Congruencia Diagnóstica Clínica-Histopatológica de Lesiones en Cavidad Oral, en la Faculta de Odontología, Universidad de Costa Rica, en el Período 2016-2019

El conocimiento de la patología oral, y su correcto diagnóstico es fundamental en Odontología, puesto que un diagnóstico tardío, particularmente en casos de lesiones premalignas o malignas, pueden conducir a serias consecuencias para el paciente. El objetivo de este trabajo fue establecer la congruencia diagnóstica clínica - histopatológica de lesiones en cavidad oral en pacientes que asistieron a la Facultad de Odontología, Universidad de Costa Rica, y a quienes se les realizó biopsia de la lesión, durante el período 2016-2019. El estudio fue descriptivo y retrospectivo, basado en datos de reportes histopatológicos en la población mencionada, por presentar alguna lesión, de tejidos blandos o duros, en cavidad oral. La muestra estadística fue por conveniencia, no probabilística y no aleatoria. Las técnicas estadísticas utilizadas fueron descriptivas para el análisis de la información, el cual se basó en la distribución de frecuencias y cruce de variables. El procesamiento estadístico de los datos se diseñó en una base de datos creada en Excel. La muestra comprendió 160 reportes histopatológicos de los cuales se excluyeron 14. La edad promedio de los pacientes fue 42 años (rango 2 - 78 años). La proporción hombre: mujer correspondió 1:1.4, predominado el sexo femenino en 58,9 %. La congruencia del diagnóstico histopatológico con el diagnóstico clínico correspondió a 55,8 %. La congruencia de los diagnósticos demuestra el conocimiento del profesional en identificar la lesión clínicamente de forma correcta, lo que permite actuar en el momento preciso y confirmar la impresión clínica diagnóstica de una patología mediante el estudio histopatológico, el cual es el estándar oro. El problema radica en aquellos casos en que hay discrepancia diagnóstica, pues exige conocer los factores responsables de esta discrepancia, exige la búsqueda de soluciones y exige reforzar y redireccionar la formación académica del profesional y de los estudiantes para reconocer y describir estas lesiones.

Knowledge of oral pathology and its correct diagnosis is fundamental in Dentistry, since a late diagnosis, particularly in cases of premalignant or malignant lesions, can lead to serious consequences for the patient. The objective of this study was to establish the clinical- histopathological diagnostic consistency of lesions in the oral cavity in patients who attended the Faculty of Dentistry, Universidad de Costa Rica, and who underwent a biopsy of the lesion, during the period 2016-2019. The study was descriptive and retrospective, based on data from histopathological reports in the mentioned population, due to presenting some lesion, soft or hard tissue, in the oral cavity. The statistical sample was for convenience, non- probabilistic nor random. The statistical techniques used were descriptive for the analysis of the information, which was based on frequency distribution and crossing of variables. The statistical processing of the data was designed in a database created in Excel. The sample collects 160 histopathological reports, of which 14 were excluded. The average age of the patients was 42 years (range between 2 - 78 years old).The male:female ratio corresponded to 1:1.4, with a predominance of the female sex at 58.9 %.The congruence of the histopathological diagnosis with the clinical diagnosis corresponded to 55.8 %. Diagnostic consistency demonstrates knowledge of the professional in correctly identifying the lesion clinically, which allows acting at the precise moment and confirming the diagnostic clinical impression of the pathology via histopathological study which is the gold standard. The problem lies in those cases in which there is a diagnostic discrepancy, since it requires having knowledge of the underlying factors and therefore, requires searching for solutions, reinforcing and redirecting the academic training of professionals and students to recognize and describe these lesions.

Benign osteoblastoma of the mandible: a case report.

Osteoblastoma is a rare benign neoplasm formed by osteoid tissue and well-vascularized bone that occurs mainly in children and adolescents. It appears primarily in the long bones, vertebral column, and small bones of the hands and feet, and not typically in the skull and maxillary bones. The purpose of this study is to present the case of an 8-year-old girl with a diagnosis of right mandibular osteoblastoma and a review of the relevant literature. The goals of treatment were to preserve dental occlusion, masticatory function and facial symmetry while minimizing the effects on patient body image and quality of life. Osteoblastoma, although it is benign, can be aggressive, and its treatment will depend on the timing of diagnosis, size and location. Early diagnosis is essential to avoid not only radical surgery as in the case presented, but also to help minimize the risk of possible relapse and potential malignancy of a benign osteoblastoma.

