Evaluation of a Three-Dimensional Stereophotogrammetric Method to Identify and Measure the Palatal Surface Area in Children With Unilateral Cleft Lip and Palate.

OBJECTIVE: To assess a three-dimensional (3D) stereophotogrammetric method for area delimitation and evaluation of the dental arches of children with unilateral cleft lip and palate (UCLP). Obtained data were also used to assess the 3D changes occurring in the maxillary arch with the use of orthopedic therapy prior to rhinocheiloplasty and before the first year of life. DESIGN: Within the collaboration between the Università degli Studi di Milano (Italy) and the University CES of Medellin (Colombia), 96 palatal cast models obtained from neonatal patients with UCLP were analyzed using a 3D stereophotogrammetric imaging system. MAIN OUTCOME MEASURES: The area of the minor and greater cleft segments on the digital dental cast surface were delineated by the visualization tool of the stereophotogrammetric software and then examined. "Trueness" of the measurements, as well as systematic and random errors between operators' tracings ("precision") were calculated. RESULTS: The method gave area measurements close to true values (errors lower than 2%), without systematic measurement errors for tracings by both interoperators and intraoperators (P > .05). Statistically significant differences (P < .05) were noted for alveolar segment and time. CONCLUSIONS: Maxillary segments have the potential for growth during presurgical orthopedic treatment in the early neonatal period. The cleft segment delimitation on digital dental casts and area measurements by the 3D stereophotogrammetric system revealed an accurate (true and precise) method for evaluating the stone casts of newborn patients with UCLP.

Janus kinase inhibitors modify the fatty acid profile of extracellular vesicles and modulate the immune response.

Background: Janus kinase inhibitors (jakinibs) are immunomodulators used for treating malignancies, autoimmune diseases, and immunodeficiencies. However, they induce adverse effects such as thrombosis, lymphocytosis, and neutropenia that could be mediated by extracellular vesicles (EVs). These particles are cell membrane-derived structures that transport cellular and environmental molecules and participate in intercellular communication. Jakinibs can modify the content of EVs and enable them to modulate the activity of different components of the immune response. Objective: to evaluate the interactions between immune system components of healthy individuals and EVs derived from monocytic and lymphoid lineage cells generated in the presence of baricitinib (BARI) and itacitinib (ITA) and their possible effects. Methods: EVs were isolated from monocytes (M) and lymphocytes (L) of healthy individuals, as well as from U937 (U) and Jurkat (J) cells exposed to non-cytotoxic concentrations of BARI, ITA, and dimethyl sulfoxide (DMSO; vehicle control). The binding to and engulfment of EVs by peripheral blood leukocytes of healthy individuals were analyzed by flow cytometry using CFSE-stained EVs and anti-CD45-PeCy7 mAb-labeled whole blood. The effect of EVs on respiratory burst, T-cell activation and proliferation, cytokine synthesis, and platelet aggregation was evaluated. Respiratory burst was assessed in PMA-stimulated neutrophils by the dihydrorhodamine (DHR) test and flow cytometry. T-cell activation and proliferation and cytokine production were assessed in CFSE-stained PBMC cultures stimulated with PHA; expression of the T-cell activation markers CD25 and CD69 and T-cell proliferation were analyzed by flow cytometry, and the cytokine levels were quantified in culture supernatants by Luminex assays. Platelet aggregation was analyzed in platelet-rich plasma (PRP) samples by light transmission aggregometry. The EVs' fatty acid (FA) profile was analyzed using methyl ester derivatization followed by gas chromatography. Results: ITA exposure during the generation of EVs modified the size of the EVs released; however, treatment with DMSO and BARI did not alter the size of EVs generated from U937 and Jurkat cells. Circulating neutrophils, lymphocytes, and monocytes showed a 2-fold greater tendency to internalize ITA-U-EVs than their respective DMSO control. The neutrophil respiratory burst was attenuated in greater extent by M-EVs than by L-EVs. Autologous ITA-M-EVs reduced T-cell proliferation by decreasing IL-2 levels and CD25 expression independently of CD69. A higher accumulation of pro-inflammatory cytokines was observed in PHA-stimulated PBMC cultures exposed to M-EVs than to L-EVs; this difference may be related to the higher myristate content of M-EVs. Platelet aggregation increased in the presence of ITA-L/M-EVs by a mechanism presumably dependent on the high arachidonic acid content of the vesicles. Conclusions: Cellular origin and jakinib exposure modify the FA profile of EVs, enabling them, in turn, to modulate neutrophil respiratory burst, T-cell proliferation, and platelet aggregation. The increased T-cell proliferation induced by BARI-L/M-EVs could explain the lymphocytosis observed in patients treated with BARI. The higher proportion of arachidonic acid in the FA content of ITA-L/M-EVs could be related to the thrombosis described in patients treated with ITA. EVs also induced a decrease in the respiratory burst of neutrophils.

