Clinical, Radiographic, and Histological Changes in Enamel and Dentin, According to Caries Care International™ Evaluation, In Permanent Posterior Teeth: An Observational Study / Cambios Clínicos, Radiográficos e Histológicos en Esmalte y Dentina, Según Evaluación de Caries Care International™, en Dientes Posteriores Permanentes: Un Estudio Observacional

SUMMARY: CariesCare International ™ practical guide is a tool for the comprehensive assessment and treatment of caries that synthesizes clinical and radiographic diagnosis and risk factors, classifying the severity, progression, and activity of lesions. The objective of this study was to analyze the validity and prediction characteristics of the proposed dental caries classification in the CariesCare International ™ practical guide as a reference through clinical and radiographic evaluation versus histological evaluation. Ninety-seven permanent posterior teeth were evaluated, and clinical and radiographic diagnoses were determined according to parameters defined in the CariesCare International™ guide as a reference. Subsequently, histological evaluation was performed to compare each stage of dental caries progression, and statistical analysis was applied. When comparing the validity and prediction values between radiographic and clinical diagnoses in relation to histological evaluation, a low sensitivity and high specificity relationship was found. The sensitivity and specificity percentages between the clinical and radiographic methods show that the clinical method has a lower number of false negatives. Histological changes in dental tissue were evident from the earliest stages of lesions, even in those not related to the caries process, indicating that the dentist should be careful when deciding on a treatment plan and take into account all variables involved in the caries process, as proposed by the CariesCare International ™ guide.

La guía práctica CariesCare International™ es una herramienta para la evaluación y tratamiento integral de la caries que sintetiza el diagnóstico clínico y radiográfico y los factores de riesgo, clasificando la gravedad, progresión y actividad de las lesiones. El objetivo de este estudio fue analizar la validez y características de predicción de la clasificación de caries dental propuesta en la guía práctica CariesCare International™ como referencia a través de la evaluación clínica y radiográfica versus la evaluación histológica. Se evaluaron noventa y siete dientes posteriores permanentes y se determinaron diagnósticos clínicos y radiográficos según parámetros definidos en la guía CariesCare International™ como referencia. Posteriormente se realizó una evaluación histológica para comparar cada etapa de progresión de la caries dental y se aplicó análisis estadístico. Al comparar los valores de validez y predicción entre los diagnósticos radiológicos y clínicos en relación con la evaluación histológica, se encontró una relación de baja sensibilidad y alta especificidad. Los porcentajes de sensibilidad y especificidad entre el método clínico y radiográfico muestran que el método clínico tiene un menor número de falsos negativos. Los cambios histológicos en el tejido dental fueron evidentes desde las primeras etapas de las lesiones, incluso en aquellas no relacionadas con el proceso de caries, lo que indica que el odontólogo debe tener cuidado al decidir un plan de tratamiento y tener en cuenta todas las variables involucradas en el proceso de caries, tal como propone la guía CariesCare International™.

Maltrato a estudiantes de medicina del Paraguay en 2022: encuesta multicéntrica

Introducción: los estudiantes de medicina son propensos a recibir maltratos de sus colegas, personal administrativo y pacientes. Objetivo: determinar las características del maltrato a estudiantes de medicina del Paraguay en 2022. Metodología: se aplicó un diseño observacional, de corte transversal. Se incluyó a estudiantes de medicina, de ambos sexos, que aceptaban participar de la encuesta telemática. El muestreo fue por conveniencia. Se midieron variables demográficas. La percepción del maltrato fue evaluada según cuatro componentes (psicológico, físico, académico y sexual) utilizando el cuestionario de Munayco-Guillén F et al, previamente validado. El estudio contó con la aprobación del Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: el cuestionario fue contestado por 214 estudiantes, siendo 146 mujeres (edad media 24 ± 3 años) y 68 varones (edad media 25 ± 5 años). La mayoría reside en Asunción (29,4%) y asiste a universidades privadas (92%). La media ± DE del maltrato psicológico fue 1,89 ± 1,02, la del físico fue 1,64 ± 0,89, la del académico fue 2,01 ± 1,11 y la del sexual fue 1,4 ± 0,83. Aplicando puntos de corte en los percentiles 60 y 70, el maltrato fue leve en 126 estudiantes (58,9%), moderado en 24 (11,2%) y grave en 64 (29,9%). El motivo principal para no denunciarlo fue el miedo a ser señalado por los demás o recibir represalias (17,3%). Discusión: se detectó maltrato leve en 58,9%, moderado en 11,2% y grave en 29,9% de los estudiantes de medicina. Se requiere aplicar medidas de prevención y contención de los maltratos.