Enfermedad von Willebrand: consideraciones prácticas para el odontólogo. Revisión de literatura / von Willebrand disease: practical considerations for the dentist. Literature review

RESUMEN La enfermedad von Willebrand es el desorden hemorrágico hereditario más común, que se origina por la deficiencia del factor von Willebrand, la cual provoca una adhesión y agregación plaquetaria defectuosa. Se caracteriza por un tiempo de sangrado y tiempo parcial de tromboplastina prolongados, con bajos valores del factor VIII, y aumento de fragilidad capilar, pero con recuento normal de plaquetas. El tratamiento odontológico en un paciente con enfermedad von Willebrand, debe ser individualizado de acuerdo con la severidad de la condición del paciente, así como coordinado con el hematólogo, quien debe de determinar el tipo de enfermedad y la necesidad de la terapia de reemplazo del factor según diagnóstico específico previo al manejo de este. Mediante esta revisión bibliográfica se desea reforzar el conocimiento al odontólogo de este trastorno hemorrágico, ya que con ello se pueden evitar o minimizar posibles complicaciones de sangrado durante el tratamiento odontológico.

ABSTRACT von Willebrand disease is the most common inherited bleeding disorder, caused by von Willebrand factor deficiency, which causes defective platelet adhesion and aggregation. It is characterized by a prolonged bleeding time and partial thromboplastin time, with low levels of factor VIII, and increased capillary fragility, but with a normal platelet count. Dental treatment in a patient with von Willebrand disease must be individualized according to the severity of the patient's condition, as well as coordinated with the hematologist, who must determine the type of disease and the need for factor replacement therapy, prior to the patient management. Through this bibliographic review, it wants to reinforce the dentist's knowledge of this bleeding disorder, since this can prevent or minimize possible bleeding complications during dental treatment.

Use of a Meter With Color-Range Indicators and a Mobile Diabetes Management App Improved Glycemic Control and Patient Satisfaction in an Underserved Hispanic Population: "Tu Salud"-A Randomized Controlled Partial Cross-Over Clinical Study.

Objective: To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Research Design and Methods: Test subjects (n = 81) used the meter and app for 12 weeks, while a randomized control group (n = 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app. Results: Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (P <0.001), a statistically significant greater reduction than in control subjects (P = 0.045). The improvement in A1C in test subjects was sustained over the next 12 weeks. Crossed-over subjects also demonstrated significant improvements in A1C (P <0.001). Mean blood glucose was reduced significantly without an increase in hypoglycemia, and results in range increased over 12 weeks of meter and mobile app use. Results were independent of subjects' numeracy skills. Subjects using the new meter and app reacted favorably to the tools and expressed improvements in their diabetes treatment satisfaction based on Diabetes Treatment Satisfaction Questionnaire-Change scores. Conclusion: Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations.

Respuesta de una red de servicios de salud ante lista de espera para cirugía / Response of the health services network to the waiting list for surgery

RESUMEN Objetivo La lista de espera para cirugía se define como la lista de pacientes pendientes para recibir un tratamiento determinado en el momento oportuno. Su gestión depende de las estrategias que se realicen para su disminución. Se presentan los resultados de una red de servicios de salud como alternativa para la reducción de la lista de espera para cirugía. Método Con el fin de disminuir la lista de espera de cirugía en un hospital del nivel III de atención, se llevó a cabo un programa quirúrgico entre dos hospitales de la Caja Costarricense de Seguro Social, en el periodo 2017-2018, previa gestión de las instancias involucradas. El programa consistió en gestionar jornadas quirúrgicas cada dos meses, en un hospital del nivel II de atención, para realizar cirugías previa priorización de los pacientes según patología, cumpliendo con los requerimientos del control interno institucional. Resultados Se ejecutaron ocho jornadas quirúrgicas durante el período 2017-2018. 44 pacientes fueron intervenidos quirúrgicamente bajo este programa y a 9 pacientes se les suspendió la cirugía, principalmente por infección de vía aérea superior. La lista de espera para cirugía se redujo en 13,25% del total inicial (332 pacientes); el porcentaje de cancelación de cirugía fue 2,71%. Conclusiones El manejo de la lista de espera es importante, ya que permite visualizar la situación actual en cuanto a tiempos de espera y prioridades de cirugía. La gestión ejecutada debe contemplar las mejores soluciones para resolver una patología cuando así lo requiera el paciente, utilizando la estructura existente.