A systematic review of barriers to accessing cleft care worldwide.

PURPOSE: Patients with cleft lip/palate need an interdisciplinary approach. Delays in the care of these patients and difficulties in accessing health services have been reported in different low-, middle-, and high-income countries. This study aimed to characterize worldwide publications on access to cleft lip and palate health treatment. METHODS: Databases were selected systematically and searched until July 2021. The review process followed standard methods for systematic reviews. The study quality was evaluated using the Strengthening the Reporting of Observational studies in Epidemiology guidelines for observational studies. RESULTS: A total of 289 publications were identified using our search strategy. After reviewing the titles and reading the abstracts and full text, 16 studies met the inclusion criteria in the review. In one study, financial difficulties obtained the attention of the professionals who attended to cleft lip/palate patients. Ethnic disparities, problems in transportation, and long distances between users and health centers were found. Additionally, there was misinformation about treatment and follow-up among the caregivers of patients with cleft lip/palate. CONCLUSION: When reviewing the literature on access to health services for patients with cleft lip/palate, barriers were reported in access to information, physical access to care centers, financial resources to cover expenses for treatment, and opportunities in care.

Microgeographic body size variation in a high elevation Andean anole (Anolis mariarum; Squamata, Polychrotidae).

Intra-specific body size variation is common and often is assumed to be adaptive. Studies of body size variation among sites should include or consider environmental and ecological variables in their designs. Additionally, reciprocal transplant or common garden studies will support which variables are really contributing to the observed body size variation. This study analyzed the microgeographic body size variation in Anolis mariarum, a small lizard endemic to Antioquia, Colombia. Parameters such as body size, shape, and lepidosis variation were quantified in 217 adult A. mariarum, belonging to six populations separated by less than 80km. Results showed that significant body size variation was not related to differences among sites in mean annual temperature, but covaried with mean annual precipitation, with the largest individuals occurring in dryer sites. Mark-recapture data obtained from 115 individuals from both the wettest and dryest sites from October 2004 to April 2005 showed that growth rates were higher at the latter. Eight males from each site were captured at the end of the mark-recapture study and reared for two months under identical conditions in a common garden study. Individuals from both sites grew faster when reared in the laboratory with food provided ad libitum. Although growth rates of males from the two populations did not differ significantly in the laboratory, males from the dryest site still maintained a significantly larger asymptotic body size in their growth trajectories. Multivariate analyses also demonstrated that both males and females from the six populations differed in terms of body shape and lepidosis. However, only female body size was found to covary significantly with an environmental gradient (precipitation). A. mariarum does not conform to Bergmann's rule, but the relationship found between mean body size and asympotic growth with mean annual precipitation at these sites needs further analysis. Generally, studies of intra-specific body size variation should consider a number of additional phenotypic traits to provide stronger baseline information on the degree of overall divergence among populations, including those likely to be selectively neutral, before interpreting results of analyses on the body size differences.

A PREDICTIVE MODEL FOR AXILLARY LYMPH NODE PATHOLOGIC COMPLETE RESPONSE IN PREMENOPAUSAL BREAST CANCER PATIENTS AFTER NEOADJUVANT CHEMOTHERAPY: A CROSS-SECTIONAL STUDY IN A L ATIN-AMERICAN POPULATION / Um modelo preditivo para a resposta patológica completa axilar em pacientes com câncer de mama premenopausal após quimioterapia adjuvante: estudo transversal em uma população latino-americana

