Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study

Abstract Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. Methodology Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. Results In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. Conclusions We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related "common risk factors".

Utilidad del cuestionario de STOP-BANG como predictor único de vía aérea difícil / STOP-BANG questionnaire as predictor of a difficult airway management during anesthesia

BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent. The STOP-BANG questionnaire is a simple and useful tool to screen for OSA. AIM: Since OSA is strongly associated with airway management troubles, we sought to determine whether the STOP-BANG can predict difficult airway management. MATERIAL AND METHODS: An observational, cross-sectional study was conducted including adult patients scheduled for major outpatient surgery under general anesthesia. The STOP-BANG questionnaire was preoperatively applied by a ward nurse. The Han scale mask ventilation difficulty scale, Cormack-Lehane laryngeal view scale were also applied and the need for video laryngoscopy was recorded. The number of attempts for successful insertion of a laryngeal mask airway were determined. RESULTS: We studied 993 patients, of whom 53% required tracheal intubation and 47% a laryngeal mask. Most patients had a low OSA risk, (STOP-BANG 2. The positive and negative likelihood ratios, (2.0 and 0.2) imply poor predictive capability. CONCLUSIONS: The STOP-BANG questionnaire was only able to predict difficult mask ventilation. Since its discriminative value was low, it cannot be recommended it as a single predictor.

Burnout en funcionarios de salud en tiempos de pandemia / Burnout syndrome in healthcare workers during COVID-19 pandemic

BACKGROUND: Coronavirus Disease (COVID-19) exposed health personnel worldwide to high stress levels, which increases the phenomenon of burnout. AIM: To evaluate burnout, its risk, and protective factors in our health team, which has been exposed for months to greater work stress and changes in their usual tasks due to the pandemic. Material and Methods: An online survey including the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and sociodemographic questions, was carried out among health care personnel who continued working during the pandemic. RESULTS: A total of 209 surveys were obtained. Seventy six percent of respondents presented some degree of burnout in the time of the pandemic. Only one protective factor was observed: living with one or more children at home (Odds ratio (OR) 0.21, 95% confidence intervals (CI) 0.05 - 0.87; p = 0.03). Having night shifts (OR 2.72, 95% CI 1.02 - 7.28; p = 0.04), having more than six years in the workplace (OR 3.58, 95% CI 1.18 - 10.8; p = 0.023) and maintaining a regular or poor diet during the pandemic (OR 4.52, 95% CI 1.51-13.48; p < 0.01) were identified as risk factors. CONCLUSIONS: A high incidence of burnout was observed in the surveyed population. Living with one or more children in the home stands out as a protective factor and working night shifts, having more than 6 years in the workplace, and maintaining a poor diet as risk factors.

Factores de riesgo de reacción paradójica asociados a sedación endovenosa con midazolam / Paradoxical reactions associated with midazolam conscious sedation

Background: Benzodiazepines are used for perioperative conscious sedation. However, its use may be associated with paradoxical reactions. The known risk factors for these reactions are age, alcohol and drug abuse and psychiatric disorders. Aim: To assess the incidence and impact of risk factors of paradoxical reactions to midazolam. Material and Methods: Cross sectional study of 218 patients aged 50 ± 16 years (51% women) scheduled for elective surgical procedures under regional anesthesia and midazolam sedation. The paradoxical reactions were classified according to their severity in three categories. Results: The incidence of paradoxical reactions to midazolam was 8.3% (95% confidence interval (CI) 5.0-12.7). All were mild and only 28% of the affected patients required pharmacological treatment, none of them flumazenil. A multivariable logistic regression model showed that the variables independently associated with a paradoxical reaction to midazolam were the use of psychoactive medications (Odds Ratio (OR) = 3.4 [1.1-11], p = 0.04, and the dose of midazolam (OR 1.35 [1.03-1.78], p = 0.03. Conclusions: The incidence of paradoxical reactions to midazolam was 8,3% and all were mild. Their risk factors are the use of psychoactive medications and the use of higher doses of midazolam.

Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo? / Vitamin D levels among anesthesiologists and other physicians

Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.

Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation / Prevalencia y Severidad de Caries Dental y Fluorosis en Niños de 8 Años con o Sin Suplementos de Flúor

ABSTRACT: One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.

RESUMEN: Una de las medidas más efectivas y estudiadas en la prevención de caries es el uso de fluoruros, que tiene la propiedad de reducir su incidencia y severidad. 75 % de la población chilena lo recibe al incluirlo en el agua potable. La OMS en 1984 recomendó el uso de leche como un vehículo alternativo. En Chile, el Programa de Alimentación Escolar con leche fluorada fue implementado en 1994 como alternativa en zonas rurales sin fluoruro en el agua. El objetivo de este estudio fue comparar la prevalencia y severidad de la caries dental y la fluorosis dental en niños de 8 años en tres escuelas públicas, con suplementación de fluoruro en el agua potable o en la leche y con aquella que no tiene ningún programa de fluoración. Estudio epidemiológico, descriptivo, comparativo, observacional y de corte transversal con una muestra de 140 niños de 8 años, sin enfermedades sistémicas y que han vivido en el mismo lugar desde su nacimiento: 50 escolares en el área con agua fluorada, 40 en el área con leche fluorada y 50 en la zona sin suplementación de fluoruro. El porcentaje de niños libres de caries fue obtenido con la metodología descrita por la OMS, usando índices ceo-d y CPO-D para evaluar severidad. Para cuantificar la prevalencia y severidad de la fluorosis dental se ocupó el índice de Dean. Niños libres de caries fueron 38 % en la comunidad con agua fluorada (CWF); 0 % en la comunidad con leche fluorada (FSFP) y 10 % en la comunidad sin programa de fluoración (CNF). La diferencia entre CWF y CNF es estadísticamente significativa (p<0,05). La prevalencia de fluorosis es significativamente mayor en CWF (48,8 %) que FSFP (35 %) y CNF (16 %). La contribución del fluoruro en el agua potable causa una disminución en la prevalencia y severidad de la caries dental en niños de 8 años, y un aumento en la prevalencia de fluorosis dental.

Tubos endotraqueales con cuff en anestesia pediátrica: ¿aumentan el riesgo de estridor post-extubación? Estudio observacional, cohorte prospectiva / Do cuffed endotracheal tubes raise post-extubation stridor risk in pediatric anesthesia? A prospective cohort study

The traditional pediatric airway model precludes the use of cuffed endotra-cheal tubes because of concerns regarding subglottic mucosal injury. Cuffed tubes have advantages which together with a change in the pediatric airway paradigm have made the practitioners to consider its use in children. Nevertheless some uneasiness remains about cuff employ in the neonatal population, specially preterms. A study was designed to determine if cuffed tracheal tubes increased the post-extubation stridor risk in children. Methods: Information concerning 535 children under 11 years old undergoing general anesthesia with tracheal intubation was prospectively recollected during a year. The choice of the type of tube was left to the anesthesiologist in charge. The post-extubation stridor risk was compared with logistic regression between those intubated with and those without cuffed tubes. Results: The post-extubation stridor incidence was 19·1,000 patients-year; Conf. Interval 95 percent [9-34·1,000]. The cuffed tracheal tubes effect on stridor risk, (adjusting for confounders), was non-significant: OR = 2,2; Conf. Interval 95 percent [0,2-20]; p = 0,5. Conclusions: The use of cuffed endotracheal tubes did not increase the risk of post-extubation stridor in children.

El concepto tradicional de vía aérea pediátrica es incompatible con el uso de tubo traqueales con cuff puesto que el área de menor circunferencia se ubica en la zona subglótica. Sin embargo, los tubos con cuff tienen ventajas, lo que unido a cambios en el paradigma de la vía aérea infantil han impulsado su uso entre los anestesiólogos. Pero aún persisten dudas respecto a su utilización, especialmente en recién nacidos prematuros. El principal objetivo de esta investigación es determinar si el uso de tubos con cuff aumenta la incidencia de estridor post-extubación en la población pediátrica. Materiales y Métodos: Se diseñó un estudio prospectivo observacional que incluyó pacientes menores de 11 años de edad, sometidos a anestesia general que requiriera intubación traqueal y el riesgo de estridor post-extubación fue comparado en pacientes en los que se usaron tubos con y sin cuff. Resultados: Se registró información de 535 pacientes durante 1 año. La incidencia de estridor post-extubación fue de 19 x 1.000 pacientes-año; (Int. Confianza 95 por ciento. [9-34 x 1.000]). El análisis controlando por las variables de confusión demostró que el uso de tubo con cuff no influyó en el riesgo de estridor post-extubación (Odds Ratio: 2,2; Intervalo Confianza 95 por ciento [0,2 -20]; p = 0,5). Conclusiones: El uso de tubos endotraqueales con cuff no aumentó el riesgo de estridor post-extubación en la población pediátrica estudiada.