Introduction: medical students are prone to mistreatment from their colleagues, administrative staff, and patients. Objective: to determine the characteristics of the mistreatment of medical students in Paraguay in 2022. Method: an observational, cross-sectional design was applied. Medical students of both sexes who agreed to participate in the online survey were included. Sampling was for convenience. Demographic variables were measured. The perception of abuse was evaluated according to four components (psychological, physical, academic, and sexual) using the previously validated questionnaire by Munayco-Guillén F et al. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: the questionnaire was answered by 214 students, 146 being women (mean age 24 ± 3 years) and 68 men (mean age 25 ± 5 years). The majority reside in Asunción (29.4%) and attend private universities (92%). The mean ± SD of psychological abuse was 1.89 ± 1.02, physical abuse was 1.64 ± 0.89, academic abuse was 2.01 ± 1.11, and sexual abuse was 1.4 ± 0. 83. Applying cut-off points at the 60th and 70th percentiles, the abuse was mild in 126 students (58.9%), moderate in 24 (11.2%), and severe in 64 (29.9%). The main reason for not reporting it was fear of being singled out by others or receiving reprisals (17.3%). Discussion: mild abuse was detected in 58.9%, moderate in 11.2%, and severe in 29.9% of medical students. It is necessary to apply measures to prevent and contain abuse.

Cerebellar Hemangioblastoma with Leptomeningeal Spread and a Fatal Outcome: A Rare Case Report with MDM2 and EGFR Alterations.

Hemangioblastoma (HB) is a Central Nervous System (CNS) tumor with a generally favorable behavior and prognosis, classified as WHO grade 1. Sporadic HB is not related to any inherited disease, and it usually appears in a single location. Sporadic or VHL-related HBs show variable patterns of growth velocity. Cases of growing HB can cause mild symptoms such as headache, but some cases develop serious complications such as accumulation of cerebrospinal fluid in the brain with secondary neurological damage sometimes being irreversible when early treatment is not started. Our case showed some clinical characteristics more frequently observed in VHL-related HB rather than sporadic HB, and the presence of alterations in MDM2 and EGFR that could be related to the oncogenesis of these tumors. Even when the treatment of choice for HB is surgery, the presence of these genetic alterations could open a new window for research aimed at assessing the possibility of new therapies with TKIs-EGFR and anti-MDM2 inhibitors in those HB cases with multifocal recurrences or cases with an adverse clinical behavior.

Anti-Hla Donor-Specific Antibodies Are Associated to Infection and Not to the Engraftment Rate in Outpatient Haploidentical Hematopoietic Cell Transplantation

ABSTRACT Background: Recipients of a related haploidentical stem cell transplant (haplo-SCT) can have preformed antibodies to HLA donor's antigens. Objective: The aim of the study was to evaluate the engraftment rate and major clinical associations of anti-HLA donor-specific antibodies (DSA) at two mean fluorescence intensity (MFI) thresholds in recipients of an outpatient haplo-SCT. Methods: Seventy haplo-HCT recipients were analyzed. A virtual crossmatch was performed using the donor HLA typing and the recipient's anti-HLA DSA test results. Data for anti-HLA-A, -B, -C, and -DR were analyzed. Recipients with DSA ≥ 500 MFI were considered positive, and those with < 500 were considered negative; the same was adopted for MFI ≥ 1000. Results: Post-transplant infection was higher in recipients with DSA ≥ 500 MFI (84.6%, p = 0.041). First-year mortality was higher in DSA-positive patients ≥ 500 MFI, p = 0.004, and DSA ≥ 1000 MFI, p = 0.022, than in DSA-negative recipients. Graft failure in the first 100 days was not associated with DSA ≥ 500 or ≥ 1000 MFI. There was no difference in acute (a-GVHD) or chronic (c-GVHD) graft versus host disease between DSA-positive and negative patients. Conclusions: There was no association of anti-HLA DSA at MFI ≥ 500 and ≥ 1000 with graft failure, however, increased infection and 1st-year mortality were documented in related haplo-HCT at the MFI cutoffs studied. (REV INVEST CLIN. 2023;75(5):249-58)

Potential benefits of microalgae intake against metabolic diseases: beyond spirulina-a systematic review of animal studies.