Introduction: A large group of lymph node-positive breast cancer patients receive neoadjuvant chemotherapy and subsequently undergo axillary lymph node dissection. It has been previously proposed that axillary lymph node dissection may be avoided ­ and it's associated reduced morbidity ­ in patients showing pathologic complete response. Therefore, the purpose of this study was to develop a nomogram to predict axillary node pathologic response to neoadjuvant chemotherapy in breast cancer patients in order to guide the surgical treatment decision-making process for this group of patients. Methods: A cross-sectional, secondary data study was carried out between 2013-2016 on 222 lymph node-positive breast cancer patients who received neoadjuvant chemotherapy followed by locoregional management, including axillary lymph node dissection. Logistic regression analysis was performed to determine the association of the axillary pathologic complete response with the different clinical and pathological variables. Variables found to be statistically significantly associated with axillary pCR (pathologic complete response) were used to create the logistic regression model and the nomogram in pre-menopausal patients. Axillary pCR was defined as absence of residual disease in the breast and of micro-metastasis in axillary lymph nodes. Samples with isolated tumor cells were considered as positive for residual disease. Results: a total of 222 patients were included, of which 131 were premenopausal at the time of diagnosis. Axillary pathologic complete response was observed in 55.7% (73 of 131) of patients, and was significantly associated with estrogen receptor (ER) negative tumors (OR 2.59, 95%CI 1.21-5.53), progesterone receptor (PR) negative tumors (OR 2.63, 95%CI 1.28-5.38), and Her2 positive tumors (OR 0.40, 95%CI 0.19-0.84), for which a significant correlation with increased probability of achieving axillary pathologic complete response was evidenced. Conclusion: The performance of this model to predict axillary pCR in pre-menopausal patients was weak, and therefore the decision to avoid surgical axillary dissection should not be based solely on the developed nomogram. However, further studies may lead to validation of this model

Introdução: Um grande grupo de pacientes com câncer de mama linfonodo-positivo recebe quimioterapia neoadjuvante, que subsequentemente são submetidos a dissecção de linfonodos axilares. Foi proposto anteriormente que a dissecção de linfonodos axilares pode ser evitada ­ assim como a redução de sua morbidade - em pacientes que apresentam resposta patológica completa. Portanto, o objetivo deste estudo foi desenvolver um nomograma para prever a resposta patológica do linfonodo axilar à quimioterapia neoadjuvante em pacientes com câncer de mama, a fim de orientar o processo de decisão do tratamento cirúrgico para este grupo de pacientes. Metodologia: Foi realizado um estudo transversal, de dados secundários, entre os anos de 2013-2016 em 222 pacientes com câncer de mama linfonodo-positivo, que receberam quimioterapia neoadjuvante seguida de tratamento locorregional, incluindo dissecção de linfonodos axilares. A análise de regressão logística foi realizada para determinar a associação da resposta completa patológica axilar com as diferentes variáveis clínicas e patológicas. Variáveis estatisticamente associadas à pCR axilar (resposta completa patológica) foram usadas para criar o modelo de regressão logística e nomograma em pacientes na pré-menopausa. A pCR axilar foi definida como ausência de doença residual na mama e de micro-metástase nos linfonodos axilares. Amostras com células tumorais isoladas foram consideradas positivas para doença residual. Resultados: foram incluídos 222 pacientes, dos quais 131 estavam na prémenopausa no momento do diagnóstico. A resposta patológica axilar completa foi observada em 55,7% (73 de 131) dos pacientes, e foi significativamente associada a tumores negativos para receptores de estrogênio(RE) (OR 2,59; IC 95% 1,21-5,53) e negativos para receptores de progesterona (RP) (OR 2.63, IC 95% 1.28-5.38), e Her2 positivos (OR 0.40, IC 95% 0.19-0.84), para o qual foi evidenciada uma correlação significativa com o aumento da probabilidade de atingir resposta completa patológica axilar. Conclusão: O desempenho deste modelo para prever a pCR axilar em pacientes na pré-menopausa era fraco e, portanto, a decisão de evitar a dissecção axilar cirúrgica não deve ser baseada apenas no nomograma desenvolvido. No entanto, estudos posteriores podem levar à validação desse modelo

Nasal changes with nasoalveolar molding in Colombian patients with unilateral cleft lip and palate.

