding an edentulous ridge spanning two or more teeth by a two-step technique with bioresorbable collagen membranes. Sixteen healthy patients were treated, four in the mandible and 12 in the maxilla. The borderline of the crest width was less than or equal to 4 mm. In each patient only one ridge augmentation was performed. After elevation of a full-thickness flap, a surgical stent was positioned to identify the area of ideal implant positioning. The width of the crest at the location of the surgical stent was measured at the time of GBR procedure and 7 to 12 months later during implant insertion. Native collagen sponges were placed buccally and lingually, and a collagen membrane was shaped and trimmed to completely cover the edentulous ridge. The flaps were sutured to achieve primary closure. Antibiotic and clorhexidine mouthrinse were prescribed, and the patients were recalled every 2 weeks. At implant placement, the mean increase in the size of the crest was 2.49 mm (+/- 1.61 mm). In 12 out of 16 patients (75%) it was possible to insert 27 implants according to the prosthetic need established previously. All implants were successfully loaded, and in the four cases where no appreciable results were obtained, no clinical complications or loss of hard and soft tissue were observed.

Use of Emdogain in the treatment of deep intrabony defects: 12-month clinical results. Histologic and radiographic evaluation.

The objective of this study was to evaluate the application of an enamel matrix derivative (Emdogain) in deep periodontal pocket therapy. Twenty-one patients presenting intrabony and interproximal defects that could be treated with guided tissue regeneration were selected. The intrabony defects were divided into deep (< 9 mm) and very deep (> or = 9 mm) defects. Bleeding on probing, Plaque Index, probing pocket depth, mobility index, gingival recession, probing attachment level, and surgical bone level were measured at baseline. At 12 months, cases were reexamined and indices recorded again. The mean probing depth decreased from 8.1 +/- 2.1 mm to 3.2 +/- 1.5 mm; attachment level decreased from 10.4 +/- 2.4 mm to 7.0 +/- 1.8 mm; recession increased from 2.3 +/- 1.4 mm to 3.8 +/- 1.8 mm; and surgical bone level decreased from 9.6 +/- 1.9 mm to 7.1 +/- 1.5 mm. No significant difference wa noted between bone defects with one or 2 walls, between local and generalized periodontitis, or between smokers and nonsmokers. Significant statistical difference was found, however, between deep intrabony defects and very deep defects when attachment gain was considered. No adverse reaction to the substance was noted. The good clinical results obtained were not confirmed by radiologic results; standardized and computerized radiographs at 12 months did not reveal significant improvement. The histologic examination carried out on 2 samples did not show evidence of new attachment. Further studies are necessary to clarify the action mechanism and to evaluate the long-term results of this method.

Guided tissue regeneration employing a collagen membrane in a human periodontal bone defect: a histologic evaluation.

The purpose of this study is to confirm histologically whether a new attachment can be obtained around a tooth by guided tissue regeneration using bioresorbable barrier. The test tooth was a maxillary molar with an intrabony pocket. At reentry 5 months after periodontal surgery, a hard, whitish, blood-free tissue was found to fill the original defect. Histologic analysis revealed presence of new bone, cementum, and periodontal ligament compatible with the expected histologic result of guided tissue regeneration techniques with barrier membrane.