CONTEXT: Microalgae are a diverse source of bioactive molecules, such as polyphenols, carotenoids, and omega-3 fatty acids, with beneficial properties in biomarkers of metabolic diseases. Unlike the rest of the microalgae genera, Arthrospira sp., commonly called spirulina, has been widely studied. OBJECTIVE: This review aims to describe the current knowledge about microalgae, besides spirulina, focusing on their beneficial properties against metabolic diseases. DATA SOURCES: A systematic research of MEDLINE (via PubMed), Cochrane, and Scopus databases was conducted to identify relevant studies published after January 2012. In vivo animal studies including microalgae consumption, except for spirulina, that significantly improved altered biomarkers related to metabolic diseases were included. These biomarkers included body weight/composition, glucose metabolism, lipid metabolism, oxidative damage, inflammation markers, and gut microbiota. DATA EXTRACTION: After the literature search and the implementation of inclusion and exclusion criteria, 37 studies were included in the revision out of the 132 results originally obtained after the application of the equation on the different databases. DATA ANALYSIS: Data containing 15 microalgae genera were included reporting on a wide range of beneficial results at different levels, including a decrease in body weight and changes in plasma levels of glucose and lipoproteins due to molecular alterations such as those related to gene expression regulation. The most reported beneficial effects were related to gut microbiota and inflammation followed by lipid and glucose metabolism and body weight/composition. CONCLUSIONS: Microalgae intake improved different altered biomarkers due to metabolic diseases and seem to have potential in the design of enriched foodstuffs or novel nutraceuticals. Nevertheless, to advance to clinical trials, more thorough/detailed studies should be performed on some of the microalgae genera included in this review to collect more information on their molecular mechanisms of action.

CO to formaldehyde transformation study on pristine and Au-modified BaTiO3(001) through DFT calculations.

CONTEXT: BaTiO3 is one of the most important ferroelectric oxides in electronic applications. Also, it has attractive properties for catalysis that could be used for reducing contamination levels, especially carbon monoxide, CO. CO is one of the main gaseous pollutants generally released from the combustion of fossil fuel. In this work, the CO transformation on pristine and Au-modified BaTiO3 perovskite for H2CO obtention is studied. The CO adsorption and hydrogenation on pristine BaTiO3 leads to formaldehyde synthesis as the most stable product through two possible routes. Furthermore, hydrogenation stages are less probable on pristine BaTiO3. On Au-modified BaTiO3 formaldehyde is the principal product too but Au adatom generates H2CO competition with HCOH. After BaTiO3 modification with Au unpaired electrons were generated. These unpaired electrons are related to the adatom reactivity. According to the obtained results, pristine and Au-modified BaTiO3 can adsorb and hydrogenate CO generating formaldehyde as the principal product. BaTiO3 modifications with Au increase the reactivity of the perovskite in the CO hydrogenation reactions. CO hydrogenation process on Au suggests that further hydrogenation stages beyond formaldehyde are possible. METHODS: The study was performed through ab initio calculations using the periodic spin-polarized Density Functional Theory (DFT) as implemented in Quantum ESPRESSO. DFT calculations were carried out using the Plane Wave self-consistent field (PWscf). Spin density difference allows us to identify reactive regions related to dangling bonds and unpaired electrons. A plane wave basis set was used to represent the electron states. Vanderbilt pseudopotentials with nonlinear core correction were used to model the ionic cores and valence electrons interaction. Exchange-correlation energies were treated within the generalized gradient approximation (GGA) with the Perdew-Burke-Ernzerhof (PBE) parameterization.

The Impact of Liquid Biopsies Positive for EGFR Mutations on Overall Survival in Non-Small Cell Lung Cancer Patients.

In recent years, non-small cell lung cancer treatment has been revolutionized. EGFR tyrosine kinase inhibitors and our improved understanding of its alterations have driven new diagnostic strategies. Liquid biopsies have emerged as a useful tool in these contexts, showing potential utility in early diagnosis combined with low-dose CT scans, as well as potential in monitoring treatment response and predicting the development of patients. We studied the circulating tumor DNA (ctDNA) of 38 EGFR-mutated non-small cell lung cancer patients at diagnosis in different moments of their disease by liquid biopsy techniques. Our results show that mean overall survival was significantly lower when a liquid biopsy was positive for the detection of EGFR mutations compared with wild-type patients in their liquid biopsy in both univariate (29 ± 4 vs. 104 ± 19 months; p = 0.004) and multivariate analysis (p = 0.008). Taking this into consideration, liquid biopsies could be key to improving the control of this disease.

