Epidemiology of balance disorders in primary care. / Epidemiología de los trastornos del equilibrio en atención primaria.

BACKGROUND AND OBJECTIVE: In our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures. MATERIALS AND METHOD: Prospective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care. RESULTS: The population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population. CONCLUSIONS: The incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients.

Balance disorders as potential confounders associated with an increased risk of acute cerebrovascular accidents.

PURPOSE: There is a higher risk of stroke after suffering from balance disorders (BDs) such as vertigo or dizziness. The causal relationship remains unclear due to the limited scope of the existing studies and the high prevalence of cardiovascular risk factors (CVRFs) in BD patients. The objective of this study is to clarify the role that BDs seem to have in the development of acute cerebrovascular accidents (ACAs). METHODS: This is an observational prospective study. The CVRFs and demographic factors of a sample of our population were noted. Five clusters of patients were tracked over the course of 2 years to detect and diagnose BDs and ACAs. The causal relationships between the CVRFs, BDs and ACAs were analyzed in a univariate analysis. A logistic regression multivariant analysis was performed on those variables that reached statistical significance. RESULTS: The sample included 7886 participants and 31 ACAs were recorded. CVRFs that reached statistical significance included age ≥ 60, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, atrial fibrillation and previous ACAs. The relationship between BDs and ACAs always reached statistical significance, regardless of how the BD variable was defined. Five different multivariate analyses were performed, but in none of them did the BD variables significantly reduce the deviance and thus, they were not taken into account when building the final model. CONCLUSION: This study shows that BDs are probably confounders that are closely linked to other CVRFs and they are also useful red flags to identify patients at a higher risk of suffering from ACAs.

Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: A randomized clinical trial.

AIM: To evaluate the impact of two non-surgical periodontal treatment modalities on metabolic and periodontal clinical parameters in subjects with type 2 diabetes mellitus (T2DM) and poor glycaemic control and chronic periodontitis. MATERIAL AND METHODS: A randomized controlled clinical trial was conducted. Ninety-three T2DM subjects with glycosylated haemoglobin (HbA1c) > 7% were randomly assigned to one of two groups receiving scaling with root planing in multiple sessions quadrant-by-quadrant (Q by Q) or within 24 hr (one stage). Periodontal parameters, HbA1c, glycaemia blood levels (FPG) and C-reactive protein (CRP) values were assessed at baseline and at 3 and 6 months post-therapy. RESULTS: At 6 months, HbA1c had decreased by 0.48% in the Q by Q group and by 0.18% in the one-stage group (p = 0.455). After therapy, subjects with an initial HbA1c < 9% showed an increase of 0.31% (p = 0.145), compared with a decrease of 0.88% (p = 0.006) in those with an initial HbA1c ≥ 9%. Periodontal parameters improved significantly (p < 0.0001) post-therapy, with similar results for both treatment modalities. CONCLUSION: Periodontal therapy had the greatest impact on HbA1c reduction on patients with an HbA1c > 9% regardless of treatment modality. Both modalities resulted in significant improvements in periodontal parameters.

Preparation of PLGA/Rose Bengal colloidal particles by double emulsion and layer-by-layer for breast cancer treatment.

The use of colloidal particles (CPs) in the transport of drugs is developing rapidly thanks to its effectiveness and biosafety, especially in the treatment of various types of cancer. In this study Rose Bengal/PLGA CPs synthesized by double emulsion (W/O/W) and by electrostatic adsorption (layer-by-layer), were characterized and evaluated as potential breast cancer treatment. CPs were evaluated in terms of size, zeta potential, drug release kinetics and cell viability inhibition efficacy with the triple negative breast cancer cell line HCC70. The results showed that both types of CPs can be an excellent alternative to conventional cancer treatment by taking advantage of the enhanced permeation and retention (EPR) effect, manifested by solid tumors; however, the double emulsion CPs showed more suitable delivery times of up to 60% within two days, while layer-by-layer showed fast release of 50% in 90 min. Both types of CPs were capable to decrease cell viability, which encourage us to further testing in in vivo models to prove their efficacy and feasible use in the treatment of triple negative breast cancer.