Sobrevida postoperatoria en pacientes nonagenarios: Estudio pronóstico en cohorte retrospectiva 2001-2010, Clínica Dávila / Postoperative survival among nonagenarians: A retrospective study

Background: As the Chilean population ages, anesthesiologists are regularly faced with elderly and even nonagenarian people undergoing surgical procedures. Aim: To determine the postoperative survival time in nonagenarians and its risk factors at a private clinic. Material and Methods: Review of medical records of the clinic, searching for patients aged 90 years or older, which were subjected to a surgical procedure between 2001 and 2012. Certification ofsurvival or death was obtainedfrom the clinical records or death certification at the National Identification Service. Survival analysis was made using Kaplan-Meier and Gompertz regression. Results: The medical records of167 patients, aged 90 to 101 years (64% women), were reviewed. Sixty four percent had an underlying cardiovascular disease; in 37%, cognitive impairment. Hip fracture surgery was the most common procedure. One intraoperative death occurred. Five percent ofpatients died one month after surgery. The median survival time was two years and the longest, seven years. According to Gompertz probability regression, the predictors of death were the presence of cardiac disease (Hazard ratio (HR): 1.91, 95% confidence intervals (95% CI): 1.16; 3.16), cognitive impairment (HR: 2.10,95% CI: 1.32; 3,22), cancer (HR:2.10,95% CI: 1.32; 3.22), requirement of transfusion (HR: 1.79, 95% CI: 1.13; 2.83) and an American Society of Anesthesiologists (ASA) Class III classification (HR: 1.95, IC95%: 1.21; 3.15). Conclusions: In nonagenarian patients undergoing surgery; 50% mortality was observed 2 years after surgery. The presence of cardiac disease, cognitive impairment, cancer, transfusion and a Class IIIASA classification were predictors of death.

Movimientos convulsivos durante la inducción inhalatoria con sevoflurano / Convulsive movements during inhalational induction with sevoflurane

La inducción inhalatoria con sevoflurano se ha asociado con actividad epileptógena y movimientos convulsivos. Se diseñó un estudio para determinar la incidencia de movimientos convulsivos durante la inducción inhalatoria con sevoflurano y sus posibles factores de riesgo. Para llevar a cabo estos objetivos, desde marzo a julio de 2011 se solicitó a los anestesiólogos de Clínica Dávila registrar la ocurrencia de movimientos convulsivos en todo paciente en que se realizara inducción inhalatoria con sevoflurano, en el período comprendido entre la etapa III de la anestesia y la inyección de drogas endovenosas. El tamaño muestral calculado fue de 400 pacientes para obtener un intervalo de confianza de 95 por ciento con un error menor a 2,5 por ciento. Se obtuvo información de 405 pacientes con una mediana de edad de 4 años (rango: 2 días a 16 años de edad), predominantemente hombres y ASA I. La incidencia de convulsiones fue de 3,5 por ciento (IC 95 por ciento: 1,9 por ciento; 5,7 por ciento) y fueron más frecuentes en mujeres (5,9 por ciento versus 2 por ciento en hombres, p = 0,039). En conclusión, la incidencia de convulsiones durante la inducción inhalatoria con sevoflurano fue de 3,5 por ciento y su único factor de riesgo fue pertenecer al género femenino...

