Factores determinantes para la atención clínica odontológica de pacientes con discapacidad / Determining factors for the clinical dental care of patients with disabilities

Objetivo: identificar los factores, inherentes a la práctica clínica, que determinan la atención odontológica de pacientes con discapacidad. Métodos: realización de estudio descriptivo, de alcance explicativo, cuantitativo y corte transversal; aplicación de en-cuesta dirigida a odontólogos que ejercen como profesionales independientes, con la cual se midieron variables de caracterización, conocimientos, habilidades, percepción, infraestructura y atención del paciente con discapacidad. También, se desarrolló un análisis descriptivo, correlacional y multivariado. Resultados: no todos los odontólo-gos recibieron formación para la atención clínica de personas con discapacidad; algu-nos conocen los métodos de comunicación alternativa y aumentativa y, de estos, una mayoría representativa no los sabe manejar. Sobre la infraestructura, se identificó que esta cumple parcialmente con la normatividad y que la mayoría de los profesionales se sienten medianamente preparados para llevar a cabo esta atención, por lo que el 67,3% (99) afirmó atender esta población con sus protocolos clínicos habituales, pero, el 83,7% (123) manifestó brindar la atención solo en casos de urgencia odontológica. Los factores que determinan la atención del paciente con discapacidad están relacio-nados con la cantidad de pacientes asistentes, las experiencias negativas previas, las habilidades en el manejo de la consulta, la sensación de preparación y los años de ex-periencia clínica. Conclusiones: las experiencias negativas previas en la práctica clínica con pacientes con discapacidad son determinantes; para su disminución se sugiere la urgente implementación de técnicas comunicativas, la adecuación de infraestructura y el desarrollo de habilidades para la atención integral e inclusiva.

Objective: Identify the factors that establish dental clinic care for patients with disabilities, that are inherent to the professional and to the clinical practice. Methods:A descriptive study of explanatory quantitative cross-cutting score was done. It was applied to dentists that worked independently where characterization variables, abilities, perception, infrastructure were measured, and attention to the patient in a situation of disability. A descriptive, correlational, multivariate analysis. Results: Only some dentists received the I information for the clinic care of patients in a situation of disability. Only some of them know the methods of alternative and augmentative communication and most of them don't know how to work with them. The infrastructure partially complies with the regulations and most of the professionals feel moderately prepared, so 67,3%(99) attend those patients in their usual clinical practice, but 83,7%(123) would attend them only in an emergency case. The factors that establish dental clinic care for patients with disabilities are related with the quantity of patients in a situation of disability, the previous, negative experiences, management skills in the consult, preparation sensation and the years of clinical experience. Conclusions: The previous negative experiences in the clinical practice with patients in a situation of disability are the most important factor for the dental clinic care for patients with disabilities, these experiences should decrease a from implementation of communication techniques, infrastructure adjustments and the development of abilities for the comprehensive and inclusive attention.

Percepción Intraoperatoria del Paciente sobre la Preparación de la Cavidad de Acceso Endodóntico / Patient Intraoperatory Perception About Endodontic Access Cavity Preparation

RESUMEN: La creencia de que el tratamiento de endodoncia es el tratamiento dental más doloroso es algo habitual. A pesar de ello, la percepción intraoperatoria durante el tratamiento de endodoncia ha sido poco estudiada. Por ello, el objetivo de esta investigación fue describir la percepción de dolor y la experiencia intraoperatoria del paciente tratado en endodoncia, durante la etapa de acceso endodóntico. Se analizaron las valoraciones sobre dolor intraoperatorio realizadas por 20 pacientes, tratados en la clínica de especialidad de una universidad tradicional chilena, durante la etapa de acceso endodóntico en molares. Para ello se utilizaron escalas cuantitativas de valoración de la intensidad del dolor y el análisis de contenido cualitativo de una entrevista semi-estructurada. Se observó que los participantes de sexo femenino, los tratamientos en molares mandibulares y en dientes con diagnóstico de pulpitis irreversible sintomática obtuvieron medias mayores en cuanto a la valoración de la intensidad del dolor. Sin embargo, en la mayoría de los casos el dolor fue descrito como leve. En el análisis cualitativo lo descrito por los participantes se agrupó en 10 categorías. Se observó un mayor porcentaje de referencias a la categoría "Ansiedad ante el tratamiento" (16 %) seguido de "Percepción de la atención profesional" (14 %). Sin embargo, también destacaron las referencias al dolor en su totalidad (25 %) ya sea a "Ausencia de dolor" (13 %) o a "Presencia de dolor en algún grado" (12 %). Se concluyó que entre los participantes de esta investigación existió percepción de dolor intraoperatorio durante la etapa de acceso endodóntico, sin embargo, este fue de carácter leve en la mayoría de los casos.

