Diagnosis and indications for the extraction of third molars - The SECIB clinical practice guideline.

BACKGROUND: The removal of third molars (3Ms) is the most frequent surgical procedure in the field of Oral Surgery. As a result, the Spanish Society of Oral Surgery (SECIB) aims to create a Clinical Practice Guideline (CPG) that offers evidence-based recommendations for optimal clinical practice. Specifically, the CPG will focus on providing guidance regarding the indications and criteria for clinical and radiological diagnosis of patients with 3Ms. MATERIAL AND METHODS: This CPG was developed by the SECIB, following the methodological guidelines described in the methodological manual for the "Development of Clinical Practice Guidelines in the National Health System". Several PICO questions related to the diagnosis and indications for the extraction of 3Ms were formulated. The leading experts carried out the evaluation of the evidence and the formulation of specific recommendations. RESULTS: A total of 17 PICO questions were evaluated, addressing the indications, prognosis, diagnosis, and cost-benefit relationship of 3M extraction. CONCLUSIONS: The present Clinical Practice Guideline provides evidence-based recommendations on the diagnosis and indications for 3M extraction. These evidence-based recommendations can assist healthcare professionals and the general population in making informed decisions regarding the management of 3Ms.

Assessment of the Effectiveness of an Exposure Technique Intervention in a Case of Amaxophobia

Amaxophobia, or driving phobia, is an anxiety disorder; more specifically a situational phobia (SP). Main symptoms of SP may include an excessive and irrational fear to certain stimuli, to which exposure produces high anxiety levels, as well as the development of avoidance mechanisms or confrontation, at the expense of a high distress. Its prognosis is chronic in the absence of treatment, but empirical evidence reveals a high efficacy of psychological interventions based on exposure techniques. The case of a 47 years old female requesting treatment for an intense driving fear is presented. The assessment was made through an ad hoc self-report of anxiogenic episodes, the Short Form Health Survey (SF-12), the General Health Questionnaire (GHQ-28), the Perceived Stress Scale (PSS-14), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). It was conducted a cognitive-behavioral intervention based on imagination and real life exposure techniques, along with breathing and relaxation techniques. After 10 sessions her anxiety levels and her negative affects decreased significantly, allowing her to resume driving and revealing the efficacy of the intervention (AU)

Dataset of the synthesis parameters to deposit YSZ on stainless steel AISI 316L by sputtering technique.

The data presented in this article are related to the research previously published "improvement of adhesion and barrier properties of biomedical stainless steel by deposition of YSZ coatings using RF magnetron sputtering". It contains the structural, morphological, compositional and electrochemical characterization of bare AISI 316L substrate which was used as a substrate to coat with yttria-stabilized zirconia (YSZ). The chemical composition and topography analyses from X-ray photoelectron spectroscopy (XPS), Auger electron spectroscopy (AES) and micrographs from atomic force microscopy (AFM) as well as the roughness value of the YSZ-sputtered coating on AISI 316L substrates are presented as complementary data of the article.

Capillary electrophoresis and mutational images of hemoglobin sendagi [Β42 (CD1) PHE → VAL; HBB: C.127T→G].

We report two cases of hemoglobin Sendagi in a Romanian family residing in Spain: a four-year-old boy and his mother, who had been previously diagnosed with another type of congenital hemolytic anemia and had undergone splenectomy in her country during childhood. The unstable hemoglobin variant, hemoglobin Sendagi, is characterized by decreased oxygen affinity caused by replacement of one of the critical amino acid residues, phenylalanine beta 42 (CD1) of the beta-chain, with valine in the heme pocket, resulting in methemoglobin formation. As a result of migratory movements in Europe, new disease-causing hemoglobin variants are emerging in our country. Here, capillary electrophoresis enabled the identification of the variant and a molecular study was used to establish an accurate diagnosis.

Dataset on electrochemical reduced graphene oxide production: Effect of synthesis parameters.

Structural and microstructural characterization combined with vibrational, rotational modes are quite important to determinate reduction degree during synthesis of reduced graphene oxide. These data and analysis support the research article "Electrochemical alternative to obtain reduced graphene oxide by pulse potential: effect of synthesis parameters and study of corrosion properties" (López-Oyama et al., 2018). The data and analysis presented here included raw data for selected reduction potentials (V SCE) and different temperatures values (°C). Transmission electron microscopy (TEM) images of the exfoliated graphite are shown to corroborate the effect of the applied voltage to obtain electrochemically reduced graphene oxide (ERGO) on commercial 304L stainless steel (304L SS). The data provided in this article has not been previously published and are available to enable critical or extended analyses.