ABSTRACT Objective The waiting list for surgery is defined as the list of patients waiting to receive a specific treatment at the right time. Its management depends on the strategies that are carried out to reduce it. The results of a network of health services are presented as an alternative for reducing the waiting list for surgery. Method In order to reduce the waiting list for surgery in a third-level hospital, a surgical program was carried out between two hospitals of the Caja Costarricense de Seguro Social, Costa Rica, in the period 2017-2018, after management of the instances got involved. The program consisted of managing surgical days every two months, in a second-level hospital, to perform surgeries after prioritizing patients according to pathology, and complying with the requirements of the institutional internal control. Results Eight surgical days were carried out during the period 2017-2018. 44 patients underwent surgery under this program and 9 patients had surgery suspended, mainly due to upper airway infection. The waiting list for surgery was reduced by 13.25% from the initial total (332 patients); the percentage of cancellation of surgery was 2.71%. Conclusions Managing the waiting list is important since it allows visualization of the current situation in terms of waiting times and surgery priorities. The management carried out must contemplate the best solutions to solve a pathology when the patient requires it, and using the existing structure.

Condición Periodontal de los Dientes Temporales Adyacentes a la Hendidura Alveolar en Pacientes con Labio y Paladar Hendido Unilateral No Sindrómico, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social

RESUMEN: Los dientes adyacentes a la hendidura alveolar, en pacientes con labio y paladar hendido, presentan mayor incidencia de problemas periodontales, según la literatura. El objetivo de este trabajo fue evaluar si los dientes temporales adyacentes a la hendidura alveolar presentan mayor incidencia de problemas periodontales en niños con labio y paladar hendido unilateral completo no sindrómico, nacidos en 2010 y 2011, atendidos en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. Este estudio prospectivo, transversal, descriptivo, e intervencional evaluó variables epidemiológicas, clínicas y radiográficas (placa bacteriana, profundidad de bolsa, nivel de inserción, recesión gingival, sangrado, encía queratinizada e insertada, cálculo y movilidad dental, tipo de hendidura alveolar). Se utilizó técnicas de análisis estadísticos descriptivas (distribución de frecuencias, cruce de variables y construcción de intervalos de confianza). El análisis de datos y procesamiento estadístico se realizó en SPSS versión 17.0 y en Excel. El grupo constó de 17 pacientes, con edad promedio de 5 años. Se encontró 47 % de placa dental y 0 % de cálculo dental. La profundidad de bolsa y el sangrado fueron estadísticamente mayores para los dientes dentro de la hendidura alveolar. Los dientes adyacentes a la hendidura presentaron menor cantidad de encía queratinizada e insertada. Referente a la movilidad dental no existe diferencia estadísticamente significativa. Solo un diente presentó recesión gingival. La hendidura alveolar completa predominó radiográficamente. Los dientes cercanos a la hendidura alveolar tienen mayor predisposición a problemas periodontales, por lo que es relevante el seguimiento regular de la salud periodontal.

ABSTRACT: The teeth adjacent to the alveolar cleft, in patients with cleft lip and palate, present a higher incidence of periodontal problems, according to the literature. The purpose of this study was to evaluate whether the temporary teeth adjacent to the alveolar cleft present a higher incidence of periodontal problems in children with non-syndromic complete unilateral cleft lip and palate, born in 2010 and 2011, treated at the Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. This prospective, cross-sectional, descriptive, and interventional study evaluated epidemiological, clinical and radiographic variables (bacterial plaque, pocket depth, insertion level, gingival recession, bleeding, keratinized and inserted gingiva, dental calculus and mobility, type of alveolar cleft). It used descriptive statistical analysis techniques frequency distribution, crossing of variables and construction of confidence intervals. Data analysis and statistical processing was performed in SPSS version 17.0 and in Excel. The group consisted of 17 patients, with an average age of 5 years. 47 % dental plaque and 0 % dental calculus were found. Pocket depth and bleeding were statistically higher for teeth in the alveolar cleft. The teeth adjacent to the cleft had less keratinized and inserted gingiva. Regarding dental mobility, there is no statistically significant difference. Only one tooth had gingival recession. The complete alveolar cleft predominated radiographically. Teeth close to the alveolar cleft have a greater predisposition to periodontal problems, so regular monitoring of periodontal health is relevant.

