Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings.

PURPOSE: To outline the demographics, clinical presentation, imaging features, and treatment modalities observed among a series of patients diagnosed with biopsy-proven granulomatous mastitis (GM). METHOD: Following approval by institutional review board, retrospective chart review was performed on patients with biopsy-proven granulomatous mastitis at our institution in the period from January 2013 until October 2017. RESULTS: A total of 90 patients were identified: 87 women and 3 men. The mean age was 35 years, mostly women in their reproductive age. In our study, patients with GM were more likely to be Hispanic compared to the general population. Sixty-three percent of patients were within 5 years of previous pregnancy. Painful palpable mass-like lesion was the most common physical finding. Breast ultrasound (US) was performed in all patients, and most commonly showed a hypoechoic irregular-shaped mass. Mammography (MG) showed asymmetry or irregular mass as the main finding. Definitive diagnosis was obtained by imaging-guided core needle biopsies in 94.4%. Conservative management was preferred, and only one patient underwent surgery. CONCLUSION: Although clinical and radiological findings of patients with GM may mimic those of breast carcinoma, our study showed that women of childbearing age, especially among Hispanic ethnicity with a recent history of pregnancy or high prolactin level and newly tender mass-like lesion, in addition to new focal asymmetry on mammogram and heterogeneous hypoechoic irregular-shaped mass on ultrasound exam, should raise concern for GM. Non-invasive approach and clinical follow-up were the preferred treatment method.

Current and Future Directions of Breast MRI.

Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient's response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.

Oncogene-specific differences in tumor mutational burden, PD-L1 expression, and outcomes from immunotherapy in non-small cell lung cancer.

BACKGROUND: Non-small cell lung cancer (NSCLC) patients bearing targetable oncogene alterations typically derive limited benefit from immune checkpoint blockade (ICB), which has been attributed to low tumor mutation burden (TMB) and/or PD-L1 levels. We investigated oncogene-specific differences in these markers and clinical outcome. METHODS: Three cohorts of NSCLC patients with oncogene alterations (n=4189 total) were analyzed. Two clinical cohorts of advanced NSCLC patients treated with ICB monotherapy [MD Anderson (MDACC; n=172) and Flatiron Health-Foundation Medicine Clinico-Genomic Database (CGDB; n=894 patients)] were analyzed for clinical outcome. The FMI biomarker cohort (n=4017) was used to assess the association of oncogene alterations with TMB and PD-L1 expression. RESULTS: High PD-L1 expression (PD-L1 ≥50%) rate was 19%-20% in classic EGFR, EGFR exon 20 and HER2-mutant tumors, and 34%-55% in tumors with ALK, BRAF V600E, ROS1, RET, or MET alterations. Compared with KRAS-mutant tumors, BRAF non-V600E group had higher TMB (9.6 vs KRAS 7.8 mutations/Mb, p=0.003), while all other oncogene groups had lower TMB (p<0.001). In the two clinical cohorts treated with ICB, molecular groups with EGFR, HER2, ALK, ROS1, RET, or MET alterations had short progression-free survival (PFS; 1.8-3.7 months), while BRAF V600E group was associated with greater clinical benefit from ICB (CGDB cohort: PFS 9.8 months vs KRAS 3.7 months, HR 0.66, p=0.099; MDACC cohort: response rate 62% vs KRAS 24%; PFS 7.4 vs KRAS 2.8 months, HR 0.36, p=0.026). KRAS G12C and non-G12C subgroups had similar clinical benefit from ICB in both cohorts. In a multivariable analysis, BRAF V600E mutation (HR 0.58, p=0.041), PD-L1 expression (HR 0.57, p=0.022), and high TMB (HR 0.66, p<0.001) were associated with longer PFS. CONCLUSIONS: High TMB and PD-L1 expression are predictive for benefit from ICB treatment in oncogene-driven NSCLCs. NSCLC harboring BRAF mutations demonstrated superior benefit from ICB that may be attributed to higher TMB and higher PD-L1 expression in these tumors. Meanwhile EGFR and HER2 mutations and ALK, ROS1, RET, and MET fusions define NSCLC subsets with minimal benefit from ICB despite high PD-L1 expression in NSCLC harboring oncogene fusions. These findings indicate a TMB/PD-L1-independent impact on sensitivity to ICB for certain oncogene alterations.