Supplementation with a New Standardized Extract of Green and Black Tea Exerts Antiadipogenic Effects and Prevents Insulin Resistance in Mice with Metabolic Syndrome.

Insulin resistance is one of the main characteristics of metabolic syndrome (MetS) and the main cause of the development of type II diabetes. The high prevalence of this syndrome in recent decades has made it necessary to search for preventive and therapeutic agents, ideally of natural origin, with fewer side effects than conventional pharmacological treatments. Tea is widely known for its medicinal properties, including beneficial effects on weight management and insulin resistance. The aim of this study was to analyze whether a standardized extract of green and black tea (ADM® Complex Tea Extract (CTE)) prevents the development of insulin resistance in mice with MetS. For this purpose, C57BL6/J mice were fed for 20 weeks with a standard diet (Chow), a diet with 56% kcal from fat and sugar (HFHS) or an HFHS diet supplemented with 1.6% CTE. CTE supplementation reduced body weight gain, adiposity and circulating leptin levels. Likewise, CTE also exerted lipolytic and antiadipogenic effects in 3T3-L1 adipocyte cultures and in the C. elegans model. Regarding insulin resistance, CTE supplementation significantly increased plasma adiponectin concentrations and reduced the circulating levels of insulin and the HOMA-IR. Incubation of liver, gastrocnemius muscle and retroperitoneal adipose tissue explants with insulin increased the pAkt/Akt ratio in mice fed with Chow and HFHS + CTE but not in those fed only with HFHS. The greater activation of the PI3K/Akt pathway in response to insulin in mice supplemented with CTE was associated with a decrease in the expression of the proinflammatory markers Mcp-1, IL-6, IL-1ß or Tnf-α and with an overexpression of the antioxidant enzymes Sod-1, Gpx-3, Ho-1 and Gsr in these tissues. Moreover, in skeletal muscle, mice treated with CTE showed increased mRNA levels of the aryl hydrocarbon receptor (Ahr), Arnt and Nrf2, suggesting that the CTE's insulin-sensitizing effects could be the result of the activation of this pathway. In conclusion, supplementation with the standardized extract of green and black tea CTE reduces body weight gain, exerts lipolytic and antiadipogenic effects and reduces insulin resistance in mice with MetS through its anti-inflammatory and antioxidant effects.

Epidemiological Study of Prostate Cancer in the Province of Salamanca (2006-2015).

OBJECTIVES: Knowing the incidence of prostate cancer in Salamanca and its evolution, as well as the age at diagnosis and its evolution. In addition, analyzing the mortality from prostate cancer in the province of Salamanca. METHODS: Descriptive and analytical, longitudinal and retrospective observational study. From the collection of data from the Pathological Anatomy service and the Clinical Documentation service of the Hospital Complex of Salamanca a database was developed for the calculation of incidence rates. The information collected on mortality was obtained through the National Institute of Statistics. For regression analysis, segmented "jointpoint" models were developed. RESULTS: 2676 males diagnosed with prostate cancer were recorded in the province of Salamanca (period 2006-2015). The risk of prostate cancer up to age 74 in 2006 was 6.23%, almost double in 2010. The evolution of mortality rates adjusted to the European population in the province of Salamanca during the period 2006-2015 showed a slight decrease. CONCLUSIONS: In general, Prostate cancer incidence rates increased progressively over the years studied, similar to Spain's overall rates. These rates increased as age progressed. In general, our incidence rates were lower than those reported by the provinces of northern Spain (except Vizcaya) and higher than those recorded by the provinces of southern Spain. In Europe, our rate was surpassed by countries in northern and western Europe and lower than countries in southern and eastern Europe, and part of central Europe. Countries like U.S.A had rates higher than ours, while Canada accounted for a similar rate. On the other hand, mortality rates remained stable during the middle of the study period, suffering from then on a non-statistically significant anual decrease.

Supplementation with Two New Standardized Tea Extracts Prevents the Development of Hypertension in Mice with Metabolic Syndrome.