Promoting Effect of Palladium on ZnAl2O4-Supported Catalysts Based on Cobalt or Copper Oxide on the Activity for the Total Propene Oxidation.

Palladium-modified Co-ZnAland Cu-ZnAl materials were used and found active for the catalytic oxidation of propene and propane. According to the results obtained by XRD, TPR and XPS, the zinc aluminate-supported phases are oxide phases, Co3O4, CuO and PdOx for Co-ZnAl, Cu-ZnAl and Pd-ZnAl catalysts, respectively. These reducible oxide species present good catalytic activity for the oxidation reactions. The addition of palladium to Co-ZnAl or Cu-ZnAl samples promoted the reducibility of the system and, consequently, produced a synergic effect which enhanced the activity for the propene oxidation. The PdCo-ZnAl sample was the most active and exhibited highly dispersed PdOx particles and surface structural defects. In addition, it exhibited good catalytic stability. The H2 pre-treated PdCu-ZnAl, PdCo-ZnAl and Pd-ZnAl samples showed higher activity than the original oxide catalysts, evidencing the important role of the oxidation state of the species, mainly of the palladium species, on the catalytic activity for the propene combustion. The synergic effect between metal transition oxides and PdOx could not be observed for the propane oxidation.

Cochlear implant in patients with single sided deafness: hearing results and communicative benefits.

Objective: Evaluate auditory results and communicative benefits in adult patients with single-sided deafness (SSD) treated with cochlear implantation.Study Design: Observational descriptive case series.Setting: Hospital Universitario Fundación Santa Fe de Bogotá.Patients: Ten patients with profound post-lingual SSD were treated with cochlear implantation between January 2011 and March 2016. Two patients were excluded because of incomplete follow-up.Interventions: Medical records included demographic information, pre and post-operative audiometric results, and binaural and monoaural speech discrimination tests in three sound-in-noise configurationswith the cochlear implant turned on and off, respectively. Subjective improvement was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Speech, Spatial, and Qualities of Hearing Scale (SSQ-B).Main Outcome Measures: Pre and post-operative audiometric and speech discrimination results, post-operative binaural and monoaural speech discrimination in noise results, and APHAB and SSQ-B questionnaire results.Results: Significant improvement in speech discrimination in a noisy environment was found when the noise and signal were presented from the front, and when the signal was presented to the implanted ear and the noise to the healthy ear. SSQ-B questionnaire showed improvement in all subscales, while APHAB showed improvement in all subscales except sound aversion.Conclusion: Patients with SSD showed improvement regarding communication skills and sound discrimination in a noisy environment.

Calidad de los resúmenes de tesis de doctorados y maestrías de la Universidad Nacional de Asunción, 2000-2017 / Quality of the abstracts of doctoral and master theses of the Universidad Nacional de Asunción, 2000-2017

Los resúmenes de las tesis permiten que los lectores conozcan de manera rápida el contenido de las mismas, y representan la visibilidad institucional, sin embargo, la calidad de los mismos no es analizada de manera frecuente. De allí, que el objetivo del trabajo fue relevar la calidad de los resúmenes de las tesis de maestrías y doctorados de la Universidad Nacional de Asunción. El diseño fue documental, descriptivo con componente analítico y trasversal donde la unidad de análisis quedó constituida por 164 tesis. Los hallazgos dan cuenta que las dimensiones calificadas como Muy bueno fueron Calidad del Título y Explicitación de Objetivos, para la dimensión Consistencia entre Objetivo, Resultado y Título, la calidad fue aceptable. Los resultados muestran la necesidad de mejorar la calidad de los resúmenes(AU)