PURPOSE: Presurgical nasoalveolar molding (PNAM) is controversial in maxillofacial orthopedics. It supposedly improves the nasal esthetics and function in unilateral cleft lip/palate (UCLP) patients. However, there is no research available in South America to support this claim. The purpose of this study was to evaluate the efficacy of presurgical nasoalveolar molding therapy on morphological changes of the noses of unilateral cleft lip/palate patients in a Colombian sample. METHODS: Seventeen neonate UCLP patients using PNAM received facial impressions at the beginning of treatment; before primary rhinocheiloplasty; and before palatoplasty. A submentovertex photograph of each cast was taken and analyzed by digital photogrammetry. Wilcoxon and Friedman tests were used for within- and between-group comparisons. RESULTS: A statistically significant reduction of cleft nostril width, without significant changes in noncleft nostril width or total nasal width, was found after PNAM. A significant increase in cleft and noncleft nostril height, plus a nonsignificant increase in nostril area in both sides and a nonsignificant uprighting of the columella were found. These changes were maintained or further improved after rhinocheiloplasty. CONCLUSION: The presurgical nasoalveolar molding technique improved nasal tip projection and alar cartilage depression and decreased partially columella deviation before rhinocheiloplasty in South American unilateral cleft lip/palate patients.

Hábitos alimentarios de las familias que pertenecen al programa de complementación alimentaria, desayunos infantiles MANÁ con amor / Eating habits of families belonging to the eating complementary program, children's breakfast mana' with love

Introducción: el departamento de Antioquia presenta una grave problemática de seguridad alimentaria con las más altas tasas de mortalidad infantil por desnutrición. El objetivo de esta investigación es identificar los hábitos alimentarios de la población del Bajo Cauca que pertenecen al programa MANÁ InfantilCMétodos: estudio descriptivo transversal, muestra a conveniencia de 350 cuidadores de niños inscritos en el programa. Se analizaron medidas de tendencia central y dispersión, frecuencias absolutas y relativas.Resultados: el 96.3% de las familias reciben algún complemento alimentario: la responsabilidad frente a la alimentación la asume la madre en el 72% de los casos.En cuanto al consumo de alimentos en los niños, la leche ocupa el primer lugarcon un 75.6%, seguido por cereales y dulces con un 63.7%.Conclusión: a pesar del acceso a programas de complementación alimentaria, la tasa de desnutrición en la zona sigue siendo una de las más altas en el país.

A retrospective characterization study on patients with oral clefts in Medellín, Colombia, South America / Un estudio retrospectivo de caracterización en pacientes con fisurasorales en Medellín, Colombia, Suramérica

Introduction: the objective of this study was to make a clinical and epidemiological characterization of the patients with cleft lip and/or palate (CLP) who consulted at the Children’s Hospital Clínica Noel Foundation of Medellín, Colombia, South America, between 1985 and 2003. Methods: 919 clinical records were evaluated for a descriptive, longitudinal, retrospective study. A univariate statistical analysis was used for the qualitative variables, and descriptive measures for the quantitative ones. A two-variate statistical analysis was performed in order to determine the association among the qualitative variables with a significance level of 5%. Results: 50.3% of the cases were classified as unilateral and 19.8% as bilateral. Among the unilateral ones, 59.0% were located at the left side and 41.3% at the right side. 3.4% presented cleft lip, 12.4% presented cleft palate, and 12.8% presented cleft soft palate. 1.2% of the sample did not present pathology classification. In terms of gender, males represented 48.0% and females 38.1%; no data was found in 13.9% of the cases. Concerning location, 87.3% of the patients came from the State of Antioquia. As for age at the time of admission to the institution, 44.3% of the children were less than thirty days old. Most parents were between nineteen and thirty years old. Most medical records did not show reports on the father or mother’s family history, diseases during pregnancy or tobacco and alcohol consumption during pregnancy. Conclusions: this study evaluated the clinical records used at the Clínica Noel Foundation. As a result, we recommend to homogenize the professionals who fill in the records and to standardize the instruments in order to generate reliable databases for future research.

