Asociación entre estado nutricional y la cantidad de dientes permanentes en niños escolares en Costa Rica / Associação entre o estado nutricional e o número de dentes permanentes em crianças em idade escolar na Costa Rica / Association between nutritional status and the number of permanent teeth in a school child in Costa Rica

Resumen: El sobrepeso y la obesidad infantil se han convertido en uno de los desafíos de la salud pública a nivel mundial. Estas condiciones pueden afectar varios sistemas, asociándose con un inicio temprano de la pubertad y erupción dental. Objetivo: evaluar si existe una asociación entre el estado nutricional y la cantidad de dientes permanentes erupcionados en una población de niños escolares en Costa Rica. Material y métodos: Estudio transversal con una muestra de 753 niños entre los 6 y 12 años. Se realizó un examen clínico donde se registró la presencia o ausencia de dientes permanentes y se tomaron medidas de peso y talla. El estado antropométrico fue evaluado según los criterios de la Organización Mundial de la Salud. Se efectuó análisis descriptivo para todas las variables, comparación de medias entre los grupos (sobrepeso/obesidad vs peso normal) con la prueba U de Mann-Whitney. Se utilizó un análisis de regresión lineal con la edad y el sexo como covariantes. Resultados: Un 69.20% niños presentaba un peso normal y 30.80 % sobrepeso/obesidad. El promedio de dientes erupcionados era mayor en los niños con sobrepreso/obesidad que en aquellos con un peso normal (p=0.001). Al realizar la comparación según el sexo, la diferencia se mantiene (hombres, p=0.001; mujeres, p=0.018). El análisis de regresión lineal demostró que el estado nutricional (p=0.001) y la edad (p=0.001) están asociadas con el número de dientes permanentes erupcionados. Conclusión: los niños en edad escolar con sobrepeso/obesidad presentan mayor cantidad de dientes erupcionados que sus pares con un peso saludable.

Resumo: O sobrepeso e a obesidade na infância tornaram-se um dos desafios da saúde pública no mundo. Essas condições podem afetar vários sistemas, estando associadas ao início precoce da puberdade e a erupção dentária. Objetivo: Avaliar se há associação entre o estado nutricional e o número de dentes permanentes erupcionados em uma população de escolares da Costa Rica. Materiais e método: Estudo transversal com amostra de 753 crianças entre 6 e 12 anos. Foi realizado un exame clínico onde foi registrada a presença ou ausência dos dentes permanentes e as medidas do peso e altura. O estado antropométrico foi avaliado de acordo com os critérios da Organização Mundial da Saúde. Fio realizada una análise descritiva para todas as variáveis, comparação das médias entre os grupos (sobrepeso/obesidade vs peso normal) com o teste U de Mann-Whitney. Uma análise de regressão linear foi utilizada como a ideade e o sexo como covariáveis. Resultados: 69,20% das crianças apresentavam peso normal e 30,80% sobrepeso/obesidade. O número médio de dentes erupcionados foi maior em crianças com sobrepeso/obesidades (p=0.001). Ao fazer a comparação pelo sexo, a diferença permanece (homens, p=0.001; mulheres, p=0.018). A análise de regressão linear demostrou que o estado nutricional (p=0.001) e a idade (p=0.001) estão associados ao número de dentes permanentes erupcionados. Conclusão: Crianças em idade escolar com sobrepeso/obesas tam mais dentes erupcionados do que seus pares com peso saudável.

Abstract: Childhood overweight and obesity have become one of the public health challenges worldwide. These conditions can affect various systems, they are associated with an early onset of puberty and tooth eruption. Objective: to evaluate whether there is an association between nutritional status and the number of permanent teeth erupted in a population of school children in Costa Rica. Materials and methods: Cross-sectional study with a sample of 753 children between 6 and 12 years old. A clinical examination was performed the presence or absence of permanent teeth weight and height measurements were recorded. The anthropometric status was evaluated according to the criteria of the World Health Organization. Descriptive analysis was carried out for all variables, comparison of means between groups (overweight/obesity versus normal weight) with the Mann-Whitney U test. A linear regression analysis was used with age and sex as covariates. Results: 69,20% children had a normal weight and 30,80% were overweight/obese. The average number or erupted teeth as higher in children with overweight/obesity than in those with normal weight (p=0.001). This difference remains in the analysis y sex (men, p=0.001; women, p=0.018). Linear regression analysis demonstrated that nutritional status (p=0.001) and age (p=0.001) are associated with the number of permanent teeth erupted. Conclusion: Overweight/obese school-age children have more erupted teeth than their healthy-weight peers.

Efectividad de una unidad de dolor torácico en el primer nivel de atención en salud con telecardiología: un estudio cuasiexperimental de series de tiempo interrumpidas / Effectiveness of the chest pain unit at primary level of health care with telecardiology: a quasi-experimental study of interrupted time series

Resumen Introducción: Las unidades de dolor torácico disminuyen la morbimortalidad de los pacientes con síndrome coronario agudo. No obstante, se desconoce su efectividad en el primer nivel de atención con el apoyo de la telecardiología. Objetivo: Evaluar la efectividad de las unidades de dolor torácico sobre los tiempos de atención, la concordancia diagnóstica y la frecuencia de reconsultas a urgencias y hospitalización. Método: Estudio cuasiexperimental de series de tiempo interrumpidas, robusto, que incluyó 20,412 pacientes que consultaron al servicio de urgencias por dolor torácico, antes y después de implementar una unidad de dolor torácico. Se analizaron los cambios en la pendiente, el nivel, la autocorrelación y la varianza de los desenlaces estudiados entre ambos periodos (previo y posterior a las unidades de dolor torácico) a 30 días. Resultados: El promedio de edad fue de 44.9 ± 17.6 años y el 45.8% fueron hombres. La proporción global de pacientes remitidos para hospitalización fue del 9.0%. La pendiente de las tasas de reconsultas a urgencias disminuyó (diferencia: −1.23; intervalo de confianza del 95% [IC95%]: −2.46 a −0.01; p = 0.049) al comparar los dos periodos de observación. Igualmente, la proporción de pacientes remitidos sin síndrome coronario agudo y que finalmente tuvieron este diagnóstico en el tercer nivel de atención disminuyó en el periodo posterior a las unidades de dolor torácico con relación al previo (diferencia: −8.31; IC95%: −15.52 a −1.11; p = 0.020). Conclusiones: Las unidades de dolor torácico incrementaron los egresos de forma segura, con disminución de las reconsultas a urgencias en los siguientes 30 días por la misma causa. Además, mejoró la concordancia diagnóstica del síndrome coronario agudo, sin modificar los tiempos de atención ni la frecuencia de rehospitalización por enfermedad cardiovascular en el seguimiento.