ABSTRACT: There is a common belief that endodontic treatment is the most painful dental treatment of all. Despite this idea, intraoperative perception during endodontic treatment has not been fully studied. Therefore, the aim of this research was to describe the perception of pain and the intraoperative experience of endodontic treated patients, during the endodontic access cavity preparation. We analyzed the valuations on intraoperative pain completed by 20 patients, treated at the endodontic clinic of a traditional Chilean university, during the endodontic access cavity preparation in molars. For this purpose, quantitative scales of pain intensity assessment and qualitative content analysis of a semi-structured interview were employed. Female participants, treatments in mandibular molars and in teeth diagnosed with symptomatic irreversible pulpitis obtained higher means in terms of assessment of pain intensity. However, in most cases the pain was described as mild. In the qualitative analysis the participant's descriptions were grouped into 11 categories. There was a higher percentage of references to the category "Anxiety before treatment" (16 %) followed by "Perception of professional care" (14 %). However, references to pain in its totality (25 %) either to "Absence of pain" (13 %) or to "Presence of pain to some degree" (12 %) also stood out. It was concluded that among the participants of this investigation there was perception of intraoperative pain during the endodontic access stage, however, this was mild in most cases.

Assessing the risk zones of Chagas' disease in Chile, in a world marked by global climatic change

BACKGROUND Vector transmission of Trypanosoma cruzi appears to be interrupted in Chile; however, data show increasing incidence of Chagas' disease, raising concerns that there may be a reemerging problem. OBJECTIVE To estimate the actual risk in a changing world it is necessary to consider the historical vector distribution and correlate this distribution with the presence of cases and climate change. METHODS Potential distribution models of Triatoma infestans and Chagas disease were performed using Maxent, a machine-learning method. FINDINGS Climate change appears to play a major role in the reemergence of Chagas' disease and T. infestans in Chile. The distribution of both T. infestans and Chagas' disease correlated with maximum temperature, and the precipitation during the driest month. The overlap of Chagas' disease and T. infestans distribution areas was high. The distribution of T. infestans, under two global change scenarios, showed a minimal reduction tendency in suitable areas. MAIN CONCLUSION The impact of temperature and precipitation on the distribution of T. infestans, as shown by the models, indicates the need for aggressive control efforts; the current control measures, including T. infestans control campaigns, should be maintained with the same intensity as they have at present, avoiding sylvatic foci, intrusions, and recolonisation of human dwellings.

Polimorfismos del gen de apolipoproteína E y polimorfimo Pro12Ala del gen PPARy-2 en niños pre-puberes con factores de riesgo cardiometabólicos / Apolipoprotein E gene polymorphisms and Pro12Ala polymorfphism of PPARy-2 gene in children with risk factors to cardiometabolic disease