Introducción: el objetivo de este estudio consistió en caracterizar clínica y epidemiológicamente pacientes con labio y/o paladar hendido (LPH) que consultaron el Hospital Infantil Clínica Noel de Medellín, Colombia, entre 1985 y 2003. Métodos: se evaluaron 919 historias clínicas, para un estudio de tipo descriptivo, longitudinal y retrospectivo. Se realizó un análisis univariado para las variables cualitativas, y medidas descriptivas para las variables cuantitativas. Se realizó análisis bivariado para determinar la asociación entre las variables cualitativas con un nivel de significancia del 5%. Resultados: 50,3% de los casos fueron clasificados como unilaterales y 19,8% como bilaterales. Dentro de los unilaterales, el 59,0% se presentaron al lado izquierdo y el 41,3% al lado derecho. El 3,4% presentó labio hendido, el 12,4% presentó paladar duro hendido, y el 12,8% presentó paladar blando hendido. El 1,2% de la muestra no incluía clasificación de la patología. En cuanto al sexo, los hombres representaron 48,0% y las mujeres 38,1%; no se encontraron datos en el 13,9%. El 87,3% de los pacientes provenían del departamento de Antioquia. La edad predominante de ingreso a la Fundación fue antes de treinta días de nacido. La mayoría delos padres estaban entre diecinueve y 30 años de edad. La mayoría de las historias clínicas no tenían reporte acerca de historia familiar de la madre y el padre, enfermedades sufridas durante el embarazo o consumo de cigarrillo y bebidas alcohólicas durante el embarazo. Conclusiones: este estudio permitió evaluar la historia clínica usada en la Fundación Clínica Noel. Se sugiere calibrar los profesionales que diligencian los registros, y estandarizar los instrumentos para generar una base de datos confiable para futuras investigaciones.

Microgeographic body size variation in a high elevation Andean anole (Anolis mariarum; Squamata, Polychrotidae)

Intra-specific body size variation is common and often is assumed to be adaptive. Studies of body size variation among sites should include or consider environmental and ecological variables in their designs. Additionally, reciprocal transplant or common garden studies will support which variables are really contributing to the observed body size variation. This study analyzed the microgeographic body size variation in Anolis mariarum, a small lizard endemic to Antioquia, Colombia. Parameters such as body size, shape, and lepidosis variation were quantified in 217 adult A. mariarum, belonging to six populations separated by less than 80km. Results showed that significant body size variation was not related to differences among sites in mean annual temperature, but covaried with mean annual precipitation, with the largest individuals occurring in dryer sites. Mark-recapture data obtained from 115 individuals from both the wettest and dryest sites from October 2004 to April 2005 showed that growth rates were higher at the latter. Eight males from each site were captured at the end of the mark- recapture study and reared for two months under identical conditions in a common garden study. Individuals from both sites grew faster when reared in the laboratory with food provided ad libitum. Although growth rates of males from the two populations did not differ significantly in the laboratory, males from the dryest site still maintained a significantly larger asymptotic body size in their growth trajectories. Multivariate analyses also demonstrated that both males and females from the six populations differed in terms of body shape and lepidosis. However, only female body size was found to covary significantly with an environmental gradient (precipitation). A. mariarum does not conform to Bergmann’s rule, but the relationship found between mean body size and asympotic growth with mean annual precipitation at these sites needs further analysis. Generally, studies of intra-specific body size variation should consider a number of additional phenotypic traits to provide stronger baseline information on the degree of overall divergence among populations, including those likely to be selectively neutral, before interpreting results of analyses on the body size differences. Rev. Biol. Trop. 57 (4): 1253-1262. Epub 2009 December 01.

Se reporta diferencias en el tamaño corporal entre individuos adultos de seis poblaciones de Anolis mariarum (Squamata: Polychrotidae), separadas por una distancia de hasta 80km. Esta variación no se relacionó con las diferencias en las temperaturas promedio anuales que existen entre los sitios analizados, pero sí covarió con la precipitación promedio anual, con los individuos de mayor talla habitando los sitios más secos. Datos de marca- recaptura del sitio más seco y más húmedo, mostraron que los individuos del sitio más seco tienen mayores tasas de crecimiento corporal. Bajo condiciones de laboratorio con alimento ad libitum, machos de ambos sitios crecieron más rápido que en condiciones naturales. Aunque las tasas de crecimiento de machos de las dos poblaciones no difirieron significativamente en el laboratorio, los machos del sitio más seco mantuvieron tamaños corporales asintóticos en sus trayectorias de crecimiento que fueron significativamente mayores. Análisis multivariados mostraron que tanto los machos como las hembras de las seis poblaciones difieren en la forma corporal y en lepiodosis, pero la única variable que covarió de manera significativa con un gradiente ambiental fue el tamaño corporal con la precipitación. Estudios de variación intraespecífica en el tamaño corporal deben considerar otras características fenotípicas adicionales para obtener una línea base sobre el grado de divergencia entre poblaciones, incluso aquellas que se consideran neutrales.