Abstract Introduction: Chest pain units (CPU) decrease morbi-mortality in patients with acute coronary syndrome (ACS). Nevertheless, its effectiveness at primary level of health care with telecardiology support is unknown. Objective: To evaluate effectiveness of CPU on times of observation, diagnostic agreement and emergency department re-admission and hospitalizations. Method: Quasi-experimental study of robust interrupted time series, which included 20,412 patients admitted to the emergency department for chest pain, before and after the implementation of a CPU. Changes in slope, level, autocorrelation and, variance between both periods (before-CPU and after-CPU) in outcomes at 30 day follow-up were analyzed. Results: Subjects had a mean age of 44.9 ± 17.6 years-old and 45.8% were men. The overall rate of hospital admission was 9.0%. The slope of emergency re-consultation rates decreased (difference: −1.23; 95% CI: −2.46 to −0.01; p = 0.049), when comparing the two observation periods. Also, the level of proportion of patients admitted without ACS who finally had an inpatient diagnosis of ACS decreased after-CPU implementation (difference: −8.31; 95% CI: −15,52 to −1.11; p = 0.020). Conclusions: The CPU increased patient discharge safely with a reduction of 30-day re-admissions. In addition, an improvement in the ACS diagnostic agreement without affecting the time of observation or the frequency of re-hospitalization for cardiovascular disease was obtained during the follow-up.

Efficacy of fluoride varnishes with different compositions on white spot lesions remineralization / Eficácia de vernizes fluoretados com diferentes composições na remineralização de manchas brancas

Objective: To evaluate the efficacy of different fluoride varnishes on white spot lesions (WSL) remineralization. Material and Methods: Polished bovine enamel specimens were obtained (n = 60) and had their initial surface Knoop microhardness (SMH) determined. WSL were created and the SMH was measured again. Then, specimens were allocated into six groups: C ­ Control (without varnish); BF ­ Bifluorid 12 (6% NaF + 6% CaF2); DP ­ Duraphat (5% NaF); PF ­ Profluorid (5% NaF); FP - Fluor Protector (0.2% NaF + 0.9% difluorsilane); CW - Clinpro White Varnish (5% NaF + 5% TCP). After varnishes application, specimens were immersed in artificial saliva for 24 h. Then, pH-cycling was performed for 8 days and SMH was measured. Data were analyzed by one-way ANOVA and Tukey's test. Results: Non-significant differences were observed among the groups at baseline (p = 0.187) and after WSL formation (p = 0.999). After treatments, significant differences were observed among the groups (p = 0.001). Mean % of alteration (SD) and results of Tukey test were: C- 92.40 (12.10)a; PF- 88.66 (10.66)a; FP- 85.90 (14.49)ab; BF- 67.85 (17.86)bc; CW- 66.60 (18.48)c; DP- 58.62 (8.69)c. Conclusion: Bifluorid 12, Clinpro White Varnish, and Duraphat showed higher efficacy than artificial saliva in promoting the remineralization of WSL, nevertheless, none of the treatments were able to recover sound enamel baseline microhardness (AU)

Objetivo: Avaliar a eficácia de diferentes vernizes fluoretados na remineralização de lesões de mancha branca (LMB). Material e métodos: Espécimes de esmalte bovino polido (n = 60) foram submetidos à análise de microdureza superficial Knoop (KMH) inicial. Foram então criadas LMB artificialmente e os espécimes foram alocados em seis grupos: C ­ Controle (sem aplicação de verniz); BF ­ Bifluorid 12 (6% NaF + 6% CaF2); DP ­ Duraphat (5% NaF); PF ­ Profluorid (5% NaF); FP - Fluor Protector (0.2% NaF + 0.9% difluorsilano); CW - Clinpro White Varnish (5% NaF + 5% TCP). Após a aplicação dos vernizes, os espécimes ficaram imersos em saliva artificial por 24h e uma ciclagem de pH foi realizada por 8 dias. Após a ciclagem, KMH final foi realizada. Os dados foram analisados por ANOVA e teste de Tukey (5%). Resultados: Não foi observada diferença significante para os grupos após a KHM inicial (p = 0.187) e após a formação de LMB (p = 0.999). Após os tratamentos, diferenças significativas foram observadas entre os grupos (p = 0.001). Valores de média de % de alteração superficial (desvio-padrão) e resultados do teste de Tukey foram: C- 92.40 (12.10)a; PF- 88.66 (10.66)a; FP- 85.90 (14.49)ab; BF- 67.85 (17.86)bc; CW- 66.60 (18.48)c; DP- 58.62 (8.69)c. Conclusão: Os vernizes Bifluorid 12, Clinpro White Varnish e Duraphat apresentaram maior eficácia na remineralização das LMB quando comparados à saliva artificial, entretanto, nenhum dos produtos testados foi capaz de recuperar os valores iniciais de microdureza. (AU)

Prognostic Factors in Severe Chagasic Heart Failure / Fatores Prognósticos na Insuficiência Cardíaca Grave de Etiologia Chagásica

Abstract Background: Prognostic factors are extensively studied in heart failure; however, their role in severe Chagasic heart failure have not been established. Objectives: To identify the association of clinical and laboratory factors with the prognosis of severe Chagasic heart failure, as well as the association of these factors with mortality and survival in a 7.5-year follow-up. Methods: 60 patients with severe Chagasic heart failure were evaluated regarding the following variables: age, blood pressure, ejection fraction, serum sodium, creatinine, 6-minute walk test, non-sustained ventricular tachycardia, QRS width, indexed left atrial volume, and functional class. Results: 53 (88.3%) patients died during follow-up, and 7 (11.7%) remained alive. Cumulative overall survival probability was approximately 11%. Non-sustained ventricular tachycardia (HR = 2.11; 95% CI: 1.04 - 4.31; p<0.05) and indexed left atrial volume ≥ 72 mL/m2 (HR = 3.51; 95% CI: 1.63 - 7.52; p<0.05) were the only variables that remained as independent predictors of mortality. Conclusions: The presence of non-sustained ventricular tachycardia on Holter and indexed left atrial volume > 72 mL/m2 are independent predictors of mortality in severe Chagasic heart failure, with cumulative survival probability of only 11% in 7.5 years.