Hypertension is considered to be both a cardiovascular disease and a risk factor for other cardiovascular diseases, such as coronary ischemia or stroke. In many cases, hypertension occurs in the context of metabolic syndrome (MetS), a condition in which other circumstances such as abdominal obesity, dyslipidemia, and insulin resistance are also present. The high incidence of MetS makes necessary the search for new strategies, ideally of natural origin and with fewer side effects than conventional pharmacological treatments. Among them, the tea plant is a good candidate, as it contains several bioactive compounds such as caffeine, volatile terpenes, organic acids, and polyphenols with positive biological effects. The aim of this study was to assess whether two new standardized tea extracts, one of white tea (WTE) and the other of black and green tea (CTE), exert beneficial effects on the cardiovascular alterations associated with MetS. For this purpose, male C57/BL6J mice were fed a standard diet (Controls), a diet high in fats and sugars (HFHS), HFHS supplemented with 1.6% WTE, or HFHS supplemented with 1.6% CTE for 20 weeks. The chromatography results showed that CTE is more concentrated on gallic acid, xanthines and flavan-3-ols than WTE. In vivo, supplementation with WTE and CTE prevented the development of MetS-associated hypertension through improved endothelial function. This improvement was associated with a lower expression of proinflammatory and prooxidant markers, and-in the case of CTE supplementation-also with a higher expression of antioxidant enzymes in arterial tissue. In conclusion, supplementation with WTE and CTE prevents the development of hypertension in obese mice; as such, they could be an interesting strategy to prevent the cardiovascular disorders associated with MetS.

Immunohistochemical Assessment of the P53 Protein as a Predictor of Non-Small Cell Lung Cancer Response to Immunotherapy.

BACKGROUND: Determining predictive biomarkers for immune checkpoint inhibitors (ICIs) is a current challenge in oncology. Previous studies on non-small cell lung cancer (NSCLC) have shown how TP53 gene mutations are correlated with different responses to ICIs. Strong and diffuse immuno-expression of p53 by immunohistochemistry (IHC) is interpreted as a likely indicator of a TP53 gene mutation. We aimed to assess the p53 protein expression via IHC in NSCLC as a predictive biomarker of the response to ICIs. METHODS: This was a retrospective hospital-based study of patients with NSCLC treated with Nivolumab in the University Hospital of Salamanca. All diagnostic biopsies were studied via IHC (measuring p53 protein expression, peroxidase anti-peroxidase immunohistochemistry technique using Leica BOND Polymer development kits). Survival analysis was performed by subgroups of expression of p53 and other factors using the Kaplan-Meier estimator and Cox proportional-hazards model. RESULTS: Seventy-three patients were included (59 men and 14 women). The median age was 68 (44-84) years. Thirty-six biopsies were adenocarcinoma, 34 were squamous, and three were undifferentiated. In 41 biopsies (56.2%), the cellular expression of p53 was <5% (Group A), and in 32 biopsies (43.8%), the expression was ≥5% (Group B). In the general analysis, no differences were observed in overall survival (OS) (A: 12 months vs B: 20 months; p = 0.070) or progression-free survival (PFS) (A: 4 m vs B: 7 m; p = 0.064). Significant differences were observed in adenocarcinomas for both OS (A: 8 m vs B: median not reached; p = 0.002) and PFS (A: 3 m vs 8 m; p = 0.013). No differences in PFS and OS were observed in squamous cell carcinoma. Significant differences were observed in OS in the PD-L1 negative group (0% expression) (A: 13 m vs B: 39 m; p = 0.024), but not in PFS (A: 3 m vs B: 7 m; p = 0.70). No differences were observed in the PD-L1 positive group. CONCLUSIONS: A trend toward a greater response to ICIs was observed in the PFS and OS of patients with high expression of p53 by IHC (TP53 mutation), especially in the PD-L1 negative adenocarcinoma subgroup. These results will make it possible to make future modifications to the clinical guidelines of NSCLC according to the expression of p53.

Influence of DNA Mismatch Repair (MMR) System in Survival and Response to Immune Checkpoint Inhibitors (ICIs) in Non-Small Cell Lung Cancer (NSCLC): Retrospective Analysis.

Mutations in the mismatch repair (MMR) system predict the response to immune checkpoint inhibitors (ICIs) like colon or gastric cancer. However, the MMR system's involvement in non-small cell lung cancer (NSCLC) remains unknown. Addressing this issue will improve clinical guidelines in the case of mutations in the main genes of the MMR system (MLH1, MSH2, MSH6, and PMS2). This work retrospectively assessed the role that these gene mutations play in the response to and survival of ICIs in NSCLC. Patients with NSCLC treated with nivolumab as the second-line treatment in the University Hospital of Salamanca were enrolled in this study. Survival and response analyses were performed according to groups of MMR system gene expression (MMR expression present or deficiency) and other subgroups, such as toxicity. There was a statistically significant relationship between the best response obtained and the expression of the MMR system (p = 0.045). The presence of toxicity grade ≥ 3 was associated with the deficiency expression of MMR (dMMR/MSI-H) group (p = 0.022; odds ratio = 10.167, 95% confidence interval (CI) 1.669-61.919). A trend towards greater survival and response to ICIs was observed in NSCLC and dMMR. Assessing the genes in the MMR system involved in NSCLC is key to obtaining personalized immunotherapy treatments.