Estudio descriptivo de los pacientes con reflujo vesicoureteral intervenidos quirúrgicamente en el hospital infantil universitario Rafael Henao Toro de Manizales (Caldas, Colombia), 2008-2015 / Descriptive study of patients with vesicoureteral reflux, treated surgically at the University Children’s Hospital Rafael Henao Toro Manizales (Caldas, Colombia), 2008-2015

Objetivo: analizar las historias clínicas de los pacientes intervenidos quirúrgicamente por reflujo vesicoureteral en el Hospital Infantil Universitario Rafael Henao Toro de Manizales-Caldas (Colombia) durante los años 2008-2015. Materiales y métodos:estudio descriptivo en el cual se revisaron 50 historias clínicas. Resultados: el género masculino tiene una proporción de 52%, en un 70% la procedencia es de Manizales,54,3% de estrato social 3, la edad promedio es de 3,22±2,81 años. En cuanto a las variables pondoestaturales, los niños tienen un peso promedio de 16,59±10,49 kg,63,3% con peso adecuado para la edad, en promedio la talla es de 98,92±24, 47 cm, 80,6% con talla adecuada para la edad. Referente a las variables clínicas el 70% consulta por fiebre la primera vez, el 77,6% tenían ecografía prenatal, el 16% presentan anomalías extrarrenales, siendo vejiga neurogénica la más frecuente 37,5%, el 32% muestra complicaciones, siendo la infección de las vía urinarias la más frecuente con un 25%, respecto a la lateralidad la afectación del riñón izquierdo fue del 40,8% y se encuentra el parcial de orina alterado en el 85,4%. El método diagnóstico más frecuente fue la ecografía post-natal con un 72%. Conclusiones: en este estudio selogra dilucidar características tanto clínicas y sociodemográficas del reflujo vesicoureteral pero no se logra confirma el perfil epidemiológico de los pacientes encontrado en otros estudios, también se obtiene información sobre los métodos diagnósticos y el manejo más utilizado en esta zona del país.

Objective: to analize medical histories of treated patients by vesicoureteral reflux atHospital Infantil Universitario Rafael Henao Toro from Manizales-Colombia duringyears 2008-2015. Materials and methods: descriptive studies in which 50 medicalhistories were reviewed. Results: male gender has a 52% proportion, in a 70% theorigin from Manizales, 54,3% are in a social stratum number 3, the average age is3.22±2,81 years old. Regarding the pondostaturals variables, kids weight is on average16.59±10,49 kg, 63.3% of them have a porportional weight according to the age, meanwhile the average height is 98,92±24,47 cm, 80,6% have a proportional heightaccording to the age. Relating to medical variables, 70% of consults are due to firsttime fever, 77.6% had a prenatal ecography, 16% have extrarenal abnormalities, beingneurogenic bladder the most frequent with a 37,5%, 32% show complications, beingurinary tract infection the most frequent with a 25%, regarding the laterality left kidney affectation was 40,8% and urine test is altered in the 85,4%. The most frequent method to diagnose was post-natal ecography with a 72%. Conclusions: in this study is possible to elucidate both medicals and sociodemographic characteristics of vesicoureteralreflux nevertheless is not possible to confirm the epidemiologyc profile of the patients found in other studies, also information is obtained about diagnose methods and the most used management in this part of the country.

Routine prophylaxes every 3 months improves chronic periodontitis status in type 2 diabetes.

BACKGROUND: Periodontitis and type 2 diabetes mellitus (T2DM) are major health problems, especially in low-income populations with little access to dental care. Low-cost models for treatment of periodontal disease have not been tested in controlled studies in low-income populations. Dental prophylaxis, which includes removal of supragingival calculus and plaque, has been shown to arrest the progression of periodontitis. A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM. METHODS: Twenty-six patients with T2DM and chronic periodontitis (CP) and 26 without T2DM with CP were selected. Periodontal probing depth (PD), gingival bleeding on probing (BOP), clinical attachment level (CAL), and surfaces with plaque were recorded at baseline and 3, 6, and 9 months after initial treatment. All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months. Glycated hemoglobin (HbA1c) levels were measured at baseline and every 3 months in patients with T2DM. RESULTS: A significant improvement of PD, BOP, and sites with plaque was observed 3 months after treatment in patients with T2DM (P = 0.001). In controls, mean PD significantly improved after 6 months compared with baseline (P = 0.001). No significant improvement of CAL occurred in either group. No significant differences in periodontal parameters between the groups were detected, and no participant showed progression of CP during the 9-month study period. Dental prophylaxis did not influence HbA1c levels, and no association among HbA1c concentration, pretreatment metabolic status, and severity of CP was found. CONCLUSION: Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well-controlled patients with T2DM.

Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a controlled clinical trial.

BACKGROUND: The systemic inflammation in both metabolic syndrome (MetS) and periodontitis is a common denominator of the association of these conditions with higher risk of atherosclerosis. The current study investigates whether periodontal therapy may reduce systemic inflammation in patients with MetS and reduce cardiovascular risk. METHODS: A parallel-arm, double-blind, randomized clinical trial of 1-year duration in patients with MetS and periodontitis was conducted. Participants were randomized to an experimental treatment group (ETG) (n = 82) that received plaque control and root planing plus amoxicillin and metronidazole or to a control treatment group (CTG) (n = 83) that received plaque control instructions, supragingival scaling, and two placebos. Risk factors for cardiovascular disease were recorded; serum lipoprotein cholesterol, glucose, body mass index (BMI), C-reactive protein (CRP) and fibrinogen concentrations, and clinical periodontal parameters were assessed at baseline and every 3 months until 12 months after therapy. The primary and secondary outcomes were changes in CRP and fibrinogen levels, respectively. RESULTS: The baseline patients' characteristics of both groups were similar. No significant changes in lifestyle factors, frequency of hypertension, BMI, serum lipoprotein cholesterol, and glucose levels were observed during the study period. The periodontal parameters significantly improved in both groups 3 months after therapy (P = 0.0001) and remained lower than baseline up to 12 months. The improvement of periodontal status was significantly greater in the ETG (P = 0.0001). A multiple linear regression analysis, controlled for sex, smoking, hypertension, and extent of periodontitis, demonstrated that CRP levels decreased with time and that this reduction was significant at 9 (P = 0.024) and 12 (P = 0.001) months in both groups, without difference between the groups. Fibrinogen levels significantly decreased in the ETG at 6 and 12 months but not in the CTG. CONCLUSION: Reduction of periodontal inflammation either with root planing and systemic antibiotics or with plaque control and subgingival scaling significantly reduces CRP levels after 9 months in patients with MetS.

Culture and characterization of mesenchymal stem cells from human gingival tissue.

BACKGROUND: Tissue engineering using mesenchymal stem cells (MSCs) is a recent therapeutic modality that has several advantages. MSCs have high proliferation potential and may be manipulated to permit differentiation before being transplanted, suggesting they may be an ideal candidate for regenerative procedures. Precise identification of cells capable of regenerating the periodontium is valuable because no predictable regeneration procedure has yet been described. The purpose of this study is to determine the presence of MSCs in human gingival connective tissue and their morphologic and functional characteristics. METHODS: Gingival connective tissue samples were obtained from five healthy students. The samples were deepithelialized, leaving only connective tissue. The explants were minced and cultured on tissue culture dishes for 3 to 4 weeks, after which cells were characterized by flow cytometry. Differentiation into osteogenic, chondrogenic, and adipogenic lineages was induced and evaluated by culture staining. An immunoregulation assay was also performed. RESULTS: The results show that gingival tissue cells fulfill the minimal criteria proposed by the International Society for Cellular Therapy to be defined as MSCs. Cell characterization was consistently positive for CD90, CD105, CD73, CD44, and CD13 markers and negative for hematopoietic markers CD34, CD38, CD45, and CD54. We observed differentiation in positive staining of adipogenic, chondrogenic, and osteogenic lineages. Furthermore, gingival cells showed immunomodulative capacity. CONCLUSION: Gingival connective tissue could be a reservoir of MSCs that could be used in regenerative procedures based on tissue engineering.

[Effects of periodontal therapy on markers of systemic inflammation in patients with coronary heart disease risk]. / Efectos del tratamiento periodontal sobre los marcadores de inflamación sistémica en pacientes con riesgo de enfermedad cardiaca coronaria. Estudio piloto.