Resumo Fundamento: Fatores prognósticos são bastante estudados na insuficiência cardíaca (IC), mas ainda não possuem um papel estabelecido na IC grave de etiologia chagásica. Objetivo: Identificar a associação de fatores clínicos e laboratoriais com o prognóstico da IC grave de etiologia chagásica, bem como a associação desses fatores com a taxa de mortalidade e a sobrevida em um seguimento de 7,5 anos. Métodos: 60 pacientes portadores de IC grave de etiologia chagásica foram avaliados com relação às seguintes variáveis: idade, pressão arterial, fração de ejeção, sódio plasmático, creatinina, teste de caminhada de 6 minutos, taquicardia ventricular não sustentada, largura do QRS, volume do átrio esquerdo indexado e classe funcional. Resultados: 53 (88,3%) pacientes foram a óbito durante o período de seguimento e 7 (11,7%) permaneceram vivos. A probabilidade de sobrevida geral acumulada foi de aproximadamente 11%. Taquicardia ventricular não sustentada (HR = 2,11; IC 95%: 1,04 - 4,31; p<0,05) e volume do átrio esquerdo indexado ≥ 72 ml/m2 (HR = 3,51; IC 95%: 1,63 - 7,52; p<0,05) foram as únicas variáveis que permaneceram como preditores independentes de mortalidade. Conclusão: A presença de taquicardia ventricular não sustentada ao Holter e o volume do átrio esquerdo indexado > 72 ml/m2 são preditores independentes de mortalidade na IC chagásica grave, com probabilidade de sobrevida acumulada de apenas 11% em 7,5 anos.

Análise da efetividade de polimerização, adaptação marginal e interna de restaurações Classe II de resinas compostas de inserção em bloco utilizando diferentes matrizes / Effectiveness of cure, marginal and internal adaptation of Class II bulkfill composites restorations made with different matrices bands

O objetivo deste estudo foi analisar a efetividade de polimerização, a adaptação marginal e interna de resinas compostas para dentes posteriores, empregando diferentes matrizes associadas ao envelhecimento artificial. Cento e vinte incisivos bovinos foram cortados e desgastados para simular dentes posteriores, nos quais foram realizados preparados de Classe II, com o ângulo cavo superficial gengival em dentina. As cavidades tinham 6 mm de altura (ocluso-cervical), 3 de largura(vestibulo-lingual) e 1,5 de profundidade (mesio-distal). Os espécimes foram divididos em seis grupos de acordo com o material restaurador utilizado: GrandioSO (Voco)– convencional incremental, G-aenial universal flo (GC)– fluída incremental, Xtrafil (Voco)– convencional com inserção em bloco, X-tra base (Voco)– fluída com inserção em bloco, Venus Bulk Fill (Kulzer)– fluída com inserção em bloco e SureFil SDR (Dentsply)– fluída com inserção em bloco. As resinas fluídas com inserção em bloco foram inseridas em incremento de 4 mm e receberam uma cobertura oclusal de 2 mm utilizando a resina GrandioSO, com exceção da X-tra fil que foi coberta com uma camada adicional do mesmo material. Nos demais grupos foi utilizada uma técnica incremental de 2 mm. Metade dos espécimes foi restaurada com matriz metálica e a outra metade com matriz de poliéster. O percentual de polimerização foi mensurado através da dureza Knoop e da relação dureza base/topo. A média da largura das fendas marginais presentes nas margens de cada restauração foi calculada após medição, em micrometros, no microscópio óptico (100x). Os espécimes foram submetidos à ciclagem mecânica (500,000 ciclos) e térmica (1,000 ciclos) e a fenda marginal foi avaliada novamente. Para fenda interna, os espécimes foram seccionados em uma cortadeira de precisão e o comprimento, em milímetros, da parede gengival que apresentava fenda foi mensurado no microscópio óptico. Foi calculada então a porcentagem de fenda em relação ao comprimento total ...

The aim of this study was to analyze the effectiveness of cure, marginal and internal adaptation of composite resins for posterior teeth using different matrices bands associated with artificial aging. One hundred and twenty bovine incisors were cut and flattened in order to simulate posterior teeth, and then were prepared for class II cavities with gingival cavosurface margin in dentin. Cavities had 6 mm height(occluso-cervical), 3 mm width (bucco-lingual) and 1.5 mm deep (mesio-distal).Specimens were divided into six groups according to the restorative material:GrandioSO (Voco)- conventional, G-aenial universal flo (GC)- flowable, X-tra fil (Voco)- conventional bulk, X-tra base (Voco)- flowable bulk, Venus Bulk Fill (Kulzer)- flowable bulk, and SureFil SDR (Dentsply)- flowable bulk. Bulk-fill composites were placed in single increment of 4mm and received a 2mm occlusal coverage of GrandioSO, with the exception of X-tra fil which was covered with a layer of the same material. The remmaing groups were restored in 2 mm incremental technique. Half ofthe specimens were restored with metallic and the other half with polyester matrix. of cure was measured by Knoop hardness and the bottom/tophardness ratio was evaluated. The average width of marginal gaps present in the restoration was calculated after optical microscope measuring (100x), in microns. The specimens were subjected to mechanical (500.000 cycles) and thermal cycling (1.000 cycles) and marginal gap was evaluated again. For internal adaptation, the specimens were sectioned and the gap length, in millimeters, present on the gingivalwall was measured in an optical microscope. The percentage of gap length in relation to the total length of the wall was also calculated. Data were analyzed with three andtwo-way ANOVA and Tukey´s test. Regarding effectiveness of cure, significant differences were observed for resin factor. Composites G-aenial universal flo (82.08%) and GrandioSO(84.62%) had the highest cure ...

Análise da efetividade de polimerização, adaptação marginal e interna de restaurações Classe II de resinas compostas de inserção em bloco utilizando diferentes matrizes / Effectiveness of cure, marginal and internal adaptation of Class II bulkfill composites restorations made with different matrices bands