Caracterización de la lesión renal aguda en un hospital de la República Dominicana

Resumen: Objetivo: Caracterizar la lesión renal aguda (LRA) para describir el patrón etiológico, manifestaciones clínicas y de laboratorio. Material y métodos: Diseño observacional, retrospectivo tipo serie de casos. Se analizaron los registros de 88 pacientes, atendidos en la Unidad de Nefrología de un Hospital en la República Dominicana, sin importar el estadio de la enfermedad. Resultados: Encontramos que la edad media es 64 años con una TFG 17 mL/min/1.73 m2. El principal motivo de ingreso como de interconsulta es la "elevación de azoados" con 7.51% (n= 19 / 253) y 29.90% (n=58 / 194), respectivamente. El diagnóstico final más común fue la anemia con un 17.09% (n=50 / 396), la hipertensión arterial con un 34.16% (n=55 / 151) fue la comorbilidad predominante. La mayoría de pacientes no tuvo ningún antecedente medicamentoso con un 31.17% (n=48 / 154), la intervención más común fue el uso de fluidos en un 40.83% (n=49 / 120). El hallazgo clínico más descrito fueron los campos pulmonares hipoventilados 42,72% (n=44 / 103). Conclusiones: Recomendamos poner en funcionamiento acciones que ayuden con un oportuno diagnóstico y tratamiento temprano de la LRA en el hospital.

Abstract: Objective: To characterize acute kidney injury (AKI) and describe its etiological pattern, clinical and laboratory manifestations. Material and methods: Retrospective, observational design, case series type. We analyzed the records of 88 patients treated in the nephrology unit of a hospital in the Dominican Republic, regardless of the stage of the disease. Results: We found that the average age is 64 years with a GFR 17mL/min/1.73 m2. The main reason for admission and consultation is the "elevation of BUN and creatinine levels" with 7.51% (n= 19 / 253) and 29.90% (n=58 / 194), respectively. The most common final diagnosis was anemia 17.09% (n=50 / 396), hypertension with 34.16% (n=55 / 151) was the predominant comorbidity. The majority of patients had no medication history with 31.17% (n=48 / 154), the most common intervention performed was fluid use with 40.83% (n=49 / 120). The most frequently described clinical finding was hypoventilated lungs with 42, 72% (n=44 / 103). Conclusions: We recommend the implementation of actions to improve the timely diagnosis and management of AKI in the hospital.

Resumo: Objetivo: Caracterizar a lesão renal aguda (LRA) prá descrever o padrão etiológico, manifestações clinicas e do laboratório. Métodos: Modelo observacional, retrospectivo tipo série de casos. Foram analisados os registros de 88 pacientes, antendidos na Unidade de Nefrología dum Hospital na República Dominicana, sem importar o estágio da doença. Resultados: Encontramos que a edade média é 64 anos com uma TFG de 17 mL/min/1.73 m2. A razão principal da admissão e interconsulta é a "elevação de azoados" com 7.51% (n=19/253) e 29.90% (n=58/194), respectivamente. O diagnóstico final mais comum foi a anemia com um 17.09% (n=50/396), a hipertensão arterial com um 34.16% (n=55/151) foi a comorbidade predominante. A maioria dos pacientes não tinha histórico medicinal com um 31.17% (n=48/154), a intervenção mais comum foi o uso de fluidos num 40.83% (n=49/120). O achado clínico mais comum foi campos pulmonares hipoventilados 47.72% (n=44/103). Conclusões: Recomendamos colocar em operação ações que ajudam com um diagnóstico oportuno e um tratamento precoce da LRA no hospital.

New Metrics to Assess Type 2 Diabetes After Bariatric Surgery: The "Time-Within-Remission Range".

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the "time-within-remission range" as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, "time-within-remission range" and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m2) underwent primary bariatric procedures. "Time-within-remission range" were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the "time-within-remission range". The association of bariatric techniques with "time-within-remission range", using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The "time-within-remission range" unveils a superiority of gastric bypass compared to sleeve gastrectomy.