Absenteísmo por covid-19 em profissionais de enfermagem de unidade de terapia intensiva / Absenteeism due to covid-19 in nursing professionals in the intensive care unit / Ausentismo debido al covid-19 em profesionales de enfermería en la unidad de cuidados intensivos

Objetivo: Identificar as variáveis associadas ao absenteísmo por covid-19 avaliando a Qualidade de Vida no Trabalho dos profissionais de enfermagem da Unidade de Terapia Intensiva de um hospital público. Métodos: Estudo de abordagem quantitativa, observacional e retrospectivo, realizada na Unidade de Terapia Intensiva de um hospital público estadual em Manaus, aplicado dois questionários para a coleta de dados. Resultados: O absenteísmo teve influência das seguintes variáveis: técnicos de enfermagem (100%); dois vínculos empregatícios (64%); especialização nível médio ou pós-técnico (50%); renda até dois salários-mínimos (73,9%). Conclusão: Este estudo visa contribuir para o avanço do conhecimento científico por meio das relações entre o absenteísmo e a Covid-19 e, através do índice de Qualidade de Vida busca ajudar na criação de melhorias para a classe da enfermagem e de aspectos organizacionais. (AU)

Objective: To identify the variables associated with absenteeism by covid-19 evaluating the Quality of Life at Work of nursing professionals in the Intensive Care Unit of a public hospital. Methods: A quantitative, observational and retrospective study. The research was carried out in the Intensive Care Unit of a public hospital in Manaus, where two questionnaires were applied for data collection. Results: The absenteeism was influenced by the following variables: nursing technicians (100%); two jobs (64%); medium or post-technical specialization (50%); income up to two minimum wages (73.9%). Conclusion: This study aims to contribute to the advancement of scientific knowledge through the relationship between absenteeism and Covid-19 and, through the Quality of Life index, seeks to help create improvements for the nursing class and organizational aspects. (AU)

Objetivo: Identificar las variables asociadas al absentismo por covid-19 evaluando la Calidad de Vida Laboral de los profesionales de enfermería de la Unidad de Cuidados Intensivos de un hospital público. Métodos: Estudio cuantitativo, observacional y retrospectivo. La investigación se realizó en la Unidad de Cuidados Intensivos de un hospital público de Manaus, donde se aplicaron dos cuestionarios para la recogida de datos. Resultados: En el absentismo influyeron las siguientes variables: técnicos de enfermería (100%); dos empleos (64%); especialización media o postécnica (50%); ingresos de hasta dos salarios mínimos (73,9%). Conclusión: Este estudio pretende contribuir al avance del conocimiento científico a través de la relación entre el absentismo y el Covid-19 y, a través del índice de Calidad de Vida, busca ayudar en la creación de mejoras para la clase de enfermería y los aspectos organizativos. (AU)

Ischemia in women with angina and normal coronary angiograms.

BACKGROUND: Coronary artery disease is frequent in postmenopausal women. Myocardial ischemia has been induced with stress testing, and a relationship between endothelial dysfunction and perfusion defects has been reported. OBJECTIVE: To evaluate whether myocardial ischemia can be evidenced both by perfusion and function abnormalities using gated single-photon emission computed-tomography myocardial scintigraphy with technetium-labeled compounds in women with typical angina, normal coronary angiography, and endothelial dysfunction. METHODS AND RESULTS: Fifty-nine postmenopausal patients were studied. Each underwent technetium-99m methoxy-isobutyl-isonitrile myocardial scintigraphy (protocol: exercise stress-rest), brachial artery endothelial function measured by ultrasonography, lipidogram, and 24-h ambulatory ECG recording (Holter). Twenty-one patients (group I) showed perfusion defects in myocardial scintigraphy, whereas the other 38 patients (group II) did not. Group I patients exhibited endothelial dysfunction more frequently (57 vs. 29%) than those of group II. Among group I patients, 12 showed a reversible perfusion defect that, in 75% of the cases, was associated with poststress left ventricular ejection fraction reduction greater than 5% and a regional hypokinesis. Nine patients had fixed defects, which in 56% of the cases were associated with poststress left ventricular ejection fraction reduction greater than 5%. Left ventricular ejection fraction poststress minus left ventricular ejection fraction at rest was -5.2% in group I patients versus -1.8% in group II (P<0.001). Three patients in group I showed evidence of ischemia by Holter compared with four in group II. CONCLUSION: Stress-induced ischemia is associated with poststress left ventricular ejection fraction reduction in postmenopausal women with typical angina, normal coronary angiography, and a trend toward abnormal endothelial-mediated vasodilation.