O objetivo deste estudo foi analisar a efetividade de polimerização, a adaptação marginal e interna de resinas compostas para dentes posteriores, empregando diferentes matrizes associadas ao envelhecimento artificial. Cento e vinte incisivos bovinos foram cortados e desgastados para simular dentes posteriores, nos quais foram realizados preparados de Classe II, com o ângulo cavo superficial gengival em dentina. As cavidades tinham 6 mm de altura (ocluso-cervical), 3 de largura(vestibulo-lingual) e 1,5 de profundidade (mesio-distal). Os espécimes foram divididos em seis grupos de acordo com o material restaurador utilizado: GrandioSO (Voco)– convencional incremental, G-aenial universal flo (GC)– fluída incremental, Xtrafil (Voco)– convencional com inserção em bloco, X-tra base (Voco)– fluída com inserção em bloco, Venus Bulk Fill (Kulzer)– fluída com inserção em bloco e SureFil SDR (Dentsply)– fluída com inserção em bloco. As resinas fluídas com inserção em bloco foram inseridas em incremento de 4 mm e receberam uma cobertura oclusal de 2 mm utilizando a resina GrandioSO, com exceção da X-tra fil que foi coberta com uma camada adicional do mesmo material. Nos demais grupos foi utilizada uma técnica incremental de 2 mm. Metade dos espécimes foi restaurada com matriz metálica e a outra metade com matriz de poliéster. O percentual de polimerização foi mensurado através da dureza Knoop e da relação dureza base/topo. A média da largura das fendas marginais presentes nas margens de cada restauração foi calculada após medição, em micrometros, no microscópio óptico (100x). Os espécimes foram submetidos à ciclagem mecânica (500,000 ciclos) e térmica (1,000 ciclos) e a fenda marginal foi avaliada novamente. Para fenda interna, os espécimes foram seccionados em uma cortadeira de precisão e o comprimento, em milímetros, da parede gengival que apresentava fenda foi mensurado no microscópio óptico. Foi calculada então a porcentagem de fenda em relação ao comprimento total...

The aim of this study was to analyze the effectiveness of cure, marginal and internal adaptation of composite resins for posterior teeth using different matrices bands associated with artificial aging. One hundred and twenty bovine incisors were cut and flattened in order to simulate posterior teeth, and then were prepared for class II cavities with gingival cavosurface margin in dentin. Cavities had 6 mm height(occluso-cervical), 3 mm width (bucco-lingual) and 1.5 mm deep (mesio-distal).Specimens were divided into six groups according to the restorative material:GrandioSO (Voco)- conventional, G-aenial universal flo (GC)- flowable, X-tra fil (Voco)- conventional bulk, X-tra base (Voco)- flowable bulk, Venus Bulk Fill (Kulzer)- flowable bulk, and SureFil SDR (Dentsply)- flowable bulk. Bulk-fill composites were placed in single increment of 4mm and received a 2mm occlusal coverage of GrandioSO, with the exception of X-tra fil which was covered with a layer of the same material. The remmaing groups were restored in 2 mm incremental technique. Half ofthe specimens were restored with metallic and the other half with polyester matrix. of cure was measured by Knoop hardness and the bottom/tophardness ratio was evaluated. The average width of marginal gaps present in the restoration was calculated after optical microscope measuring (100x), in microns. The specimens were subjected to mechanical (500.000 cycles) and thermal cycling (1.000 cycles) and marginal gap was evaluated again. For internal adaptation, the specimens were sectioned and the gap length, in millimeters, present on the gingivalwall was measured in an optical microscope. The percentage of gap length in relation to the total length of the wall was also calculated. Data were analyzed with three andtwo-way ANOVA and Tukey´s test. Regarding effectiveness of cure, significant differences were observed for resin factor. Composites G-aenial universal flo (82.08%) and GrandioSO(84.62%) had the highest cure...

Lesiones combinadas complejas postraumáticas en la pierna. Tratamiento temprano frente a tratamiento diferido / Complex combined post-traumatic leg injuries. Early versus delayed treatment

Introducción: El objetivo de este trabajo es comparar los resultados obtenidos en las lesiones combinadas complejas postraumáticas del tercio medio y distal de la pierna, tratadas en forma temprana o tardía. Materiales y Métodos: Se evaluaron retrospectivamente 14 pacientes tratados entre 2004 y 2012. Se los dividió en dos grupos: con cobertura de partes blandas realizada en los primeros 10 días posteriores al trauma (grupo I, 6 casos) y con cobertura después de los 10 días (grupo II, 8 casos). En el grupo I, la cobertura se efectuó con seis colgajos musculares libres de dorsal ancho y, en el grupo II, con seis colgajos musculares libres y dos colgajos fasciocutáneos rotatorios surales de base distal. Resultados: El seguimiento promedio fue de 39.5 meses en el grupo I y de 50.6 meses en el grupo II; el promedio de días de internación fue de 20.8 y 42.4, respectivamente. En dos casos del grupo I y seis casos del grupo II, todos con pérdida ósea de la tibia distal, se efectuó la reconstrucción ósea en dos tiempos. En dos pacientes, uno de cada grupo, se necrosó el colgajo muscular libre y se practicó la amputación infrarrotuliana. Conclusiones: En lesiones agudas, es recomendable la cobertura con colgajos libres, pero en lesiones crónicas, nuestras indicaciones se han ido modificando, y los colgajos fasciocutáneos rotatorios son nuestra primera opción de cobertura en la actualidad. Nivel de evidencia: IV

Introduction: The objective of this study is to evaluate treatment of complex combined post-traumatic injuries of the distal and middle third of the leg, and compare the results obtained with early versus delayed treatment. Methods: Fourteen patients treated between 2004 and 2012 were retrospectively evaluated. They were divided into two groups: those with soft tissues coverage performed during the first 10 days following trauma (group I, 6 cases) and those with coverage performed after 10 days (group II, 8 cases). Coverage was performed using six latissimus dorsi free flaps in group I, and with six muscle free flaps and two rotational fasciocutaneous flaps in group II. Results: Follow-up averaged 39.5 months in group I and 50.6 months in group II. Hospital stay averaged 20.8 days for group I and 42.4 days for group II. Staged bony reconstruction was performed in two patients from group I and six patients from group II, all with distal tibia bone loss. In two patients, one in each group, the muscle free flap became necrotic, and an amputation was performed. Conclusions: In lesions treated early coverage using free flaps should be favored; but in chronic ones, our practice has changed towards using rotatory fasciocutaneous flaps when possible. Level of evidence: IV

The effect of CPP-ACP and Nd:YAG laser on the bond strength of softened dentin

The purpose of this study was to investigate the effect of CPP-ACP treatment and Nd:YAG laser on microtensile bond strength (µTBS) of softened dentin. Sixty samples were obtained from thirty sound third molars. All samples were submitted to dentin softening procedure, by the immersion of the specimens in 30 mL of Sprite Zero for 30min. Afterwards, the samples were randomly divided according to the CPP-ACP treatment: CG-Control group; MP-treated with CPP-ACP paste (MI Paste); MPP-treated with CPP-ACP+900 ppm NaF paste (MI Paste Plus). Each group was further divided according to bonding procedure: NL-No laser; L–Laser irradiation after adhesive application and before polymerization. The laser parameters used were 1.4 W, 10 Hz, 140 mJ/pulse, with an optic fiber of 320 µm, generating energy of 174 J/cm2 per pulse. All samples were restored with Clearfil SE Bond/Filtek Z350 XT. After 24 h, the restored samples were cut into beams (± 1 mm2adhesive interface area) and subjected to a µTBS test. Data were analyzed by two-way ANOVA test and Holm-Sidak post-hoc method (α = 0.05). The treatment with CPP-ACP pastes did not significantly affect softened dentin µTBS (p = 0.070). Statistic revealed significant reduction on µTBS values for CG/L, leading to the rejection of the second null hypothesis (p < 0.001). Both CPP-ACP based pastes did not affect µTBS of softened dentin for the adhesive system utilized. The Nd:YAG laser irradiation after application of adhesive system did affect µTBS values of softened dentin samples untreated with CPP-ACP based pastes.