The thesis abstracts allow readers to quickly know the content of the theses, and represent the institutional visibility, however, the quality of them is not analyzed frequently. Based on this, the objective was to evaluate the quality of the abstracts of the master and doctoral theses of the Universidad Nacional de Asunción. The design was documentary, descriptive cross-sectional with analytical components. The analysis unit was constituted by 164 theses. The findings show that the dimensions classified as very good were Quality of the Title and Objectives Explicitation, while for the dimension Consistency between Objective, Result and Title, the quality was acceptable. The results show the need to improve the quality of the abstracts(AU)

Comparación de la eficacia de los materiales usados como obturadores retrógrados en cirugías dentales apicales / Comparison of the effectiveness of materials used as retrograde obturators in apical dental surgeries

Introducción: las lesiones perirradiculares aparecen solo cuando los conductos radiculares están expuestos a la microbiota oral. Estos conductos radiculares albergan a varias especies bacterianas y sus toxinas que llegan a los tejidos perirradiculares y se inicia la formación de lesiones Objetivo: evaluar la eficacia de los materiales usados como obturadores retrógrados en cirugías apicales según capacidad de microfiltración y adaptación marginal en dientes permanentes. Metodología: se realizó una revisión bibliográfica de bases de datos electrónicas de los últimos 10 años. Se excluyeron artículos no originales, que solo medía la eficacia de un material o que comparaba dos marcas o tipos de un mismo material. Resultados: la mayor cantidad de artículos fueron del año 2014. El MTA fue el material más estudiado. La amalgama se estudia hasta el año 2015 y en el mismo año desaparecen las investigaciones del Biodentine. La mayoría de los artículos evaluó la microfiltración para medir la eficacia. El material que fue considerado eficaz en mayor porcentaje fue el MTA con 27% en estudios de microfiltración y 15% de adaptación. El Biodentine es el siguiente con un 15% de estudios de microfiltración y 6% de adaptación marginal. Se puede concluir que el MTA todavía es el material más eficaz cuando se lo utiliza en obturaciones retrógradas, seguido del Biodentine. Conclusiones: en base a los resultados de los investigadores, se podría considerar al material recientemente fabricado, Biodentine, con igual eficacia que al MTA.

Introduction: periradicular lesions appear only when the root canals are exposed to the oral microbiota. These root canals house several bacterial species and their toxins that reach the periradicular tissues and the formation of lesions begins Objective: to evaluate the effectiveness of the materials used as retrograde obturators in apical surgeries according to microfiltration capacity and marginal adaptation in permanent teeth. Methodology: a bibliographic review of electronic databases of the last 10 years was carried out. Non-original articles were excluded, which only measured the effectiveness of a material or that compared two brands or types of the same material. Results: the largest number of articles were from 2014. The MTA was the most studied material. The amalgam is studied until 2015 and in the same year the Biodentine research disappears. Most articles evaluated microfiltration to measure effectiveness. The material that was considered effective in the highest percentage was the MTA with 27% in microfiltration studies and 15% adaptation. Biodentine is next with 15% of microfiltration studies and 6% of marginal adaptation. It can be concluded that MTA is still the most effective material when used in retrograde seals, followed by Biodentine. Conclusions: based on the results of the researchers, the newly manufactured material, Biodentine, could be considered as effectively as the MTA.

Riesgo de diabetes mellitus de tipo 2 como indicador de desigualdad social / Risk of diabetes mellitus type 2 as indicator of social inequality

La diabetes mellitus de tipo 2 posee mayor prevalencia en países en vías de desarrollo, pues cuentan con menos recursos para enfrentar situaciones relacionadas con la incidencia de la enfermedad. Para analizar si este patrón se replica en Córdoba, se utilizó el test de Findrisk, en 2 poblaciones con diferentes niveles socioculturales, con el objetivo de caracterizarlas y compararlas en función de los indicadores de riesgo, para lo cual se realizó un estudio epidemiológico, descriptivo, transversal y de base poblacional de 743 pacientes entre 18-45 años de edad, de ambos sexos, sin diagnóstico previo de diabetes y, en el caso de las mujeres, que no estuvieran en estado gestacional. Los resultados indicaron que la diferencia entre los grupos fue significativa en la puntuación general y en las variables: perímetro de cintura, antecedentes familiares y hábitos dietarios. Se reveló la necesidad de diseñar políticas sociales en salud, que incorporen instancias formativas y participativas, para la prevención de la enfermedad, con una atención interdisciplinaria.