Influence of Hispanic ethnicity on blood pressure control and cardiovascular outcomes in women with CAD and hypertension: findings from INVEST.

BACKGROUND: Prospective data regarding blood pressure (BP) control and cardiovascular (CV) outcomes in Hispanic women are lacking. METHODS: We analyzed 5017 Hispanic and 4710 non-Hispanic white hypertensive women with coronary artery disease (CAD) in the INternational VErapamil SR/Trandolapril STudy (INVEST) to determine the impact of baseline characteristics and BP control on CV outcomes. RESULTS: At baseline, Hispanic women were younger and a had lower prevalence of most established CV risk factors than non-Hispanic white women. At 24 months, BP control (< 140/90 mm Hg) was achieved in 75% of Hispanic and 68% of non-Hispanic white women, (p < 0.001), with most women, regardless of ethnicity, requiring > or =2 antihypertensive agents. Following 26,113 patient-years of follow-up, the primary outcome (first occurrence of nonfatal myocardial infarction [MI], nonfatal stroke, or all cause death) occurred in 5.7% of Hispanic and 12.3% of non-Hispanic white women (adjusted HR = 0.84, 95% CI = 0.71-0.98, p = 0.03). There was no difference in outcome in either group of women comparing the randomized antihypertensive treatment strategies. CONCLUSIONS: Despite accounting for a lower risk profile, deployment of protocol-based antihypertensive treatment regimens resulted in superior BP control and fewer CV events in Hispanic women compared with non-Hispanic white women.

Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients--findings from the International Verapamil SR/Trandolapril Study (INVEST).

BACKGROUND: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease (CAD). METHODS AND RESULTS: An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14,531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61,835 patient-years of follow-up, treatment with either a verapamil sustained release (SR) or atenolol antihypertensive strategy resulted in greater blood pressure control in Hispanic patients, and Hispanic patients were at significantly lower risk of experiencing a nonfatal myocardial infarction, nonfatal stroke, or death (hazard ratio [HR] 0.87, 95% CI 0.78-0.97). Hispanic ethnicity was associated with an increase (HR 1.19, 95% CI 1.04-1.36), and randomization to the verapamil SR strategy was associated with a decrease (HR 0.85, 95% CI 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SR strategy was associated with reduced risk of new-onset diabetes, whereas increasing doses of atenolol and hydrochlorothiazide in the atenolol strategy were associated with increased risk of new-onset diabetes. CONCLUSIONS: The Hispanic cohort of INVEST had better blood pressure control and lower risk of adverse cardiovascular outcomes compared with the non-Hispanic cohort. A verapamil SR strategy is an alternative to an atenolol strategy for the treatment of Hispanic patients with hypertension and CAD and can reduce the risk of new-onset diabetes.

Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms.

BACKGROUND: Coronary artery disease is frequent in postmenopausal women. Silent myocardial ischemia has been induced with mental stress testing. METHODS AND RESULTS: To evaluate whether mental stress can induce ischemia in women with typical angina and normal coronary angiography, postmenopausal patients (n = 16) were studied. Each underwent technetium 99m methoxyisobutylisonitrile myocardial scintigraphy (exercise stress/rest/mental stress protocol), brachial artery endothelial function measurement by ultrasonography, and 24-hour ambulatory electrocardiographic recording (Holter). During mental stress testing, 6 patients (group I) had reversible perfusion defects on myocardial scintigraphy whereas the other 10 patients (group II) did not. Group I patients exhibited endothelial dysfunction more frequently than those in group II (83% vs 20%). Myocardial scintigraphy showed anteroapical/septal ischemia in 5 patients and inferoapical ischemia in one other patient, with both types of stress. Among group II patients, none showed a reversible perfusion defect during physical or mental stress. No group I patients had evidence of ischemia by Holter monitoring, whereas 2 of 10 group II patients did. CONCLUSION: In postmenopausal women with typical angina and normal coronary arteries, mental stress may provoke myocardial ischemia, which can be concordant with ischemia induced by exercise stress, and is associated with endothelial dysfunction.

Estrogen does not prevent endothelial dysfunction caused by cigarette smoking.