Biopsia por congelación: recomendaciones en la práctica clínica y dermatológica / Frozen biopsy: Recommendations in clinical and dermatology practice

Los avances en histotecnología han permitido a lo largo de los años el desarrollo de diferentes técnicas diagnósticas en la práctica de la patología. Entre estas técnicas se encuentra la biopsia por congelación, sin embargo, en el ámbito clínico es común el desconocimiento de esta herramienta diagnóstica. Presentamos una breve revisión acerca de sus limitaciones, sus posibles indicaciones y los casos en los que la biopsia por congelación brinda información importante al clínico para orientar una modificación terapéutica. Al final se hace énfasis sobre las consideraciones a tener en cuenta sobre la biopsia por congelación de piel y las condiciones clínicas en las cuales resulta útil.

The advances in histotechnology over the years have enabled the development of different diagnostic techniques in the pathology practice. These techniques include frozen biopsy; however, in the clinical field use of this diagnostic tool generally unknown. A brief review of their limitations are presented, along with their possible indications, as well as cases in which frozen biopsy provides important information to the clinician to guide therapeutic changes. Finally, emphasis is placed on the considerations to take into account in frozen skin biopsy, and the clinical conditions in which it is useful. © 2013 Instituto Nacional de Cancerología. Published by Elsevier España, S.L.U. All rights reserved.

Colgajo fasciocutáneo sural inverso para cobertura de defectos de partes blandas en pierna, tobillo y pie / Reverse fasciocutaneous sural flap for soft-tissue coverage in leg, ankle and foot

Introducción: El objetivo de este trabajo es evaluar los resultados obtenidos con la utilización del colgajo fasciocutáneo sural de base distal para la reconstrucción de defectos de partes blandas alrededor de la tibia distal, el tobillo y el pie. Materiales y Métodos: Se evaluaron, en forma retrospectiva, 20 colgajos pediculados fasciocutáneos surales inversos realizados entre 2007 y 2013. la edad promedio de los pacientes era de 42 años (rango 6-79); 14 hombres y 5 mujeres. las causas de los defectos fueron: postraumáticas (17 casos, un caso bilateral) y secundarias a resecciones oncológicas (2 casos). la muestra incluyó tres pacientes diabéticos, una mujer obesa y ocho pacientes tabaquistas. en 10 casos, las heridas presentaban exposición tendinosa y, en 10 casos, exposición ósea. el diámetro promedio de los defectos fue de 8,9 x 5,75 cm. Resultados: El seguimiento promedio fue de 16 meses. se logró una exitosa cobertura completa del defecto en los 20 casos. el tiempo promedio de internación fue de 3.15 días. tres colgajos presentaron necrosis parcial superficial, en un caso el colgajo sufrió necrosis en su tercio distal y, en un paciente, se decidió amputar la extremidad por persistencia de la osteomielitis. Conclusiones: Pese a que se han descrito múltiples opciones de cobertura en defectos de tejidos blandos alrededor de la tibia distal, el tobillo y el pie, el colgajo sural inverso es, en la actualidad, uno de los procedimientos más frecuentes para cubrir estos defectos. se evaluaron 20 colgajos surales inversos y se logró la cobertura completa de los defectos de tejidos blandos, tanto en defectos postraumáticos como en los resultantes de resecciones oncológicas.

Background: The objective of this paper is to evaluate the results after the use of distally-based reverse fasciocutaneous sural flap in the reconstruction of soft-tissue loss around the distal tibia, ankle and foot. Methods: Twenty fasciocutaneous pedicled reverse sural flaps performed between 2007 and 2013 were retrospectively evaluated. Average age of the patients: 42 years (range 6-79), 14 were male and 5 were female. soft-tissue loss was post-traumatic in 17 cases (one bilateral) and secondary to oncologic resections in two cases. the series included three diabetic patients, one obese woman, and eight smokers. ten cases had exposed tendons and ten had bony exposure. defect size averaged 8.9 x 5.75 cm. Results: Follow-up averaged 16 months. complete soft tissue defect coverage was achieved in all 20 cases. Hospital stay averaged 3.15 days. three flaps had superficial necrosis, one flap suffered necrosis of its distal third, and the lower extremity was amputated in a patient due to persistent osteomyelitis. Conclusions: Although multiple coverage options have been described for soft-tissue coverage around the distal tibia, ankle and foot, the reverse sural flap is one of the most frequently used procedures to cover these defects. We evaluated 20 reverse sural flaps, achieving complete soft-tissue coverage in post-traumatic lesions as well as in those defects resulting from oncologic resections.

Integración de los aloinjertos óseos impregnados con alendronato. Estudio experimental / Alendronate-impregnated bone allograft integration. Experimental study

Introducción: El propósito de este estudio experimental es investigar la variabilidad en la reabsorción ósea de aloinjertos impregnados con alendronato respecto a aloinjertos sin impregnación con alendronato. Materiales y Métodos: Se utilizaron 18 conejos neozelandeses, divididos en dos grupos de 9 animales cada uno. Se trabajó sobre el fémur derecho, se realizó una ventana ósea y se colocó aloinjerto con alendronato local en el grupo I y aloinjerto sin alendronato en el grupo II. Todos fueron sacrificados a las 10 semanas del procedimiento inicial, y se valoró el fémur operado con anatomía patológica, radiografías de frente y de perfil, y tomografía axial computarizada. Se evaluaron la osteointegración, la vascularización y la calidad ósea. Resultados: El estudio histológico demostró mayor osteointegración en el grupo I que en el grupo II (p = 0,003), y fenómenos bien definidos de “acoplamiento” entre el tejido óseo receptor e injertado, leve actividad osteoclástica. En el grupo II, se observó menor acoplamiento óseo (osteointegración). La evaluación de la reabsorción ósea con radiografía y tomografía computarizada no reveló una diferencia estadísticamente significativa entre ambos grupos. En el grupo I, se observó mayor osteointegración del aloinjerto (p = 0,577; no significativo). Conclusión: Los resultados obtenidos en este trabajo experimental muestran que el alendronato local asociado a aloinjertos ayuda a mejorar la osteointegración de los aloinjertos, que es un método seguro, y que no se asocia a riesgos locales o sistémicos en conejos, aun en dosis elevadas.