Diabetes mellitus type 2 has a higher prevalence in developing countries, as they have fewer resources to face situations related to the incidence of the disease. To analyze if this pattern replies in Córdoba, the Findrisk test was used, in 2 populations with different socio-cultural levels, with the objective of characterizing and comparing them regarding the risk indicators, for which an epidemiological, descriptive, cross-sectional and population- based study was carried out in 743 patients between 18-45 years, of both sexes, without previous diagnosis of diabetes and, in the case of the women they should not be pregnant. The results indicated that the difference between the groups was significant in the general score and in the variables: waist perimeter, family history and dietary habits. The necessity of designing health social policies which incorporate formative and participative instances, for the prevention of the disease, with an interdisciplinary care was revealed.

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique, quality of life, and audiological benefit / Análise retrospectiva de complicações cutâneas relacionadas ao implante de prótese auditiva óssea: associação com técnica cirúrgica, qualidade de vida e benefício audiológico

Abstract Introduction: The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision. Objective: To assess skin complications and their association with surgical technique, quality of life, and audiological benefit in patients with bone-anchored hearing aids. Methods: This was a retrospective study conducted in a tertiary referral center in Bogotá, Colombia. Patients who had been fitted with a bone-anchored hearing aid implant (unilaterally or bilaterally) for at least 6 months were included in the study. The Holgers classification was used to classify skin complications (Grade 0 = none; Grade 1 = erythema; Grade 2 = erythema and discharge; Grade 3 = granulation tissue; and Grade 4 = inflammation/infection resulting in the removal of the abutment). The Glasgow Benefit Inventory questionnaire was used to determine quality of life, and the Abbreviated Profile of Hearing Aid Benefit questionnaire was used to determine the subjective audiological benefit. Results: A total of 37 patients were included in the study (30 with unilateral implants and 7 with bilateral implant). Of the 44 implants evaluated, 31 (70.3%) were associated with skin complications (7 [15.9%] Grade 1; 4 [9.1%] Grade 2; 15 [34.1%] Grade 3, 5 [11.4%] Grade 4). The U-shaped graft was statistically associated with major complications (Grades 3 and 4) compared with the linear incision technique (p = 0.045). No statistically significant differences were found between Abbreviated Profile of Hearing Aid Benefit scores and severity of complications. Similarly, no differences were found between Glasgow Benefit Inventory physical health questions and skin complications. Conclusion: Despite the high frequency, skin complications did not seem to affect quality of life or subjective audiological benefits of patients with bone-anchored hearing aids.

Resumo Introdução: A prótese auditiva óssea (BAHA, do inglês Bone-Anchored Hearing Aid) é uma forma eficaz de reabilitação auditiva. Devido à natureza do implante, as complicações mais comuns são relacionadas à pele. Várias técnicas opcionais de implantação cirúrgica têm sido usadas para reduzir a frequência e a gravidade das complicações cutâneas, inclusive o enxerto em forma de U e a incisão linear. Objetivo: Avaliar as complicações cutâneas e sua associação com a técnica cirúrgica, qualidade de vida e benefício audiológico em pacientes com BAHAs. Método: Estudo retrospectivo feito em um centro terciário de referência em Bogotá, Colômbia. Os pacientes que receberam um implante de BAHA (unilateral ou bilateralmente) durante pelo menos seis meses foram incluídos no estudo. A classificação de Holgers foi usada para classificar as complicações cutâneas (Grau 0 = nenhuma, Grau 1 = eritema, Grau 2 = eritema e secreção, Grau 3 = tecido de granulação e Grau 4 = inflamação/infecção, resultou na remoção da estrutura de apoio). O questionário Glasgow Benefit Inventory (GBI) foi usado para determinar a qualidade de vida e o questionário Abbreviated Profile of Hearing Aid Benefit (APHAB) foi usado para determinar o benefício audiológico subjetivo. Resultados: Foram incluídos 37 pacientes (30 com implantes unilaterais e sete com implantes bilaterais). Dos 44 implantes avaliados, 31 (70,3%) foram associados às complicações cutâneas (sete [15,9%] Grau 1; quatro [9,1%] Grau 2; 15 [34,1%] Grau 3 e cinco [11,4%] Grau 4). O enxerto em forma de U foi estatisticamente associado a complicações maiores (Graus 3 e 4) em comparação com a técnica de incisão linear (p = 0,045). Não foram encontradas diferenças estatisticamente significativas entre os escores APHAB e gravidade das complicações. Do mesmo modo, não foram encontradas diferenças entre as questões de saúde física pelo questionário GBI e complicações cutâneas. Conclusão: Apesar da alta frequência, as complicações cutâneas não parecem afetar a qualidade de vida ou os benefícios audiológicos subjetivos de pacientes com BAHAs.