BACKGROUND: Estrogen favors endothelial function while acute tobacco use provokes dysfunction. Previous studies have not examined the effect of smoking one cigarette at different stages of the menstrual cycle. HYPOTHESIS: Favorable actions of estrogen on endothelial function are transitorily abolished by smoking one cigarette. METHODS: Brachial artery endothelium-dependent dilation was measured noninvasively before, 10 min, and 1 h after smoking in 17 healthy premenopausal women. Studies were done in the first 3 days (early stage) and repeated between Days 9 and 13 of the menstrual cycle (middle stage). Estradiol was measured after each study. RESULTS: At basal conditions, women in the middle stage of their cycles, when estradiol was 20 times higher than in the early stage, had significantly more endothelial-dependent brachial dilatation. No difference in the marked depression caused by cigarette smoking was found between the two stages. One h recuperation was complete in both phases. CONCLUSION: Cigarette smoking abolishes the protection of circulating estrogen on endothelial function.

Characteristics of contemporary patients with hypertension and coronary artery disease.

BACKGROUND: Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials. HYPOTHESIS: There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension. METHODS: This report describes the characteristics of Caucasian, Hispanic, and black patients enrolled in the International Verapamil SR/trandolapril Study (INVEST), a prospective trial undertaken exclusively in patients with CAD and hypertension. RESULTS: In all, 10,925 Caucasian, 8,045 Hispanic, and 3,029 black patients are described. An abnormal angiogram or documented myocardial infarction was observed more frequently in Caucasian patients (73%), while angina pectoris was more prevalent in Hispanic patients (87%). Diabetes and left ventricular hypertrophy were most common in black patients (33 and 29%, respectively), while hypercholesterolemia and prior revascularization (coronary artery bypass graft or angioplasty) were most common in Caucasian patients (64 and 41%, respectively). More than 60% of Hispanic and black patients were women--a unique characteristic for randomized CAD trials. Comparing race/ethnic cohorts, there were significant differences for all characteristics. More than 80% of patients in all race/ethnic groups were receiving antihypertensive therapy; however, only fewer than 25% had controlled blood pressure according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSIONS: This high-risk population of hypertensive patients with CAD has been undertreated and does not have well-controlled BP. Race/ethnic differences were observed for clinical characteristics and medication use.

[Endothelial dysfunction in cardiologists after 24 hours on call]. / Disfunción endotelial en cardiólogos tras una guardia médica.

The objective was to determine if the stress caused by 24 hours on call in a cardiology emergency room alters endothelial function assessed by high-resolution ultrasonography in the brachial artery. Fifteen young physicians were studied in a crossover design: a) after a normal night of sleep at home, and b) after 24 hours on call without sleeping in an emergency room. Both studies were made at rest, 5 minutes after forearm occlusion and 3 minutes after administration of sublingual nitroglycerin. High-resolution ultrasonography and a 7.5-MHz linear array transducer were used to measure the brachial artery lumen. After 24 hours on call, physicians had significantly higher resting systolic and diastolic blood pressure. They also had a non-significant increase in heart rate and a lower brachial artery diameter. Brachial artery dilatation caused by hyperemia was only 3.35%, while it increased to 11.34% after normal sleep (p < 0.001). Only 2 physicians showed more than 4.4% dilatation, which was considered a normal response, while 13 had more than 4.4% after a normal night of sleep at home (p < 0.01). The response to nitroglycerin was similar under control conditions and after 24 hours of duty oncall.In conclusion, stress caused by 24 hours on call in a cardiology emergency room depresses or abolishes endothelial function.

A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial.

CONTEXT: Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. OBJECTIVE: To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). DESIGN, SETTING, AND PARTICIPANTS: Randomized, open label, blinded end point study of 22 576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. INTERVENTIONS: Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. MAIN OUTCOME MEASURES: Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. RESULTS: At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61 835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. CONCLUSION: The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.

Percepção dos profissionais de enfermagem frente à prática da distanásia e ortotanásia / Perception of nursing professionals before the practise of disthanasia and orthothanasia

Objetivo: analisar a produção científica acerca da percepção dos profissionais e estudantes de enfermagem diante da prática da distanásia e ortotanásia. Metodologia: realizou-se uma revisão integrativa de literatura, nas bases de dados Bireme, Medline, PubMed, com os descritores “enfermagem”, “eutanásia”, “cuidados intensivos” e “percepções”, nos idiomas português, inglês e espanhol, respectivamente. Foram encontrados 204 artigos, porém apenas 14 artigos responderam ao objetivo da pesquisa. A análise dos resultados ocorreu por meio da análise temática. Resultados: apontaram para a tomada de decisão do paciente e familiares; deficiência do ensino e na comunicação entre os profissionais sobre a temática; os sentimentos negativos vivenciados durante a assistência e medo de sofrer alguma sanção legal. Conclusão: é necessário investir mais na educação sobre o tema durante a graduação, estimular a comunicação entre os profissionais, além de valorizar seus sentimentos e preocupações.