Background: The use of allografts in bone reconstruction may be associated with an increased absorption of the latter, which may cause loss of stability and failure of reconstructions. The purpose of this experimental study was to investigate the variability in bone resorption in alendronate impregnated allografts versus non-impregnated allografts. Methods: Eighteen New Zealand rabbits were divided into two groups of nine animals each. We worked on the right femur; a bone window was performed and allografts were placed (with alendronate in group I and without alendronate in group II). All rabbits were sacrificed at 10 weeks after the initial procedure. Femur was evaluated with pathology, frontal and lateral radiographs and computed tomography. Osteointegration, vascularization and bone quality were evaluated. Results: No deaths or infections were reported, with 18 rabbits up to final analysis. histology showed better osteointegration in group I than group II (p = 0.003), with well-defined attachment between receptor bone tissue and low osteoclastic activity. In group II, we observed less osteointegration. Assessment of bone resorption with radiographs and computed tomography showed no statistically significant difference between both groups. Group I showed more osteointegration of the allograft (p = 0.577; not significant). Conclusions: Results of this experimental study show that allografts impregnated with alendronate help to improve the osteointegration. Also, it is a safe way and it is not associated with local or systemic risks in rabbits, even with high doses of alendronate.

Osteointegración del aloinjerto crioconservado asociado a plasma enriquecido en plaquetas, en defectos óseos infectados. Estudio experimental / Osseointegration of cryopreserved allograft associated with platelet-rich plasma, in infected bone defects. Experimental study

El objetivo de este trabajo experimental es determinar si el agregado de plasma rico en plaquetas influye en la osteointegración del aloinjerto crioconservado con antibióticos, en fracturas infectadas, con pérdida ósea, en huesos largos de conejos. Materiales y métodos: Se evaluaron cuatro grupos de 7 conejos cada uno, a los cuales se les generó una fractura infectada del fémur derecho. En los cuatro grupos, se colocó aloinjerto molido con antibiótico local, en el grupo II y en el grupo IV, se agregó también plasma rico en plaquetas. Se sacrificó a los grupos I y II, a los 30 días, y a los grupos III y IV, a los 90 días. Se realizó una evaluación histológica y tomográfica. Resultados: Nueve conejos murieron en el período de estudio. No hubo diferencias estadísticamente significativas entre los grupos evaluados. En el grupo IV, con plasma rico en plaquetas, se observó neoformación ósea en tres de las cuatro muestras; se advirtieron sectores de acoplamiento entre el tejido receptor y el injertado, con consolidación en las imágenes tomográficas. Conclusiones: En este trabajo, hubo correlación entre los resultados histológicos y tomográficos. Pese a que no se hallaron diferencias estadísticamente significativas, el agregado de plasma rico en plaquetas, además de estimular la generación de nuevos tejidos, disminuyó la reabsorción del tejido injertado al análisis anatomopatológico, y mostró mayor neoformación ósea y consolidación en el grupo IV (75 por ciento) tratado con plasma rico en plaquetas que en el grupo III (25 por ciento) al que no se asoció plasma rico en plaquetas al aloinjerto óseo

The objective of this experimental work was to determine whether the addition of platelet-rich plasma influences the osseointegraton of cryopreserved allograft with antibiotics in infected fractures with bone loss, in long bones of rabbits.Methods: Four groups of 7 rabbits with generated infected fracture of the right femur. Milled allograft with local antibiotic was placed in the four groups; groups II and IV also received platelet-rich plasma. Rabbits in groups I and II were sacrificed at 30 days, and those of groups III and IV at 90 days. Histological and CT evaluation was performed.Results: Nine rabbits died during the study period. There were no statistically significant differences between groups. In group IV with platelet-rich plasma, bone formation was observed in three of the four samples, with noticeable areas of coupling between the receiver and the grafted tissue with consolidation in CT.Conclusions: In our study, there was no correlation between the histological and tomographic findings. Although we found no statistically significant differences, the addition of platelet-rich plasma stimulated the generation of new tissue, and also decreased reabsorption of the grafted tissue according to the pathologic analysis. Besides increased bone formation and consolidation was detected in group IV (75%) treated with platelet-rich plasma, compared to group III (25%) without platelet-rich plasma bone allograft.

Effectiveness of low level laser therapy in the treatment of TMD myalgia: two case reports / Eficácia do laser de baixa potência no tratamento da DTM: dois relatos de casos

Objective: To report two cases of low level laser therapy used in the treatment of muscle pain caused by temporomandibular disorders (TMDs). Methods: Two patients were selected and subjected to eight applications of low level laser therapy (diode - wavelength of 795 nm, energy density of 8 J/cm2, power of 120 mW, 66 se per point). Laser was punctually applie on masseter and temporalis muscles bilaterally. Three methods were used to evaluate the effectiveness of treatment: pressure algometer, visual analog scale (VAS) and maximal mouth opening. Each measurement was performed before and after the laser therapy session. The results were subjected to statistical analysis (ANOVA two factors and Tukey’s test, α = 0.05). Results: For both patients, no significant difference was found between the results obtained with the algometer, before and after laser application, within each session. VAS results showed a tendency to lower values after laser application. In both cases, the highest values obtained by the pressure algometer were found between the days 9 (fourth application) and 16 (sixth application). Both patients had an improvement on mouth opening. Conclusions: The assessment methods used were quite practical to register the pain before and after treatment. Therapy with low level laser seems to have a beneficial effect for the masticatory muscles pain.