Geriatric oncology in Spain: survey results and analysis of the current situation

Introduction: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived

No disponible

Geriatric oncology in Spain: survey results and analysis of the current situation.

INTRODUCTION: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. OBJECTIVES: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. METHODS: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. RESULTS: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. CONCLUSIONS: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.

Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico.

BACKGROUND: Mexico's 2009 "narcomenudeo reform" decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers' drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. METHODS: Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar's tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers' ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. RESULTS: Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4-3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3-4.3), methamphetamine (aOR 2.2, 95% CI 1.4-3.2), and marijuana (aOR 2.5, 95% CI 1.6-4). CONCLUSIONS: Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.

Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index.

Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

Certificación en seguridad del paciente en un Servicio de Medicina Intensiva: nuestra experiencia con la norma UNE 179003:2013 / Patient safety certification in a Department of Intensive Care Medicine: Our experience with standard UNE 179003:2013

Para asegurar que el riesgo asistencial se gestiona de manera efectiva es necesario utilizar métodos sistemáticos y estructurados. La Norma española UNE 179003:2013 ofrece a las organizaciones sanitarias un marco y una forma sistemática de abordar la gestión de la seguridad del paciente desde una perspectiva clínica y organizativa, que contribuye a alcanzar un balance eficiente entre riesgo, resultados en salud y costes. Obtener la certificación con UNE 179003:2013 demuestra el cumplimiento de unas normas y unos procedimientos de trabajo dirigidos a disminuir la incidencia de eventos adversos, y obliga a realizar intervenciones de mejora continua, porque la Norma exige realizar un seguimiento periódico del sistema de gestión de riesgos mediante auditorias regulares. El objetivo de este trabajo es presentar el proceso realizado para obtener la certificación por la Norma UNE 179003:2013 en nuestro Servicio de Medicina Intensiva, proponer un programa de gestión de riesgos del paciente crítico y hacer algunas recomendaciones sobre su implantación

Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation

Patient safety certification in a Department of Intensive Care Medicine: our experience with standard UNE 179003:2013.

Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation.

Enfermedad de Addison en un niño con adrenoleucodistrofia ligada al cromosoma X / Primary adrenal failure associated to X-linked adrenoleukodystrophy: report of one case

Primary adrenal failure (PAF) can be congenital or acquired. X-linked adrenoleukodystrophy (ALD-X), produced by the mutation of the ABDC1 gene (Xq28), that leads to the plasma accumulation of very long chain fatty acids, is one of the congenital diseases associated to adrenal destruction. We report a 7 years old boy with fast progression of right strabismus and general symptoms as weariness, weakness and mucosal and skin pigmentation. A brain magnetic resonance image showed a leukoencephalopathy, characteristic of ALD-X. Low plasma cortisol, high ACTH levels and lack of response to ACTH test, confirmed the diagnosis of primary adrenal insufficiency. High plasma levels of C26:0 fatty acids, and C24/22, C26/22 ratios confirmed ALD-X.

Fern Distortion Syndrome of Leatherleaf Fern in Costa Rica: Symptoms, Incidence, and Severity.

A syndrome has been recognized on leatherleaf fern (Rumohra adiantiformis) in Costa Rica for many years that causes widespread damage but has not been described in the literature. A full description of the syndrome, termed fern distortion syndrome (FDS), is reported here, along with evidence that FDS is a new disease and that it is associated with endophytic fluorescent pseudomonads but not with any other major groups of pathogens or pests. The main aboveground symptoms of FDS are twisting and distortions of fronds, which make the fronds unmarketable. In advanced cases of FDS, fronds are often thickened, new frond growth ceases or slows dramatically, and uneven sporulation is apparent on the underside of fronds. Symptoms of FDS belowground are reduced diameter of rhizomes and reduced overall root mass. The incidence of FDS in Costa Rica was typically over 80%, and severity typically ranged from 1.26 to 2.48 using a 0 to 3 rating scale in fields propagated vegetatively with rhizomes from fields with FDS. In contrast, in three fields planted 1.5 to 4 years previously with rhizomes derived from tissue culture, incidence and severity were markedly lower: 23 to 34% and 0.24 to 0.36, respectively. Paired sampling of symptomatic and asymptomatic plants revealed significantly greater populations of fluorescent pseudomonads inside rhizomes of symptomatic plants.

Analysis of temporal artery biopsies in an 18-year period at a community hospital.