Objective: To analyze the scientific production on the perception of professionals and nursing students with the practice of disthanasia and orthothanasia. Metodology: An integrative review of literature was realized in databases as: Bireme, Medline, PubMed with these keywords “nursing”, “euthanasia”, “intensive cares” and “perceptions” in the languages Portuguese, English and Spanish. 204 articles were found, but only 14 articles responded to the objective of the research. The analysis of the results was carried out through thematic analysis, grouped into thematic units. Results: they pointed to decision making process of the patient and his family: Lack of education and communication among professionals on the subject; Negative feelings experienced during service and fear of suffering any legal sanction. Conclusion: It is necessary to invest more in education on the subject during graduation, stimulate communication between professionals, and enhance their feelings and concerns.

Objetivo: analizar la evidencia científica acerca de la percepción de los profesionales y estudiantes de enfermería en la práctica de la distanasia y ortotanasia. Metodología: Se llevó a cabo una revisión integradora de la literatura en las bases de datos Bireme, Medline, PubMed. Fuerón utilizados los descriptores “enfermeria”, “distanasia”, “vigilancia intensiva” y “percepciones” en los idiomas portugués, inglés e spañol. Fueron encontrados 204 artículos. Mas solamiente 14 artículos han respondido a el propósito de la investigación. El análisis se llevó a cabo mediante análisis temático, agrupados en unidades temáticas. Resultados: Han apuntado a la toma de decisiones del paciente y su familia; la educación de la discapacidad y la comunicación entre los profesionales en la materia; los sentimientos negativos experimentados durante el servicio y el miedo a sufrir de una sanción legal. Conclusión: es necesario invertir más en la educación sobre el tema durante la graduación, estimular la comunicación entre los profesionales, y mejorar sus sentimientos y preocupaciones.

Nivel de conocimiento sobre prevención de caries dental en universitarios / Dental caries prevention related knowledge among students

Introdución: El conocimiento adecuado de aspectos sobre prevención de caries dental, puede resultar fundamental para mantener un estado de salud bucal óptimo. Objetivo: Determinar el nivel de conocimiento sobre prevención de caries dental en estudiantes de carreras distintas a Odontología de la Universidad del Pacífico, matriculados en el año 2015. Materiales y métodos: Estudio descriptivo de corte transversal, donde participaron 131 estudiantes, que completaron una encuesta con 10 preguntas cerradas sobre mecanismos de prevención de la caries dental. Resultados: Pertenecían al sexo femenino 63.4%; procedían de Asunción 58,8%, el promedio de edad fue de 20 años. Solo el 8,4% respondió que bacterias que dañan los dientes aparecen en el niño desde que se transmite, considerando sólo un 25,1% a la caries dental transmisible. El 41,2% contestó que es tan importante la técnica de cepillado como la marca del cepillo. Sólo el 19,1% cree que se debe realizar limpieza bucal desde el nacimiento, mientras que el 56,5% desde que erupciona el primer diente. Así también, solo un 35,1% consideró que los dientes deciduos cariados deben ser tratados para conservar el espacio de los permanentes. El nivel de conocimientos fue insuficiente (1-2 aciertos) en 8,4%; aceptable (3-4 aciertos) en 43,5%; (5-6 aciertos) en 41,2%; (7-8 aciertos) en 6,9% y ninguno obtuvo excelente. Conclusiones: Menos de la mitad presentó conocimiento muy bueno sobre prevención de la caries dental, lo que indicaría que en la población de estudio se necesita promocionar estrategias para conseguir una buena salud bucodental.