Objetivo: relatar dois casos do uso do laser de baixo potência no tratamento da dor muscular causada pela disfunção temporomandibular (DTM). Métodos: Dois pacientes foram selecionados e submetidos a oito aplicações de laser de baixa potência (diodo - comprimento de onda de 795 nm, densidade de energia de 8 J/cm2, potência de 120 mW, 66 segundos por ponto). O laser foi aplicado pontualmente nos músculos masseter e temporal bilateralmente. Três métodos foram utilizados para avaliar a eficácia do tratamento: algômetro de pressão, escala visual analógica (VAS) e abertura máxima da boca. Cada medição foi realizada antes e após a sessão de terapia com laser. Os resultados foram submetidos à análise estatística (ANOVA dois fatores e teste de Tukey, α= 0,05). Resultados: Em ambos os casos, não foi encontrada diferença significativa entre os resultados obtidos com o algômetro antes e depois da aplicação do laser dentro de cada sessão. Os resultados com o VAS mostraram uma tendência a reduzir os valores após a aplicação do laser. Foram encontrados os maiores valores obtidos pelo algômetro de pressão entre os dias 9 (quarta aplicação) e 16 (sexta aplicativo), em ambos os casos. Ambos os pacientes tiveram uma melhora na abertura da boca. Conclusões: Os métodos de avaliação utilizados foram bastante prático para registrar a dor antes e após o tratamento. A terapia com laser de baixa potência parece ter um efeito benéfico para a dor músculos mastigatórios

Bond Strength of composite repairs using flowable, conventional resins or the association of both / Resistência de união de reparos de resinas compostas usando resinas convencionais, fluidas, ou a associação de ambas

Objectives: The aim of this in vitro study was to evaluate the effect on bond strength of composite repairs using flowable resin as an intermediate agent . Methods: Thirty truncated cones were fabricated with Grandio SO (VOCO) and were thermo-cycled for 5000 cycles for artificial aging. Specimen’s surface was sandblasted with aluminum oxide, cleaned with air/water spray and conditioned with phosphoric acid for 15 s. One coat of Admira Bond Adhesive (VOCO) was applied and light cured for 20 s. Specimens were divided into 3 groups according to the repairing material used (n = 10): Conventional Resin – Grandio SO (R), A thin layer of Flowable resin – Grandio SO Heavy Flow + conventional Resin (FR), and Flowable resin (F). Over the original specimens, a sectional cone-shaped teflon matrix was hold in position and the cones were built according the groups described above. Other thirty specimens were built, 10 of each group, simulating a restoration without repair. Specimens were submitted to tensile stress in a universal testing machine. Data were recorded in MPa and evaluated with ANOVA, Tukey´ s and non-paired “t’’ tests. Results: ANOVA showed significant differences among groups in which repair was performed (p < 0.00). The results of Tukey´ s test for those groups were: R (19.89 + 5.31)ab; F+R (14.49 + 5.59)a; F (20.91 + 3.99)b. The groups followed by the same letter did not show statistical differences. Non-paired “t” test showed that groups R and F repairs were similar to the correspondent groups simulating restoration without repair. Conclusions: The repair with conventional or flowable composite produced bond strength values similar to cohesive strength of the same materials. The use of a thin layer of flowable resin as an intermediate agent in composite repair decreased the bond strength when compared the same method for restoration.

Objetivos: O objetivo deste estudo in vitro foi avaliar o efeito sobre a resistência de união de reparos de compósitos com resina fluida como um agente intermediário. Métodos: Trinta cones truncados foram fabricados com Grandio SO (VOCO) e foram termociclados por 5.000 ciclos de envelhecimento artificial. A superfície da amostra foi jateada com óxido de alumínio, limpa com spray ar / água e condicionada com ácido fosfórico por 15 s. Uma camada de adesivo (Admira - VOCO) foi aplicada e fotopolimerizada por 20 s. As amostras foram divididas em três grupos de acordo com o material de reparo utilizado (n=10): resina convencional - Grandio SO (R), uma fina camada de resina flowable - Grandio SO Heavy Flow + Resina convencional (FR), e resina flowable (F). Sobre espécimes originais, foi adaptada uma matriz, e os cones foram construídos de acordo com os grupos descritos acima. Trinta amostras foram construídos, 10 de cada grupo, simulando uma restauração sem reparos. As amostras foram submetidas ao Teste de tração em uma máquina universal de ensaios. Os dados foram registrados em MPa e avaliados com ANOVA, Tukey e teste “t’’ não pareado. Resultados: ANOVA mostrou diferenças significativas entre os grupos em que o reparo foi realizado (p < 0,00). Os resultados do teste de Tukey para os grupos foram: R (19,89 + 5,31) ab; F + R (14,49 + 5,59) a; F (20,91 + 3,99) b. Os grupos seguidos pela mesma letra não apresentaram diferenças estatísticas. O Teste “t” não pareado de Student mostrou que as reparações dos grupos R e F foram semelhantes aos dos grupos correspondentes que simulam restauração sem reparos. Conclusões: O reparo com resina flowable ou convencional produziu níveis de resistência próximos a força coesiva dos mesmos materiais. A utilização de uma camada fina de resina fluida como um agente intermediário no reparo dos compósitos diminuiu a resistência de união, quando comparado o mesmo método para a restauração.

Edad de diagnóstico, cuadro clínico y crecimiento del hipotiroideo congénito / Age of diagnosis, clinical and congenital hypothyroid growth

OBJETIVO: El hipotiroidismo congénito es una de las principales causas de retardo mental prevenibles. El propósito del presente trabajo es el de determinar la edad actual de diagnóstico del hipotiroideo congénito mediante criterios clínicos. MATERIALES y MÉTODOS: Se realizó un estudio de tipo descriptivo, longitudinal y retrospectivo. Se analizaron 247 historias clínicas, de las cuales sólo 37 reunieron los criterios de inclusión. Los datos fueron consignados en una ficha confeccionada para este propósito, siguiendo los criterios de diagnóstico clínico de Blanco López et al., los datos de antropometría fueron analizados con el programa EPI-INFO 2002. El análisis de los datos recogidos fue realizado con el programa estadístico Statistical Package for the Social Science v15.0 (SPSS Inc. Chicago III ) RESULTADOS: Se halló una mayor incidencia en el sexo femenino (78 por ciento) que en el sexo masculino (22 por ciento), con una relación de 3.62/1. La edad promedio al momento del diagnóstico fue de 5.93 ± 5.28 meses para el total de la muestra. Las manifestaciones clínicas mayores al momento del diagnóstico fueron: facies abotagada (73 por ciento), piel seca (70.3 por ciento), fontanelas amplias (70.3 por ciento), estreñimiento (64.9 por ciento), hipotonía (64.9 por ciento) e ictericia (64.9 por ciento). Así mismo, se evidenció un marcado retardo del crecimiento. Posterior al diagnóstico y con la administración de L-tiroxina, el patrón de crecimiento muestra encarrilamiento del crecimiento en lo que debería ser su patrón de crecimiento y mejoramiento del peso...