Dental caries prevalence in children and youths with vertically-transmitted HIV/AIDS from the pediatric HIV clinic (Cali, Colombia) and its relationship with biological factors, 2013 / Prevalencia de caries dental en niños y jóvenes con VIH/SIDA de transmisión vertical de la clínica pediátrica de VIH, Cali, Colombia, y su relación con factores biológicos, 2013

ABSTRACT. Introduction: among the oral pathologies afflicting children with HIV/AIDS is dental caries, a preventable disease if detected and controlled in its early stages to avoid further complications. The aim of this study was to determine the prevalence of caries in children and youths with vertically-transmitted HIV/AIDS from the Pediatric HIV Clinic in Cali, Colombia, in 2013, and to explore relationships with biological factors. Methods: descriptive prevalence study in 101 clinical records of children and youths aged 1 to 17 years with vertically-transmitted HIV/AIDS from the Pediatric HIV Clinic in Cali. The ICDAS and DMF/def classification systems were used. Multivariate analysis and confounding variable adjustment were included to explore relationships with demographic, paraclinical, nutritional, and dental factors. The institutional ethics committees endorsed the study. Results: the prevalence of caries experience in children with HIV was 34.65% DMF/deft (5-6) 3.29 ± 3.06. This prevalence increases 83.17% with the ICDAS 2-6 system. The point prevalence of active caries was 74.26% DMFT 5.68 ± 5.48. No statistically significant association was found with any socioeconomic or immunologic variables. Patients with moderate to severe immunosuppression had OR 1.13 CI95% (0.33-3.81) p = 0.84. A probable association was found with plaque index OR 4.58 CI95% (1.44-14.55) p = 0.006 and caries experience OR 4.21 CI95% (1,09-16.13) Conclusion: HIV patients from the Pediatric Clinic show high caries prevalence when pre-cavitated lesions are assessed. No probable association was found between caries and immunological or clinical status, and therefore this aspect is not an additional risk factor.

RESUMEN Introducción: entre las patologías bucales que aquejan a los niños con VIH/sida se encuentra la caries dental, entidad prevenible si se detecta y controla en sus etapas iniciales para evitar mayores complicaciones. El objetivo del presente estudio consistió en determinar la prevalencia de caries en niños y jóvenes con VIH/sida de transmisión vertical de la Clínica Pediátrica de VIH, de Cali, Colombia, 2013, y explorar relaciones con factores biológicos. Metodología: estudio descriptivo de prevalencia en 101 historias clínicas de niños y jóvenes de 1 a 17 años con VIH/sida por transmisión vertical de la Clínica Pediátrica de VIH, de Cali. Se usaron los sistemas de clasificación ICDAS y COP/ceo. Se incluyó análisis multivariado y ajuste por variables confusoras para explorar relaciones con factores sociodemográficos, paraclínicos, nutricionales y odontológicos. Se contó con el aval de los comités de ética institucionales. Resultados: la prevalencia de vida de caries cavitada en niños con VIH fue de 34,65% COP/ceo_d (5-6) 3,29 ± 3,06. Esta prevalencia aumenta 83,17% con el sistema ICDAS2-6. La prevalencia puntual de caries activa fue de 74,26% COP-d 5,68 ± 5,48. No se encontró asociación estadísticamente significativa con ninguna variable socioeconómica ni inmunológica. Los pacientes con inmunodepresión moderada y severa presentaron un OR 1,13 IC95% (0,33-3,81) p = 0,84. Se encontró una probable asociación con el índice de placa OR 4,58 IC95% (1,44-14,55) p = 0,006 y con la historia de caries OR 4,21 IC95% (1,09-16,13) Conclusión: los pacientes con VIH de la Clínica Pediátrica presentan alta prevalencia de caries cuando se valoran lesiones precavitacionales. No se encontró una probable asociación de caries con el estadio inmunológico ni con el clínico, por lo que este aspecto no es un factor de riesgo adicional.

Correlation of clinical and radiographic diagnosis of carious lesions in posterior teeth / Correlación del diagnóstico clínico y radiográfico de la lesión de caries en dientes posteriores

ABSTRACT. Introduction: dental caries is a public health problem affecting a large percentage of the population. The carious process is highly variable and has periods of progression that alternate with periods of stability of the damaged tissue. There are different techniques to diagnose dental caries, including clinical and radiographic evaluation. Objective: the objective of this study was to establish correlation between the clinical and radiographic caries diagnosis suggested by ICCMSTM, in deciduous and permanent molars of a school population. Methods: descriptive study evaluating a sample for convenience of 1174 proximal and occlusal tooth surfaces of permanent and deciduous molars, taken from the database of 35 outpatients treated at the school of dentistry, who were clinically and radiographically evaluated for caries as recommended by the ICCMSTM based on bitewing x-rays. Results: the clinical and radiographic diagnosis was correlated in 1174 proximal and occlusal surfaces, with 0.41 Spearman's rank correlation coefficient (p < 0,05). The findings suggest that 95.6% of teeth diagnosed as healthy coincided with the clinical and radiographic results; in early mild stages, there was coincidence in only 8.16% and 6.4% respectively. Conclusions: there is low correlation between the clinical diagnosis of caries and the radiographic examination, in relation to ICCMSTM standards.