Rehabilitación temprana de los maxilares en pacientes con labio y paladar hendido bilateral utilizando un dispositivo ortopédico dinámico intraoral, cinta adhesiva labial y gingivoperiosteoplastia: estudio piloto experimental / Early maxillary rehabilitation of bilateral cleft lip and palate patients using an intraoral dynamic orthopedic appliance, lip tape adhesion and gingivoperiosteoplasty: experimental pilot study

Introducción: el objetivo fue corroborar la respuesta ortopédica de los componentes alveolares al dispositivo ortopédico dinámico intraoral propuesto en el estudio piloto realizado por el mismo grupo investigador, combinado con la utilización de una cinta adhesiva sobre el labio y la gingivoperiosteoplastia (GPP) en una población colombiana. Métodos: denueve pacientes con LPHB entre los cinco y diez meses de edad, se seleccionaron seis pacientes, cuatro hombres y dos mujeres. Se les implantó el dispositivo dinámico y la cinta adhesiva durante un promedio de 3,5 semanas. Después de obtener el resultado ortopédico se les realizó la GPP y la rinoqueiloplastia primaria. Se obtuvieron modelos maxilares antes y después del tratamiento ortopédico, donde se tomaron medidas directamente con un calibrador digital y se compararon entre sí. Se evaluó la formación ósea cualitativamente con tomografías computarizadas, seis meses después de realizada la GPP. Se les hizo análisis estadístico descriptivo. Resultados: en todos los pacientes se logró retracción óptima de la premaxila. Cuatro de los seis pacientes requirieron expansión anterior. Hubo neoformación ósea en los ocho sitios donde se realizó la GPP. Conclusiones: el uso del dispositivo ortopédico dinámico y la cinta adhesiva sobre el labio permite disminuir las discrepancias entre los segmentos maxilares enpacientes con LPHB. La gingivoperiosteoplastia hecha en este esquema de tratamiento actúa como un procedimiento osteoinductor que propicia la neoformación ósea. Se corroboraron los hallazgos del estudio piloto realizado por el mismo grupo investigador y representa una opción terapéutica para pacientes con LPHB en nuestra comunidad.

Introduction: the purpose of this study was to corroborate the orthopaedic alveolar results of dynamic orthopaedic devices used in the pilot study by the same research group, combined with the use of an adhesive tape over the lip and gingivoperiostioplasty in a Colombian population. Methods: 6 patients with complete bilateral cleft lip and palate, 4 males and 2 females were selected out of 9 patients between five and ten months of age. The dynamic orthopaedic device and the adhesive tape were used during an average time of 3.5 weeks. After obtaining the orthopaedic result, the gingivoperiostioplasty and rhinoplasty were performed. Comparisons between before and after treatment casts were analyzed with an electronic digital calliper. The boneformation was evaluated with a dental CT scan after a period of 6 months. Descriptive statistical analysis was used. Results: every patient after orthopaedic treatment retracted the premaxilla, four of the six patients studied required anterior alveolar expansion. There was bone formation in the 8 sites where the gingivoperiostioplasty was performed. Conclusion: the use of the dynamic orthopaedic device and the adhesive tape over the lip decreased the discrepancies in maxillary segments of bilateral cleft lip and palate patients. The gingivoperiosteoplasty performed in this protocol serves as an osteo-inductor suitable for bone formation. This study corroborates the pilot study by the same research group and represents a practical option for the treatment in cases with protrusion of the premaxilar in our community.