Introduction: Mask induction with Sevoflurane has been associated with epileptic form changes of the EEG and sometimes with tonic-clonic movements. Objectives: To determine the incidence rate of convulsive movements during the induction of anesthesia with Sevoflurane and its risk factors. Methods: From march 1st to july 31st 2011, we asked to the anesthesiologists of our institution to watch the occurrence of tonic-clonic movements during Sevoflurane induction, after the loss of eyelash reflex and before the injection of intravenous drugs. The sample size was calculated in 400 patients to obtain a 95 percent confidence interval with an error lesser than 2.5 percent. Results: We obtain data from 405 patients with a median age of 4 years old (range 2 days to 16 years old), predominantly males and ASA physical status I. The incidence rate of convulsions was 3.5 percent (CI 95 percent 1.9; 5.7), more frequent in females (5.9 percent versus 2.0 percent in males, p = 0.039). Conclusions: The incidence rate of convulsions during inhalatory induction with Sevoflurane was 3.5 percent and associated to female gender...

La prevención de caries a través de un vehículo nutricional / Caries prevention through a nutritional vehicle

Con el propósito de evaluar la prevención de caries a través de un importante elemento de la nutrición infantil como es la leche, se estudiaron las possibilidades biológicas, tecnológicas y de costos relativos cuando ésta se suplementa con fluoruro (f), utilizando monofluorfosfato de sodio (MFP) como fluorante en dicho producto. Através de encuestas y análisis químicos, se determinó el rango de ingesta de F en la población preescolar chilena de nivel socioeconómico bajo y bajo-medio, obteniéndo-se valores de 0.15-0.35 mg F/día. De determinó la absorción relativa de F a partir de los elementos dietarios que lo contienen en mayor proporción, obteniéndose valores de 0.58 y 0.32 en ayunas y co-administrato con alimentos sólidos con té, respectivamente, y un valor de 0.34 para el pescado, considerándose que el valor de absorción del F (como fluoruro de sodio) en agua y en ayunas,m es de 1.00. El estudio en cuestión demostró que la absorción de F (como MFO) en leche, es equivalente a la de F (como FNa) en agua. Se estimaron los costos relativos (para la situación en Chile) de la fluoración de leche y de la fluoración de aguas, encontrando-se que la fortificación de la leche es por lo menos 1,000 veces más económica que la fluoración de agua. Se concluye que para la prevención de caries, la fluoración de leche es una alternativa más económica y viable que la fluoración de aguas, para algunos países en vías de desarrollo

Prevalencia de obesidad y de algunos factores asociados en una población escolar adolescente / Prevalence of obesity and some associated factors in a school adolescence population

Fueron pesados, medidos y clasificados, según tablas y criterios OMS, 1.051 escolares entre 13 y 15 años, de 3 colegios del Area Occidente de Santiago; 50,1% mujeres (527) y 49,9% (524) hombres. Se efectuó una encuesta alimentaria a una submuestra del 9% estratificada según sexo y estatura; se consideraron antecedentes de prácticas deportivas y de obesidad en los padres. El cálculo calórico se hizo en base a la Tabla de Composición Química de Alimentos Chilenos y los resultados se compararon con las recomendaciones FAO/OMS. La prevalencia global de obesidad, según peso/talla fue 33,5%; con un 41% en mujeres y 26% en hombres (p < 0,001). Por peso/edad la cifra fue 4,9% sin diferencias por sexo. De acuerdo a talla/edad, 39,9% tiene retraso en la talla, siendo mayor en las mujeres (52,5% contra 27,5% en hombres; p < 0,001). Las mujeres obesas encuestadas tienen un promedio de ingesta calórica menor que las recomendaciones (adecuación de 94,5%), en cambio, las no obesas tiene una cifra superior (124,9%), significativo respecto a las primeras. De los hombres encuestados, el 71,1% refiere hacer deporte, lo que ocurrió sólo en el 24% de las mujeres (p < 0,001). Según estado nutritivo, hacen deporte: 65,2% de los hombres obesos y 77,3% de los no obesos; 19,2% de las mujeres obesas y 29,2% de las no obesas (diferencias no significativas). El 68,4% del total, encuestado refirió tener padre y/o madre obesos. Entre los obesos, el 73,5% tiene este antecedente; 88,5% en las mujeres y 56,6% en los hombres (p < 0,006)