RESUMEN. Introducción: la caries dental es un problema de salud pública que afecta a un gran porcentaje de la población. El proceso de actividad de la caries es muy variable y presenta períodos de progresión que alternan con períodos de detención del tejido dañado. Actualmente existen diversas técnicas para el diagnóstico de caries dental, entre las cuales se encuentra la evaluación clínica y radiográfica. Objetivo: el objetivo de este estudio consistió en establecer la correlación entre el diagnóstico clínico de caries y el diagnóstico radiográfico propuesto por el ICCMSTM, en molares temporales y permanentes de una población escolar. Métodos: estudio descriptivo, en el que se evaluó una muestra por conveniencia de 1174 superficies dentales proximales y oclusales de molares permanentes y temporales, tomada de la base de datos de 35 pacientes atendidos en área extramural de la escuela de odontología, los cuales fueron evaluados clínica y radiográficamente para caries según lo propuesto por el ICCMSTM a partir de radiografías aleta de mordida. Resultados: se correlacionó el diagnóstico clínico y radiográfico en 1174 superficies proximales y oclusales con un coeficiente de correlación de Spearman de 0,41 (p<0,05). Se encontró que el 95,6% de los dientes diagnosticados como sanos coincidió con los resultados clínicos y radiográficos; en estadios iniciales y moderados se encontró coincidencia solo en el 8,16% y 6,4% respectivamente. Conclusiones: hay baja correlación entre el diagnóstico clínico de caries y el examen radiográfico, según lo propuesto por ICCMSTM.

Uterine Fibroids: Diagnosis and Treatment.

Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician. Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery.

National registry of hemoglobinopathies in Spain (REPHem).

BACKGROUND: Although highly prevalent throughout the world, the accurate prevalence of hemoglobinopathies in Spain is unknown. PROCEDURE: This study presents data on the national registry of hemoglobinopathies of patients with thalassemia major (TM), thalassemia intermedia (TI), and sickle cell disease (SCD) in Spain created in 2014. Fifty centers reported cases retrospectively. Data were registered from neonatal screening or from the first contact at diagnosis until last follow-up or death. RESULTS: Data of the 715 eligible patients were collected: 615 SCD (497 SS, 64 SC, 54 SBeta phenotypes), 73 thalassemia, 9 CC phenotype, and 18 other variants. Most of the SCD patients were born in Spain (65%), and 51% of these were diagnosed at newborn screening. Median age at the first diagnosis was 0.4 years for thalassemia and 1.0 years for SCD. The estimated incidence was 0.002 thalassemia cases and 0.03 SCD cases/1,000 live births. Median age was 8.9 years (0.2-33.7) for thalassemia and 8.1 years (0.2-32.8) for SCD patients. Stroke was registered in 16 SCD cases. Transplantation was performed in 43 TM and 23 SCD patients at a median age of 5.2 and 7.8 years, respectively. Twenty-one patients died (3 TM, 17 SCD, 1 CC) and 200 were lost to follow-up. Causes of death were related to transplantation in three patients with TM and three patients with SCD. Death did not seem to be associated with SCD in six patients, but nine patients died secondary to disease complications. Overall survival was 95% at 15 years of age. CONCLUSIONS: The registry provides data about the prevalence of hemoglobinopathies in Spain and will permit future cohort studies and the possibility of comparison with other registries.

Diagnosis and management of pancreatic cancer.

Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States. Risk factors include family history, smoking, chronic pancreatitis, obesity, diabetes mellitus, heavy alcohol use, and possible dietary factors. Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms. In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection. Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer. Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually. Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement. Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression.

An update on breast cancer screening and prevention.

The goal of this article is to provide clinical guidance on breast cancer screening and prevention in primary care. The discussion highlights the importance of risk assessment, including screening options and risk-reduction strategies, for women at average and high risk. We review recommendations for breast cancer screening, evaluate current evidence on primary prevention, examine current practice patterns, and consider the impact of recent changes within health care.