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique, quality of life, and audiological benefit.

INTRODUCTION: The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision. OBJECTIVE: To assess skin complications and their association with surgical technique, quality of life, and audiological benefit in patients with bone-anchored hearing aids. METHODS: This was a retrospective study conducted in a tertiary referral center in Bogotá, Colombia. Patients who had been fitted with a bone-anchored hearing aid implant (unilaterally or bilaterally) for at least 6 months were included in the study. The Holgers classification was used to classify skin complications (Grade 0=none; Grade 1=erythema; Grade 2=erythema and discharge; Grade 3=granulation tissue; and Grade 4=inflammation/infection resulting in the removal of the abutment). The Glasgow Benefit Inventory questionnaire was used to determine quality of life, and the Abbreviated Profile of Hearing Aid Benefit questionnaire was used to determine the subjective audiological benefit. RESULTS: A total of 37 patients were included in the study (30 with unilateral implants and 7 with bilateral implant). Of the 44 implants evaluated, 31 (70.3%) were associated with skin complications (7 [15.9%] Grade 1; 4 [9.1%] Grade 2; 15 [34.1%] Grade 3, 5 [11.4%] Grade 4). The U-shaped graft was statistically associated with major complications (Grades 3 and 4) compared with the linear incision technique (p=0.045). No statistically significant differences were found between Abbreviated Profile of Hearing Aid Benefit scores and severity of complications. Similarly, no differences were found between Glasgow Benefit Inventory physical health questions and skin complications. CONCLUSION: Despite the high frequency, skin complications did not seem to affect quality of life or subjective audiological benefits of patients with bone-anchored hearing aids.

Disfunción temporomandibular: causas y tratamientos / Temporomandibular dysfunction: causes and treatments

Introducción: la articulación temporomandibular (ATM) es muy compleja y está compuesta por el hueso temporal y el maxilar inferior o mandíbula. La disfunción temporomandibular (DTM) comprende una serie de signos y síntomas, entre ellos el dolor bucofacial y las alteraciones funcionales como los ruidos articulares y las limitaciones a los movimientos mandibulares. Objetivo: realizar revisión bibliográfica sobre las causas más frecuentes de la DTM y sus posibles tratamientos en pacientes adultos. Metodología: se realizó una revisión bibliográfica de bases de datos electrónicas de los últimos 10 años. Se excluyeron reportes de casos. Resultados: se detectaron 40 artículos en bases bibliográficas de internet de los cuales se incluyeron 30 que reunían los criterios de inclusión. Se encontró al dolor y al ruido articular como síntomas más frecuentes de la DTM y está asociada con el sexo femenino y el bruxismo o parafunción en mayores porcentajes. La placa neuromiorelajante es el tratamiento más mencionado. Conclusiones: el dolor de la ATM fue la variable medida en mayor proporción. Entre los factores que se encontraron asociados a la DTM, tuvo mayor porcentaje el sexo femenino seguido del bruxismo o parafunción y los pacientes parcialmente edéntulos.

Introduction: the temporomandibular joint is very complex and is composed of the temporal bone and the lower jaw or mandible. Temporomandibular dysfunction (TMD) comprises a series of signs and symptoms, including orofacial pain and functional alterations such as joint noises and limitations to mandibular movements. Objective: to describe the most frequent causes of TMD and its possible treatments in adult patients. Methodology: a bibliographic review of electronic databases of the last 10 years was carried out. Case reports were excluded. Results: 40 articles were detected in internet bibliographic bases, of which 30 were included that met the inclusion criteria. Joint pain and noise were found as the most frequent symptoms of TMD and are associated with female sex and bruxism or parafunction in higher percentages. The neuromyorelaxing plaque is the most mentioned treatment. Conclusions: TMJ pain was the most widely measured variable. Among the factors that were found associated with TMD, the female sex had a higher percentage followed by bruxism or parafunction and partially edentulous patients.