Introduction: Adequate knowledge of dental caries prevention may be critical to maintain optimal oral health status. objective: to determine the dental caries prevention related knowledge among Universidad del Pacífico students, in different faculties than Dentistry, enrolled in the year 2015. Materials and methods: A descriptive cross-sectional study conducted among 131 undergraduate students, who completed a survey of 10 closed questions on caries prevention mechanisms. Results: 63.4% were female; 58.8% came from Asunción city, the average age was 20. Only 8.4% said bacteria that damage the teeth appear in the child right from the moment bacteria reach child's mouth and only 25.2% considered dental caries as transmissible. 41.2% consider brushing techniques and brush brand as very important. Only 19.1% believed that dental cleaning should be performed at birth, while 56.5% since the first tooth erupts. Likewise, only 35.1% considered temporary teeth decayed must be treated to keep space for future permanent teeth. Knowledge level was insufficient (1-2 hits) at 8.4%; acceptable (3-4 hits) in 43.5%; good (5-6 hits) in 41.2%; very good (7-8 hits) on 6.9% and none got excellent. Conclusions: Less than half the students have good knowledge about dental caries prevention, which would indicate that the study population needed strategies to reach good oral health habits.

Comparación del tiempo de cepillado de la técnica habitual con la técnica de bass en estudiantes de odontología / Comparison of brushing time with the usual technique and bass technique on dental students

El proceso de cambio de hábitos comienza con la educación del paciente, promocionando el desarrollo de un aceptable control de la placa. Dentro de este contexto, varios métodos se emplean para ejecutarlo, sin embargo el valor de cepillado en la prevención depende no solo del tipo de cepillo de dientes, sino también en la técnica de cepillado apropiada y del tiempo que se dedique a la ejecución del mismo. El objetivo del estudio fue comparar los tiempos de cepillado con técnica habitual y de Bass en estudiantes de la Cátedra de Odontología Preventiva de la Universidad del Pacífico. El estudio es cuasi-experimental e incluyó la participación de 21 estudiantes del primer año de la carrera de Odontología matriculados en el 2014.En la clase previa al desarrollo del contenido programático "Control mecánico de placa microbiana", se invitó a participar del estudio a todos los estudiantes. Con un espejo de rostro y el cepillo personal del estudiante se le solicitó a cada uno que proceda a cepillarse con su técnica habitual y posterior a la clase, con la de Bass, se registraron en la ficha los tiempos que cada uno tomo, en segundos, a través cronómetro digital. El tiempo promedio con la técnica de Bass fue significativamente (p<0,0001) mayor que con la técnica habitual (193,9±51,9versus 109,6±34,5segundos). El mayor tiempo que se ocupa para el cepillado con la técnica de Bass puede resultar particularmente importante, considerando que el ritmo actual de vida del estudiante y de la población en general implica una carrera contra reloj, limitando así las posibilidades de un adecuado control mecánico de la placa microbiana, reconocida como uno de los más importantes factores cariogénico y periodontopático.

The process of changing habits starts with patient’s education, promoting thedevelopment of an acceptable plaque control. Within this context, several methods areused, however, the value of brushing in prevention depends not only on the type oftoothbrush, but also in the art of proper brushing and time devoted to the execution of it.The aim of this study was to compare regular brushing times and Bass techniques instudents of the Department of Preventive Dentistry at the Universidad del Pacífico. TheQuasi-experimental study involves the participation of 21 first year students of the career ofDentistry enrolled in 2014. In the previous class to the development of the content"Mechanical control of microbial plaque", all students were invited to participate in thisstudy. Using a mirror and personal thoot brushe very student was asked to proceed to brushing with conventional technique and after class using Bass technique, time spent inevery process was measured by a digital stopwatch and written in the file. The average timeusing Bass technique was significantly greater than (p <0.0001) using the standardtechnique (193.9 ± 51.9 versus 109.6 ± 34.5 seconds). More time dealing for brushingusing Bass technique may be particularly important given the current pace of student lifeand the population generally involves a time rush, limiting the possibilities of a suitablemechanical control of microbial plaque, recognized as one of the more important cariogenicand periodontopathic facts.

Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms.