La resistencia a la insulina es muy frecuente en niños y adolescentes obesos, la cual conlleva a un significativo riesgo de desarrollar enfermedades cardiometabólicas causadas por la combinación de factores genéticos y factores asociados al estilo de vida. Evaluar la relación entre los polimorfismos del gen ApoE y el polimorfismo Pro12Ala del gen PPARγ2 en niños pre-púberes con factores de riesgo cardiometabólicos. Población y Métodos: Se evaluaron 141 niños (CANIA y Hospital “JM de los Ríos”), de los cuales 46 tienen obesidad, 33 hipercolesterolemia, 30 resistentes a la insulina (RI) y 32 controles. Se determinó colesterol total y fracciones, triglicéridos, glucosa, insulina e índice HOMA; se realizó extracción de ADN y análisis de los polimorfismos. La distribución de la frecuencia del alelo ε4 del gen de ApoE fue: 10,9% obesos, 7,6% hipercolesterolémicos, 18,3% RI y 4,6% controles. La frecuencia del polimorfismo Pro12Ala fue de 6,4% en la población estudiada. En los niños obesos e hipercolesterolémicos se observó aumento de colesterol total, LDL-c y triglicéridos asociados con la presencia del ε4; en el grupo con RI, se encontró que existen diferencias estadísticamente significativas entre el alelo ε4 con respecto al grupo control, lo que refiere que puede haber una relación clínica importante entre la presencia del alelo y el desarrollo de la enfermedad. No se encontró relación entre el polimorfismo Pro12Ala del gen PPARγ2 con factores de riesgo cardiometabólico. La presencia de varios polimorfismos en un mismo individuo podría estar asociada a factores de riesgo para enfermedad cardiometabólica

Insulin resistance (IR) is very frequent in children and adolescents obeses, which could contribute significantly in the development of cardiometabolic diseases, this could be associated to a combination of genetics factors and life’s style. Aim: To evaluate the relationship between ApoE gene polymorphisms and PPARγ2 gene Pro12Ala polymorphisms with risk factors to cardiometabolic disease in children. Population and Materials: 141 children (CANIA and Hospital “JM de los Ríos”), 46 with obesity, 33 with hypercholesterolemia, 30 with IR and 32 normal subjects. Total cholesterol and fractions, glucose, insulin and triglycerides were measured; also it was determinated the polymorphism genes on each patient. Results: The distribution of the frequency of the allele E4 of the ApoE gene were: 10, 9% obese, 7,6% hypercholesterolemia, 18,3% IR and 4,6% on normal subjects. The frequency of Pro12Ala polymorphism were up to 6,4% on the total subjects in the study. In the obese and hypercholesterolemic groups we found an increase of the total cholesterol, LDL-c and triglycerides, associated with the presence of allele ε4. In children with IR we got a significant difference of the presence of allele ε4 compared with the control group, which means that this allele could be related with the development of thedisease. It was not found a relation between the Pro12Ala of PPARγ2 gene and the development of obesity, hypercholesterolemia and insulin resistance in children. The presence of several polymorphisms in a same individual could be associated with risk factors to cardiometabolic disease

Dinámica epidemiológica del dengue en Isla de Pascua / Epidemiological dynamics of dengue on Easter Island

Dengue is considered an emerging disease with an increasing prevalence especially in South America. In 2002, an epidemic of classic Dengue (DENV-1) occurred unexpectedly on Easter Island, where it had never been detected before. It reappeared in 2006-2007 and 2008, 2009 and 2011. The aim of this study was to estimate the most relevant parameters of the epidemiological dynamics of transmission of Dengue on Easter Island and to model the dynamics since 2002, comparing the predictions with the actual situation observed. Of the total cases, 52.27% were females and 47.73% men. The average age of infection was 31.38 ± 18.37 years, similar in men and women. We estimated the reproductive number R0 = 3.005 with an IC0,95 = [1.92, 4.61]. The inter-epidemic period reached an estimated T = 5.20 to 6.8 years. The case simulation showed recurrent epidemics with decreasing magnitude (damped oscillations), which is a known phenomenon in models of dengue and malaria. There was good qualitative fit to the epidemiological dynamics from 2002 onwards. It accurately predicted the rise in cases between 2006 and 2011. The predicted number of cases during the 2002 epidemic is greater than the confirmed cases and the predicted epidemic was faster than notified cases. Interepidemic period in the simulation was 6.72 years between 2002 and 2008 and 4.68 years between 2008 and 2013. From the theoretical perspective, the first epidemic had affected 94% of the population (approximately 3500 cases), but 639 were reported suggesting underreporting and a lot of sub-clinical cases occurred. Future epidemic of decreasing size are expected, although the main danger are epidemics of hemorrhagic dengue fever resulting from the introduction of different dengue virus serotypes.