OBJECTIVE: To identify analytical and clinical variables that may improve the effectiveness of temporal artery biopsy (TAB) for the diagnosis of giant cell arteritis (GCA). MATERIALS AND METHODS: A retrospective study of TABs conducted between 1989 and 2007 at the 450-bed Hospital Parc Taulí, Sabadell. Demographic data, clinical manifestations, analytical data prior to the biopsy and final diagnoses were recorded, including only those cases in which these data were reflected in the clinical history. RESULTS: In this period, 278 TABs were conducted in 181 women (65.1%) and 97 men (mean age 74 years). Seventy-nine (28.4%) were positive (GCA+) and 199 (71.5%) negative (TAB-). The most frequent final diagnoses in the TAB- group were: polymyalgia rheumatica (PMR) (18.6%), giant cell arteritis plus negative TAB (GCA-) (13.6%), tension headache (7.5%), infection (7.5%), other vasculitis (7.5%), and neoplasm (6.0%). The GCA+ group was compared with the TAB- group, the GCA- group and the PMR group. In the multivariate analysis only headache (RR 3.6), jaw claudication (RR 2.9) and abnormal temporal artery on palpation (RR 2.5) revealed statistical differences between the GCA+ and TAB- groups. CONCLUSION: One third of the biopsies performed at our centre were positive for GCA. The clinical variables that best predicted a positive TAB in our series were headache, jaw claudication, and abnormal temporal artery on palpation.

Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars.

The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.

Microbial production of C13-norisoprenoids and other aroma compounds via carotenoid cleavage.

Carotenoids are important precursors of a variety of compounds: the C(20)-retinoids, the C(15)-phytohormones, and the C(9)- to C(13)-aromas. Among the last type, C(13)-carotenoid-derived compounds (norterpenoids/norisoprenoids) such as ionones and damascones, constitute an essential aroma note in tea, grapes, roses, tobacco, and wine. Extraction of carotenoid-derived aroma compounds from plant sources is not economically realistic or considerably expensive. The biotechnological production of aroma compounds represents a feasible alternative and offers the production of enantiomerically pure molecules which can be labeled as "natural." To date, research in the production of ionones or the C(10)-compound, safranal, has mainly been focused on plant dioxygenases that cleave carotenoids in the positions between carbons 9 and 10 (9'-10') or 7 and 8 (7'-8'), respectively. Although relatively little is known about the microbial conversion of carotenoids into compounds with aroma due to the well known advantages of manipulating microorganisms, the aim of this work is to review the current state of the research in microbial production of norisoprenoids and other aroma compounds derived from carotenoid cleavage.

Effects of varying the threshold of alarm systems and workload on human performance.

The purpose of this research was to investigate the effects of varying the threshold of alarm systems and workload on human response to alarm signals and performance on a complex task. A receiver operating characteristic (ROC) curve was selected to reflect the sensitivity of the alarm system. The threshold of the alarm system was manipulated by changing the value of beta along the ROC curve. A total of 84 students participated in experiment 1 and 48 students participated in experiment 2. Participants performed a compensatory-tracking, a resource management and a monitoring task. As expected, results showed that participants responded significantly faster to true alarm signals when they were using the system with the highest threshold under low-workload conditions. Results also indicated that changing the threshold of the alarm system had a significant effect on overall performance and this effect was greater under high-workload conditions. However, contrary to expectations, the highest level of performance was achieved by setting the threshold at a low level. Results from both experiments revealed that the advantage of faster alarm reaction time as a result of increasing the system's threshold was lost because of its increased probability of missed events.

Shock séptico por Mycobacterium tuberculosis / Septic shock due to Mycobacterium tuberculosis

No disponible

Novel method for aroma recovery from the bioconversion of lutein to beta-ionone by Trichosporon asahii using a mesoporous silicate material.

In this work, we report on the synthesis and ability of the mesoporous material MCM-41 to adsorb the norisoprenoid beta-ionone. This compound, with a violet aroma note, can be produced from lutein by the yeast Trichosporon asahii through a bioconversion process. We found that beta-ionone inhibited the yeast growth and constrained aroma formation. Growth inhibition was overcome using silicate MCM-41 as sorbent device in a fermentation system that allowed product removal from the culture medium by headspace manipulation. Compared to a commercial silica gel, the mesoporous material exhibited a 4.5-fold higher beta-ionone adsorption. Contrasting to cultures without the sorbent device, the presence of MCM-41 allowed a marked increase (14-fold) in beta-ionone production. Our results suggested that confinement of the norisoprenoid into the sorbent material bypassed its toxicity which allowed a better beta-ionone production. This study represents the first report on the use of MCM-41 to recover an aroma produced by fermentation and therefore, a novel application for a mesoporous material.