BACKGROUND: Microvascular disease is proposed as a cause of segmental myocardial blood flow abnormalities and heterogeneous myocardial perfusion in cardiac syndrome X. OBJECTIVE: To assess if myocardial ischemia can be evidenced through both perfusion abnormalities and poststress left ventricular ejection fraction (LVEF) reduction by gated single photon emission tomography (SPECT) myocardial scintigraphy in women with syndrome X in a similar way to those with epicardial coronary lesions. METHODS: Three groups of postmenopausal women were studied: group I, 20 women with angina, perfusion defects, and normal coronary angiography; group II, 20 women with epicardial coronary lesions (> or =50% of coronary lumen reduction); group III, 15 volunteers without signs or symptoms of ischemia (control group). Each underwent technetium-99m ((99m)TC) methoxyisobutylisonitrile gated SPECT myocardial scintigraphy (protocol: exercise-stress-rest), brachial artery endothelial function measured by ultrasonography, and lipidogram. RESULTS: Groups I and III patients had a higher body mass index (BMI). There were more smokers in groups I and II. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides were higher in group II patients. The brachial artery vasodilator responsiveness after 5 minutes of ischemia was similarly lower in patients of groups I and II compared with those of group III (3% vs. 6.5%, respectively; p = 0.03 group III vs. group I and group II). Mean DeltaLVEF (LVEF poststress minus LVEF at rest) was -3.86%, -2.90%, and 4.18% in groups I, II, and III, respectively (p = NS between I and II, p = 0.005 between II and III, and p = 0.003 between I and III). In 43% of group I patients and in 10 of 18 group III patients with perfusion defects, there was a poststress LVEF reduction >5%. CONCLUSIONS: Stress-induced ischemia is associated with poststress LVEF reduction as a probable manifestation of myocardial stunning in postmenopausal women with typical angina and normal coronary angiography.

Control ambulatorio de la presión arterial en hipertensos sistólicos con cardiopatía isquémica asociada / Ambulatory control of arterial systolic pressure in hypertensive patients presenting with associated ischemic heart disease

Cuando la cardiopatía isquémica coexiste con la hipertensión arterial, el tratamiento de esta se torna una tarea compleja. El objetivo de este trabajo fue evaluar el efecto sobre el control ambulatorio de la presión arterial (en una cohorte de hipertensos sistólicos mayores de 50 años con cardiopatía isquémica asociada) de una estrategia de tratamiento antihipertensivo basada en un betabloqueador (atenolol), un diurético y un inhibidor de la enzima convertidora de angiotensina. Se incluyeron 126 pacientes (hipertensos no controlados mayores de 50 años con cardiopatía isquémica estable crónica que fueron evaluados al inicio y a las 6, 24 y 52 sem. A las 6 sem estaban controlados el 52,38 por ciento de los pacientes, a los 6 meses 54,76 por ciento y al año el 71,42 por ciento. Los resultados indican que el tratamiento fue efectivo para controlar la presión arterial y reducir las crisis de angina de pecho en hipertensos sistólicos. Para lograr esto, la mayoría de los pacientes necesitó 2 ó 3 medicamentos, lo que indica que esta cohorte de pacientes hipertensos sistólicos, en su mayoría de la tercera edad y con una cardiopatía isquémica estable crónica asociada, necesitan una terapéutica adecuada, con un seguimiento frecuente

When ischemic heart disease is associated with arterial hypertension, treatment becomes a complex task. A group of 126 non-controlled patients with isolated systolic hypertension aged over 50 with associated ischemic heart disease was studied to assess the effect of an antihypertensive treatment strategy based on the combination of a b-blocker (Atenolol), a diuretic, and an angiotensin-converting enzyme inhibitor (ACEI) on the ambulatory control of arterial pressure. All patients were assessed at onset and 6, 24 and 52 weeks later. The percentage of patients achieving blood pressure control was 52.38 percent; 54.76 percent and 71.42 percent at 6, 24 and 52 weeks respectively. The results showed that treatment was effective to control the arterial pressure and to reduce the angina episodes in the systolic hypertensive ones. To achieve it, most of patients needed two or three drugs indicating that this group of hypertensive and systolic patients in the main of third age and with an associated chronic stable ischemic heart disease needs an appropriate therapy with a frequent follow-up

Control ambulatorio de la presión arterial en pacientes blancos y negros con cardiopatía isquémica asociada / Ambulatory control of arterial pressure in white and blacks patients with associated ischemic heart disease

Cuando la cardiopatía isquémica se asocia a la hipertensión arterial, el tratamiento se convierte en una tarea compleja. Se estudió una cohorte de 557 pacientes (446 blancos y 111 negros) hipertensos no controlados, mayores de 50 años, con cardiopatía isquémica estable crónica asociada, para evaluar el efecto de una estrategia de tratamiento antihipertensivo basada en la combinación de un betabloqueador (atenolol), un diurético y un inhibidor de la enzima convertidora de angiotensina, sobre el control ambulatorio de la presión arterial. Todos fueron evaluados al inicio y a las 6, 24 y 52 sem. A las 6 sem estaban controlados el 47,98 % de los blancos y el 44,14 % de los negros (p=0,68); a los 6 meses, el 65,91 % en el primer grupo y el 63,06 % en el segundo (p=0,78). Al año estaba controlado el 70,4 % de los hipertensos blancos y el 75,67 % de los negros (p=0,49). Se observó que el tratamiento fue igualmente efectivo para controlar la presión arterial en ambos grupos. Se concluyó que una estrategia basada en la combinación de varios medicamentos, con diferentes mecanismos de acción, es efectiva para tratar la hipertensión en hipertensos con cardiopatía isquémica asociada, independientemente de las características étnicas de los sujetos.