El dengue es considerado una enfermedad emergente que aumenta su prevalencia especialmente en Sudamérica. En 2002 ocurrió inesperadamente una epidemia de dengue clásico (DENV-1) en Isla de Pascua, hecho nunca antes detectado. Posteriormente, ha reaparecido en 2006-2007 y 2008, 2009 y 2011. El objetivo de este trabajo fue estimar los parámetros epidemiológicos más relevantes de la dinámica de transmisión del dengue en Isla de Pascua y modelar la dinámica desde 2002, comparando las predicciones con la situación real observada. Del total de casos, 52,27% correspondieron a mujeres y 47,73% a hombres. La edad promedio de infección fue E = 31,38 ± 18,37 años, similar en hombres y mujeres. Se estimó el número reproductivo R0 = 3,005 con un IC0,95 = [1,92; 4,61]. El período inter-epidémico esperado puede ir entre T = 5,20 y 6,8 años. La simulación de casos mostró una dinámica con epidemias recurrentes que van decreciendo en magnitud (oscilaciones amortiguadas), lo que es un hecho conocido en todos los modelos de dengue y malaria. Hubo un buen ajuste cualitativo a la dinámica epidemiológica desde 2002 en adelante. Se predijo adecuadamente el alza de casos entre 2006 y 2011. El número de casos predichos durante la epidemia de 2002 es mayor que los casos confirmados y el curso de la epidemia predicha es más acelerado. El período inter-epidémico en la simulación es de 6,72 años entre 2002 y 2008 y 4,68 años entre 2008 y 2013. Desde la perspectiva teórica, la primera epidemia debió afectar a 94% de la población (aproximadamente 3.500 casos); sin embargo, se notificaron 639 lo que sugiere sub-notificación y gran cantidad de casos sub-clínicos. Se esperan futuros rebrotes epidémicos de tamaño decreciente, aunque se advierte que el principal peligro radica en epidemias de dengue hemorrágico, producto de la introducción de los otros serotipos.

Symmorphosis in the proximal pathway for oxygen in the leaf-eared mouse Phyllotis darwini

In this report, we explore the matching of structures to functional needs by comparing previously reported data of maximal oxygen consumption and the development of the lung in the leaf-eared mouse Phyllotis darwini in warm and cold environments. We discuss whether the state of structural design is commensurate with functional needs from regulated morphogenesis as predicted by the hypothesis of symmorphosis. We found a close match between respiratory structures and functional needs during postnatal development, expressed as safety factors close to unity. However, in the adult stage the safety factors were greater than two, which suggests that adult animals acquired a structure greater than that required considering their maximum capacities. A high safety factor in the respiratory system of adult mice may be a consequence of the symmorphosis that operates during ontogeny and does not necessarily support a rejection of this hypothesis.

Marcadores de inflamación y disfunción endotelial en sujetos obesos con/sin diabetes mellitus tipo 2 / Inflammatory markers and endothelial dysfunction in obeses with or without type 2 diabetes mellitus