BACKGROUND: Studies investigating effects of periodontal treatment (PT) on markers of inflammation in healthy subjects show conflicting results. Few studies have investigated the effects of PT among subjects with coronary heart disease (CHD) risk factors. AIM: To report the results of a pilot prospective study on the effects of periodontal treatment on markers of inflammation among subjects with CHD risk factors. MATERIAL AND METHODS: Seventy three patients aged 53+/-6 years (25% males) with chronic periodontitis, dyslipidemia and other CHD risk factors were subjected to PT consisting on root planning and oral metronidazol and amoxicillin for 7 days. Periodontal clinical parameters, serum C-reactive protein (CRP), fibrinogen levels and erythrocyte sedimentation rate (ESR) were assessed before and at 6 weeks after PT. Polymorphisms at the ILlA-889 and IL1B+3954 genes were also genotyped. RESULTS: After the treatment period, CRP levels significantly increased from 3.6+/-3.7 mg/ L to 5.4+/-5.7 mg/L (p =0.001). No significant changes were observed in fibrinogen levels and ESR. Higher post-treatment CRP levels were significantly associated with the composite polymorphic genotype at the ILlA-889 and IL1B+3954 genes (p =0.0001), and extensive periodontitis (p =0.005). Moderate alcohol consumption appeared as a protective factor for CRP elevation (p =0.029). CONCLUSIONS: The increase of the CRP levels after PT in patients with CVD risk factors appeared associated with IL-1 gene polymorphisms and extensive periodontitis.

Efectos del tratamiento periodontal sobre los marcadores de inflamación sistémica en pacientes con riesgo de enfermedad cardiaca coronaria: Estudio piloto / Effects of periodontal therapy on markers of systemic inflammation in patients with coronary heart disease risk

Background- Studies investigating effects of periodontal treatment (PT) on markers of inflammation in healthy subjects show conflicting results. Few studies have investigated the effects ofPT among subjects with coronary heart disease (CHD) risk factors. Aim: To report the results of a pilot prospective study on the effects of periodontal treatment on markers of inflammation among subjects with CHD risk factors. Material and methods: Seventy three patients aged 53±6 years (25 percent males) with chronic periodontitis, dyslipidemia and other CHD risk factors were subjected to PT consisting on root planning and oral metronidazol and amoxicillin for 7 days. Periodontal clinical parameters, serum C-reactive protein (CRP), fibrinogen levels and erythrocyte sedimentation rate (ESR) were assessed before and at 6 weeks añerPT. Polymorphisms at the ILlA-889 andIL1B+3954genes were also genotyped. Results: After the treatment period, CRP levels significantly increased from 3.6±3.7 mg/ L to 5.4±5.7 mg/L (p =0.001). No significant changes were observed in fibrinogen levels and ESR. Higher post-treatment CRP levels were significantly associated with the composite polymorphic genotype at the ILlA-889 and IL1B+3954 genes (p =0.0001), and extensive periodontitis (p =0.005). Moderate alcohol consumption appeared as a protective factor for CRP elevation (p =0.029). Conclusions: The increase of the CRP levels after PT in patients with CVD risk factors appeared associated with IL-1 gene polymorphisms and extensive periodontitis.

Thrombophilic polymorphisms in preterm delivery.

Single nucleotide polymorphisms tumor necrosis factor (TNF) G-308A, coagulation factors V G1691A and II G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, as well as the angiotensin-converting enzyme (ACE) insertion/deletion polymorphism were investigated in 86 women with a history of premature delivery (PD) and compared with those of a control group of adults from Guadalajara, Mexico (a minimum of 162 individuals were typed for each polymorphism). Significant differences in the frequency of these polymorphisms were found for MTHFR C677T (increased), and the ACE deletion (increased) among women who had a history of preterm delivery compared with controls. These polymorphisms therefore might be associated with PD.

Los pescadores del Golfo de Cariaco / The fishermen of the Gulf of Cariaco

Se realizó un análisis socieconómico de los pescadores que habitan en las riberas del Golfo de Cariaco-Venezuela, en los poblados de los cinco municipios que lo limitan. La información fue obtenida mediante la aplicación de una cédula de entrevista y con ayuda de entrevistadores en un barrido censal en 44 poblaciones. Se concluye que el total de familias de pescadores en las riberas del Golfo de Cariaco es de 745, de los cuales la mayoría reside en la costa norte del Golfo y cuyas condiciones de vida debido a factores naturales (vías de acceso, condiciones climáticas) y humanos (servicios públicos, acceso a centros de trabajo, ingresos, etc.) se encuentra en desventaja con respecto a la costa sur del Golfo de Cariaco. la merma del recurso sardinero y en general de la pesca practicada en el golfo, ha traído como consecuencia el peligro inminente de corrientes migratorias negativas o cambio en las prácticas de oficios de los pescadores del Golfo de Cariaco