Los niños tienen la palabra: nuestras bocas sanas para una vida sana / Children have the word: our healthy mouths for a healthy life

Introducción y Objetivo: La niñez es una etapa de la vida que se considera decisiva para el adecuado desarrollo de los seres humanos, y esta fue la motivación para ejecutar un programa de intervención comunitaria, familiar e individual, orientado a la promoción de la salud general y bucal, en la vereda Tierradentro, municipio de Bello Antioquia, durante los años 2005 y 2006. Materiales y Métodos: El programa se realizó en tres fases: (1) Diagnóstica: Identificación de las principales características de la población involucrada. (2) Intervención: Estrategias de información, educación y comunicación, buscando negociación de saberes e incorporación de aprendizajes para una vida sana. (3) Evaluación: Identificación de resultados alcanzados. Resultados: Sensibilización de la comunidad educativa (profesores y estudiantes) sobre la importancia de la salud bucal; posicionamiento de hábitos de higiene bucal en la cotidianidad de la escuela; reducción de valores del Índice de Higiene Oral; atención a necesidades básicas de salud bucal y general; aprendizaje de los estudiantes de Odontología del CES, sobre las características y el compromiso que requiere el trabajo comunitario. Conclusión: El trabajo comunitario con propósitos educativos es posible y productivo y los resultados permanecerán en el tiempo, si hay participación y compromiso de todos los actores implicados y los objetivos se integran al diario vivir de las comunidades.

Introduction and Objective: To execute a community, family and individual intervention program, oriented towards the promotion of the general and oral health in Tierradentro Community in Bello during 2005 and 2006. Materials and Methods: The intervention program was carried out into three phases: (1) Diagnosis: Identification of the characteristics of the population, priorities, existent support networks, needs, main health - illness problems and their conditions. (2) Intervention: information, education and communication strategies, aimed to incorporate healthy lifestyle habits. (3) Evaluation: Identification of results and impact of the therapy in terms of the incorporation of new knowledge, attitudes and skills for general and oral health. Results: Sensibilization of the educational community (teachers and students) on the importance of oral health, incorporation of daily routine oral habits within school activities, reduction of the Oral Hygiene Index, attention of basic oral health needs was obtained. Motivation of CES Dental students on the characteristics and commitment required for community work was gathered as well. Conclusion: Community work with educational purposes is possible and results will have long-term effect only if there is participation and commitment of all actors implied and if the results are incorporated in the daily lifestyle of the community. The program should be assumed by the Local Direction of Health.

Rehabilitación temprana del paciente con labio y paladar hendido bilateral utilizando un dispositivo ortopédico y gingivo-periosteoplasty: pilot study / Early rehabilitation of bilateral cleft lipand palate patients using an orthopaedic appliance and gingivo-periosteoplasty: pilot study

Introducción: la reposición de la premaxila en los casos de labio y paladar hendido bilateral (LPHB) por medio de dispositivos intraorales ha sido un aspecto controvertido en su tratamiento. En este estudio se presenta una propuesta terapéutica de ortopedia dinámica intraoral temprana para nuestra comunidad. El objetivo fue evaluar los resultados obtenidos por el uso de un dispositivo intraoral muco-óseo-soportado, acompañado de la cirugía de gingivoperiosteoplastia como parte del cierre primario del labio en los casos de LPHB completo. Métodos: se evaluaron 4 sujetos de 20 semanas de nacidos con LPHB completo, 3 hombres y una mujer. A todos los pacientes se les implantó un dispositivo intraoral muco-óseo-soportado. Después de obtener el resultado ortopédico se les realizó la gingivoperiosteoplastia y la rinoqueiloplastia primaria. Se compararon los modelos del arco maxilar, antes y después del tratamiento ortopédico mediante mediciones digitales a las cuales se les realizo análisis estadístico descriptivo y se evaluó la formación ósea con tomografías computarizadas, 6 meses después de realizada la gingivoperiosteoplastia. Resultados: en cada uno de los pacientes se logró una retracción de la premaxila y una alineación alveolar satisfactoria. Hubo formación ósea en 3 de los 6 sitios en los que se realizó la gingivoperiosteoplastia. Conclusiones: la ortopedia dinámica intraoral temprana con este tipo de dispositivo mejora la posición de la premaxila y de los segmentos laterales en los casos de LPHB y propicia la neoformación ósea en el sitio de la fisura cuando se acompaña de la gingivoperiosteoplastia. Los resultados sugieren que este dispositivo ortopédico intraoral es una opción terapéutica para pacientes con LPHB en nuestra comunidad.