Estrategia en salud: establecimiento de una red de servicios de salud como alternativa para la reducción de listas de espera para cirugía / Health strategy: networking of health services as an alternative to reducing waiting lists for surgery

En el área de la salud, se deben buscar estrategias que permitan mejorar el nivel de la salud de la población, entendiendo que debe haber eficacia en el actuar, con criterios de mejora, e instaurando iniciativas que funcionen y perduren en el tiempo, para fortalecer dicho sistema, como por ejemplo el establecimiento de una red de servicios de salud, como sucedió en el presente caso, en el que, con el fin de reducir la lista de espera para cirugía en la Unidad de Labio y Paladar Hendido-Craneomaxilofacial del Hospital Nacional de Niños en Costa Rica, el cual es un hospital del nivel III de atención, se estableció una estrategia basada en una red de servicios de salud con un hospital del nivel II de atención, por poseer este la infraestructura y el equipo humano para llevarlo a cabo, y al cual el cirujano se desplazaría para realizar una jornada quirúrgica de 2 días cada 2 meses. En dicho programa se realizaron 6 jornadas quirúrgicas durante el año 2014, en las cuales se intervinieron quirúrgicamente 37 pacientes y se suspendieron 10 pacientes a consecuencia, principalmente, de infección de vía aérea superior. En conclusión, el establecimiento de una estrategia de red de servicios de salud exige disponer de instrumentos eficaces de coordinación y cooperación entre las instituciones involucradas, motivación y disposición de las personas participantes para lograr alcanzar el objetivo en común, y evaluación para realizar los reajustes correspondientes durante su ejecución.

In the area of health, strategies to improve the level of health of the population should be seek, meaning that there must be effectiveness in acting, with criteria for improvement and setting up initiatives that will work and endure over time in order to strengthen the system, such as the establishment of a network of health services, as happened in this case, where in order to reduce the waiting list for surgery at the Cleft Lip and Palate-Craniomaxillofacial Unit, Hospital Nacional de Niños, Costa Rica, which is a level III hospital in care, it was decided to establish a strategy based on network health services with a level II hospital in care, by having the infrastructure and human resources to carry it out and where the surgeon will travel to the hospital to perform a two day surgical workshops every two months. In this program, six surgical workshops were conducted during 2014, in which 37 patients underwent surgery and 10 patients were discontinued due mainly to upper airway infections. In conclusion, the establishment of a network strategy of health services requires effective tools for coordination and cooperation between the institutions involved, motivation and willingness of participants to reach the common goal, and evaluation for the corresponding adjustments during implementation.

Cochlear Implants Versus Hearing Aids in a Middle-Income Country: Costs, Productivity, and Quality of Life.

OBJECTIVE: In Colombia there are three main treatment approaches for bilateral profound sensorineural hearing loss, also known as profound deafness (PD): cochlear implants (CI), hearing aids (HA), and no treatment (NT). The objective of this study is to determine the optimal treatment approach for PD in terms of productivity and cost-effectiveness. STUDY DESIGN: Hearing levels and SES data were obtained from audiometric tests conducted on 100 patients with CI. For each treatment approach, productivity and cost-effectiveness assessments were estimated using influence diagrams and Monte Carlo simulations. Productivity was calculated as the net present value of a patient's lifetime income divided by total health-related and educational costs. For the CI and HA, the cost-effectiveness indicator was calculated as quality-adjusted life-years (QALYs) gained in comparison with the NT approach divided by the total cost of the treatment option. RESULTS: The results for the CI, the HA, and NT in terms of productivity ratio were 1.53, 0.94, and 1.47, respectively. Patients using CI had a gain of 5.7 QALYs, whereas patients using HA had a gain of 4.6 QALYs. The results for the CI and the HA in terms of cost-effectiveness were $15,169 and $15,430 per QALY, respectively. CONCLUSION: The CI was found to be the optimal treatment for PD, as it was the most efficient and cost-effective in terms of improving patients' productivity and quality of life. We observed that children who had received CI developed hearing and speech abilities that contributed to their productivity and quality of life to a greater extent than those with HA.