La obesidad y la diabetes son patologías que desarrollan cambios en el ambiente molecular del organismo favoreciendo la expresión de citoquinas y diferentes mediadores pro-inflamatorios, proporcionado así, el daño al endotelio. El objetivo fue analizar la asociación entre la obesidad y los marcadores de inflamación y disfunción endotelial (PCRus, Fibrinógeno, IL-6, TNF-a,ICAM-1 y VCAM-1). Se tomaron muestras de sangre a 96 sujetos obesos con DT2, 24 sujetos obesos sin DT2, 24 sujetos no obesos con DT2 y 24 sujetos no obesos sin DT2 (controles). Siendo clasificados en obesos aquellos con un índice de masa corporal >30kg/m². El diagnóstico de diabetes tipo (2) (DT2) fue asignado según los criterios de la ADA. Se determinaron parámetros bioquímicos (glucosa e insulina), además se realizó el perfil inflamatorio (PCRus, fibrinógeno, IL-6, TNF-a), y de activación endotelial (VCAM-1, ICAM-1). Comparados con el grupo control los sujetos obesos con/sin DT2 y los sujetos no obesos con DT2 tienen niveles más elevados de PCRus (3,64± 1,72; 2,67±1,48; 1,25±1,02 frente a 0,75±0,49 de los controles), fibrinógeno (395,00±123,59; 431,13±118,32; 346,67±86,74 frente a 315,67±86,15 de los controles) e IL-6 (1,81±0,30; 2,71±0,80; 3,98±1,54 frente a 0,83±0,16 de los controles. Por otro lado, los sujetos obesos y no obesos con DT2 tenían valores más elevados de ICAM-1 (655,46±35,31 y 660,99±39,52 frente a 462,92±28,63 de los controles) y VCAM-1 ( 647,62±85,03 y 809,05±104,29 frente a 442,48±22,72 de los controles) el TNF-á no presentó diferencias entre los grupos en estudio. El incremento de los valores de VCAM-1 en los sujetos con DT2 (obesos o no), refleja lesión endotelial asociada a DT2 e indica la importancia de la prevención en los sujetos con síndrome metábolico en el que se está iniciando el daño al endotelio.

Obesity and Diabetes are pathologies tat are involved in the changes in the organ molecular environment that favor the expression of endothelial markers and secretion of different pro-inflammatory cytokines that injured the endothelium. Analyze the association between obesity, inflammatory marker and endothlial dysfunction (usCRP, fibrinogen, TNF-a, ICAM-1 and VCAm-1. Blood specimens were harvested of 96 subjects, 24 obeses with type 2 Diabetes Mellitus (T2DM), 24 obeses without T2DM, 24 non obeses with T2DM and 24 non obeses without T2DM (controls). The obeses were classified with a corporal mass index (CMI)>30kg/m². he diagnosis of T2DM was done following the ADA's criteria. Glucose, insulin, usCPR, fibrinogen, IL6, TNF-a, ICAM-1 and VCAM-1 levels were measured. The obeses with/Without T2DM and the non obeses with T2DM showed highly significant elevation levels of usCPR (3,64± 1,72; 2,67±1,48; 1,25±1,02 compared to 0,75±0,49 in controls), fibrinogen (395,00±123,59; 431,13±118,32; 346,67±86,74 compared to 315,67±86,15 in controls) and IL-6 (1,81±0,30; 2,71±0,80; 3,98±1,54 compared to 0,83±0,16 in controls) In the other hand, obeses y non obeses with T2DM showed highly significant elevations levels of ICAM-1 655,46±35,31 y 660,99±39,52 compared to 462,92±28,63 in controls) and VCAM-1 (647,62±85,03 y 809,05±104,29 compared to 442,48±22,72 in controls. TNF-á did not have significant differences between groups. Highly levels of VCAM-1 and ICAM-1 in subjects with T2DM (obeses or non obeses), likely to endothelial injure associated to T"DM and important markers of the beginning of endothelial injue and the cardiovascular disease.

Interplay between the morphometry of the lungs and the mode of locomotion in birds and mammals

We studied the lung diffusion parameters of two species of birds and two species of mammals to explore how structural and functional features may be paralleled by differences in life style or phylogenetic origin. We used two fast-flying species (one mammal and one bird), one running mammal and one bird species that flies only occasionally as models. The harmonic mean thickness of the air-blood barrier was very thin in the species we studied. An exception was the Chilean tinamou Notoprocta perdicaria, which only flies occasionally. It showed an air-blood barrier as thick as that of flightless Galliformes. We found that the respiratory surface density was significantly greater in flying species compared to running species. The estimated values for the oxygen diffusion capacity, DtO2 follow the same pattern: the highest values were obtained in the flying species, the bat and the eared dove. The lowest value was in N. perdicaria. Our findings suggest that the studied species show refinements in their morphometric lung parameters commensurate to their energetic requirements as dictated by their mode of locomotion, rather than their phylogenetic origin. The air-blood barrier appears to be thin in most birds and small mammals, except those with low energetic requirements such as the Chilean tinamou. In the species we studied, the respiratory surface density appears to be the factor most responsive to the energetic requirements of flight