Estudo do entrópio em cavidades anoftálmicas / Entropion in anophthalmics sockets

Realizou-se um estudo retrospectivo, durante um período de 22 anos, em 380 pacientes com cavidades anoftálmicas sem implantes, tendo sido encontrado um total de 83 casos com entrópio. Säo apresentados e analisados a etiologia, os tipos de cavidade, a localizaçäo do entrópio, as técnicas cirúrgicas utilizadas e os resultados. Concluímos que o entrópio é uma deformidade habitualmente presente nessas cavidades, e que deveria ser incluído no quadro clínico que compöe a Síndrome da Cavidade Anoftálmica

Complicaciones en la intubación de vías lagrimal / Complications in the intubation of lachrymal vias

Se revisó las historias clínicas de pacientes sometidos a intubación de vías lagrimales es el período comprendido entre Noviembre 1982-Julio 1988 en el Instituto de Oftalmología de la Universidad Nacional de Trujillo. Cuarentidos pacientes son sometidos a intubación de las vías lagrimales como tratamiento de su obstrucción. Las complicaciones presentadas post intubación de vías lagrimales fueron: Laceración de punto y canaliculos lagrimales: 18 casos, 42.85 por ciento; Conjuntivitis: 7 casos, 16.66 por ciento; Epífora: 3 casos, 7.14por ciento. Erosión corneal; 3 casos, 7.14 por ciento, Granulomas: 2 casos 4.76 por ciento. En 8 casos: 19.07 por ciento no se presentó complicaciones durante el lapso de tiempo en que fueron evaluados. La sonda de polietileno es la causante de la mayor parte de las complicaciones observadas

Reflejo rectoesfinteriano: registro simplificado / Retosphicter reflex: simplified record

El presente trabajo comunica los resultados del estudio del reflejo rectoesfinteriano practicado mediante un dispositivo simple de diseno original de uno de los autores. Se comparan dos grupos de pacientes. El primer grupo no presenta patologia colorectal; el segundo grupo presenta trastornos en la defecacion por causas organicas, funcionales o secundarias a intervenciones quirurgicas diversas (constipacion cronica, incontinencia fecal, estados quirurgicos postanoplastias). Es notoria la correlacion que existe entre las ausencias del reflejo rectoesfinteriano anual y la Enfermedad de Hirschprung como lo comunican algunos autores utilizando diferentes tecnicas de investigacion. El dispositivo disenado premite tambien emplearlo en la reeducacion de pacientes con alteraciones en la continencia mediante programas muy bien reglados de retroalimentacion

Nuevo tratamiento quirurgico de la hernia hiatal y correccion del reflujo gastroesofagico con arnes epiploico / Surgical management of gastroesophageal reflux and hiatal hernia with epiploic arnes

Todos los pacientes adultos y ninos fueron operados con la tecnica descrita. No se presento complicacion transoperatoria en ninguno. La desaparicion de los sintomas digestivos se presento en la totalidad de los pacientes en el post-operatorio inmediato y fue especialmente espectacular en los ninos que habian presentado sintomatologia cardiorrespiratoria mas severa. En el post-operatorio tardio uno de los ninos (12.5 X 100) presento sangrado digestivo alto que fue controlado medicamente y otro (12.5 X 100) tres meses despues continuaba con tos post-prandial. En el grupo de adultos se comprobo la persistencia del reflujo GE radiologico en dos de ellos (11,7 X 100) aunque la sintomatologia estaba presente solamente en uno. En cuanto a los sintomas respiratorios persistieron en dos de ellos (22.2 X 100)(uno de los que continuo con reflujo). En la mayoria de los pacientes adultos operados con esta tecnica lo mismo que con otras se presenta disfagia transitoria por lo cual sistematicamente recomendamos dieta blanda durante el primer mes de post-operatorio. En conclusion los resultados fueron excelentes a buenos en 23 pacientes (92 X 100). Operados en el Hospital Universitario Santa Sofia de Manizales (adultos) y en el Hospital Infantil de la Cruz Roja en Manizales (Ninos)