When ischemic heart disease is associated with arterial hypertension, treatment becomes a complex task. A group of 557 non-controlled hypertensive patients (446 whites and 111 blacks) aged over 50 presenting with associated chronic ischemic heart disease was studied to assess the effect of antihypertensive treatment strategy based on the combination of beta-blocker (Atenolol), a diuretic, and a angiotensin-converting enzyme inhibitor (ACEI) on the ambulatory control of arterial pressure. All were assessed at onset and at 6, 24 y 52 weeks. At six weeks the 47.98% of white patients was under control and the 44.14 of the black ones (p= 0.68); at six months the 65.91% in the first group and the 63,06% in the second one (p= 0.78). A year later the 70,4% of white hypertensive patients and the 75.67% of the black ones were under control (p= 0.49). Treatment was also effective to control the arterial pressure in both groups. We conclude that a strategy based on combination of some drugs with different action mechanisms, is very effective to treat the high blood pressure in hypertensive patients presenting associated heart disease, independently of the ethnic features of subjects.

Comportamiento de algunas variables relacionadas con la atención al Infarto del Miocardio Agudo, Maracaibo, Venezuela / Behavior of some variables associated with treatment of acute myocardial infarction, Maracaibo, Venezuela

A pesar de la evidencia del beneficio del tratamiento médico oportuno en cuanto a disminuir mortalidad y otros eventos clínicos importantes, continúan existiendo fallas en la atención a los pacientes con infarto del miocardio agudo. Se realizó un estudio descriptivo transversal de los pacientes que acudieron a cuatro Centros de Diagnósticos Integrales del municipio Maracaibo, estado Zulia, Venezuela en el período comprendido entre octubre de 2006 a agosto de 2007 con el objetivo de evaluar el comportamiento de algunas variables relacionadas con la atención del infarto con elevación del segmento ST. El universo estuvo constituido por todos los pacientes con enfermedades cardiovasculares ingresados en los centros de atención. La muestra estuvo integrada por la historia clínica de 44 pacientes con diagnóstico de infarto agudo del miocardio. La misma fue agrupada según las variables a estudiar cumpliendo los criterios de inclusión y exclusión. Hubo un predominio del sexo masculino y de las edades mayores de 60 años. Se utilizó tratamiento fibrinolítico en el 71,7 por ciento de los pacientes. El tiempo puerta aguja fue demorado. Hubo mayor reperfusión en los pacientes que tuvieron una puerta aguja menor de 60 minutos. Se utilizó beta bloqueadores e IECAs en el 79,5 por ciento y 65,9 por ciento respectivamente. El fallo de bomba fue la complicación más frecuente y estuvo presente en el 35,2 por ciento. Se hace necesario cumplir con las normas establecidas para el tratamiento del IMA basada en la evidencia de los estudios disponibles con el objetivo de disminuir la mortalidad por esta entidad.

In spite of the evident benefits of prompt medical treatment to reduce mortality and other important clinical events, there are still failures in the care of patients with acute myocardial infarction. A cross-wise descriptive study was performed in patients who were seen at four integral diagnostic centers located in Maracaibo, Zulia state, in Venezuela in the period from October 2006 to August 2007. The objective was to evaluate the behaviour of some variables associated with the treatment of heart attack with increased ST segment. The universe of study was made up of all the patients with cardiovascular diseases admitted to the integral diagnostic centers. The sample covered the medical histories of 44 patients diagnosed with acute myocardial infarction, grouped according to study variables and followed the inclusion and exclusion criteria. Males and the over 60 years-old age group prevailed. Fibrinolytic treatment was used in 71,7 percent of patients. The needle-door time was delayed. There was more reperfusion in patients with needle door below 60 minutes. Beta blockers and IECAs were used in 79,5 percent and 65,9 percent of cases, respectively. Pump failure was the most frequent complication in 35,2 percent of cases. It is necessary to comply with the set standards for the treatment of acute myocardial infarction based on evidence of available studies, with the aim of reducing mortality from this health problem.