OBJECTIVE: Congenital hypothyroidism is the most common preventable cause of mental retardation. The purpose of this study is to determine the current age of diagnosis of congenital hypothyroidism detected by clinical parameters. MATERIALS AND METHODS: For this descriptive and retrospective study, a total of 247 clinical records were examined, from which only 37 were included in the data processing. The information was gathered applying a clinical scoring system elaborated by Blanco Lopez et. al for clinical diagnosis of congenital hypothyroidism, and the anthropometric data were analyzed with the EPI-INF02002 software and the statistics were calculated using the Statistical Package for the Social Science (SPSS Inc. Chicago III) RESULTS: Congenital hypothyroidism was predominantly found in females (78 per cent) than in males (22 per cent) with a female-to-male ratio of 3.62/1. The average age at diagnosis was 5.93 ± 5.28 months. The most prevalent clinical parameters at the moment of diagnosis were: puffy face (73 per cent), dry skin (70.3 per cent), larger fontanels (70.3 per cent constipation (64.9 per cent hypotonia (64.9 per cent) and exaggerated jaundice (64.9 per cent). Poor growth and growth delay was also found. After diagnosis and receiving the proper levothyroxine treatment, the growth development was improved, such as their weight...

Evaluación funcional de pacientes con accidente cerebrovascular en el Hospital Dr. Gustavo Fricke / Funcional evaluation of cerebrovascular, patients at Hospital Dr. Gustavo Fricke

El accidente cerebrovascular (ACV) es una enfermedad prevalente, correspondiendo a una de las principales causas de incapacidad. Uno de los métodos usados para evaluar la capacidad funcional de los pacientes es la Escala pronóstica de Orpington (EPO). Este es un estudio prospectivo que evalúa la capacidad funcional de pacientes con ACV. Se incluyeron 41 pacientes con ACV hospitalizados en el Servicio de Medicina del Hospital Dr. Gustavo Fricke durante el período del 2 de septiembre y 2 de noviembre de 2007. Se obtuvo que: 26 ACV fueron en hombres y 15 en mujeres, con una edad promedio de 75 años (rango 47 a 94 años); 37 presentaban alguna comorbilidad asociada y 26 de éstos más de una comorbilidad; en 32 de los casos el déficit se manifestó como una parálisis faciobraquiocrural. Al aplicar la EPO se obtuvo que 6 casos tenían buen pronóstico, 23 moderado y 12 mal pronóstico funcional, siendo el equilibrio (33 casos) y el déficit motor (34 casos) los parámetros que más se afectaron. Así mismo, se obtuvo que el antecedente de ACV previo tiene un riesgo individual del 100 por ciento de tener un ACV de mal pronóstico (p<0,05), con un riesgo atribuible de un 76,32 por ciento. Por lo anterior, se entiende que debido a la gran prevalencia de comorbilidades asociadas, sumado al déficit inherente de esta patología, los convierten en pacientes muy demandantes de cuidados, tanto hospitalizados como en sus hogares, dificultando su traslado. Cabe destacar la importancia de la prevención secundaria de los ACV, debido al incremento del riesgo que tienen estos pacientes de que este evento sea de mal pronóstico funcional.

Stroke is a prevalent disease, corresponding to one of the leading causes of disability. One of the methods used to assess the functional status of patients is the Orpington Prognostic Scale (OPS). This is a prospective study that assesses the functional ability of stroke patients. Forty-one stroke patients admitted to Hospital Dr. Gustavo Fricke's medicine service between September 2nd and November 2nd 2007, were included. The following results were obtained; 26 cases were male and 15 cases were female, with a mean age of 75 years (range, 47 to 94); 37 had comorbidities and 26 of them had more than one. In 32 cases the deficit presented as faciobrachiocrural paresis. The OPS was administered to patients, obtaining a good prognostic score in 6 cases, intermediate score in 23 cases, and a poor prognosis in 12 cases. The most affected parameters were balance (33 cases) and motor function (34 cases). It was also found that a history of prior stroke has an individual risk of 100 per cent for having a stroke with poor prognosis (P<0.05), with an attributable risk of 76.32 per cent. Therefore, due to the high prevalence of associated comorbidities, and the inherent deficiency of stroke, this patients have high needs of care both in the hospital and their homes, difficulting their transport. The importance of secondary prevention in stroke patients is to be emphasized, considering their increased risk of having a new event with bad functional prognosis.

Evaluación de la calidad de vida en pacientes con hiperhidrosis sometidos a simpaticectomía por toracoscopia: Clínica Cardiovascular Santa María, Medellín, Colombia / Quality of life in patients with hyperhidrosis after thoracoscopic sympathectomy in the Clínica Cardiovascular Santa Maria in Medellin, Colombia

Introducción: la simpaticectomía por toracoscopia está indicada como tratamiento de la hiperhidrosis.Objetivo: evaluar la percepción que tienen los pacientes con hiperhidrosis de la calidad de vida antes y después de la simpaticectomía toracoscópica. Metodología: se encuestaron telefónicamente a los pacientes a quienes se les había practicado simpaticectomía toracoscópica. Durante la misma entrevista se utilizó el instrumento SF-36 para evaluar la calidad de vida antes y después del procedimiento. Resultados: se estudiaron 33 pacientes, el 66.6 por ciento eran de sexo femenino. La edad promedio fue de 26,5 años (11.2). Las áreas corporales con mayor compromiso fueron: palma de las manos (90.9 por ciento), axilas (72.7 por ciento), planta de los pies (39.4 por ciento), cara (24.2 por ciento) y región inguinal (3.0 por ciento). El efecto secundario más frecuente fue la sudoración compensatoria (60.6 por ciento), siendo la espalda el sitio más común. No se presentaron complicaciones. Al evaluar el cuestionario de calidad de vida se notó claramente una mejoría significativa en la calidad de vida en los pacientes, siendo las variables con aumento porcentual más notorio: la función social (69.1 por ciento), desempeño físico (59.7 por ciento) y desempeño emocional (34.5 por ciento). Conclusión: la simpaticectomía toracoscópica es un procedimiento seguro y efectivo, que mejoró la calidad de vida de los pacientes con hiperhidrosis.

Grupo de investigación emergencias y desastres / Research group on emergencies and disasters

Se presenta el contexto sociopolítico, jurídico y ambiental donde suceden los desastres y las emergencias, el cual sustenta la importancia de realizar trabajos que aporten, desde la atención en salud y desde lo psicosocial para la prevención, la atención, la mitigación y la rehabilitación de las personas y las comunidades. También se presentan investigaciones, actividades de extensión y de capacitación, publicaciones y ponencias, vinculaciones nacionales e internacionales, participcaipón en la formación de estudiantes de especializaciones y de pregrado y referencias bibliográficas. Los desastres son uno de los principales problemas y generan diferentes situaciones que alteran la calidad de vida de las comunidades; para el trabajo en investigación se consideran como núcleos problemáticos: el trauma, el autocuidado, las repercusiones fisicas y psicosociales, la particpación de las comunidades y el desplazamiento forzado.