Interdisciplinary management of maxillary incisors with root resorption caused by impacted canines: A case report.

The aetiology of impacted canines is multi-factorial. Several theories have been proposed, such as lack of space, genetic predisposition, physical barriers like supernumerary teeth, odontomas and other conditions that interfere with the eruption pathway. One of the main complications that can be generated by impacted canines is the resorption of the root of the adjacent teeth. This case report examines the importance of interdisciplinary management of maxillary incisors with root resorption caused by impacted canines in a 13-year-old male patient. Careful traction of impacted canines and proper tissue management followed by space closure and retroclination of anterior incisors with orthodontic treatment. Finally, functional and aesthetic results using dental veneers for oral rehabilitation allowed the patient to obtain favourable results.

Alveolar ridge preservation: A review of concepts and controversies.

The loss of thickness and height of the alveolar process after tooth extraction is a significant impediment to implant placement, which limits the aesthetic results of many restorative treatments. Alveolar ridge preservation can reduce bone resorption. Knowing how beneficial this procedure is can help clinicians decide if it is worth doing. The purpose of this article is to present a contemporary review of the different approaches to preserving the dimensions of the alveolar ridge. We analyze the alveolar healing process, atraumatic extraction techniques, graft materials, and controversies.

Daptomycin Plus Fosfomycin as Salvage Therapy in a Difficult-to-Treat Total Femoral Replacement Infection.

The highly active anti-biofilm combination of daptomycin plus fosfomycin was successfully used in a difficult-to-treat infection of a total femoral replacement caused by multi-drug resistant Staphylococcus epidermidis in a 79-year-old woman. There was no need to remove the orthopedic hardware, and the patient is currently pain free and able to walk.

Glucose time series complexity as a predictor of type 2 diabetes.

BACKGROUND: Complexity analysis of glucose profile may provide valuable information about the gluco-regulatory system. We hypothesized that a complexity metric (detrended fluctuation analysis, DFA) may have a prognostic value for the development of type 2 diabetes in patients at risk. METHODS: A total of 206 patients with any of the following risk factors (1) essential hypertension, (2) obesity or (3) a first-degree relative with a diagnosis of diabetes were included in a survival analysis study for a diagnosis of new onset type 2 diabetes. At inclusion, a glucometry by means of a Continuous Glucose Monitoring System was performed, and DFA was calculated for a 24-h glucose time series. Patients were then followed up every 6 months, controlling for the development of diabetes. RESULTS: In a median follow-up of 18 months, there were 18 new cases of diabetes (58.5 cases/1000 patient-years). DFA was a significant predictor for the development of diabetes, with ten events in the highest quartile versus one in the lowest (log-rank test chi2 = 9, df = 1, p = 0.003), even after adjusting for other relevant clinical and biochemical variables. In a Cox model, the risk of diabetes development increased 2.8 times for every 0.1 DFA units. In a multivariate analysis, only fasting glucose, HbA1c and DFA emerged as significant factors. CONCLUSIONS: Detrended fluctuation analysis significantly performed as a harbinger of type 2 diabetes development in a high-risk population. Complexity analysis may help in targeting patients who could be candidates for intensified treatment. Copyright © 2016 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.

Procalcitonin and C-reactive protein levels as diagnostic tools in febrile patients admitted to a General Internal Medicine ward.

OBJECTIVE: We study the extent to which procalcitonin (Pro-CT) and/or C-reactive protein (CRP) may be helpful in the early triage of febrile patients admitted to a general internal medicine ward. METHODS: This is a prospective, observational study on 62 admitted patients in whom a temperature >38°C had been observed the day before inclusion. RESULTS: Neither Pro-CT nor CRP was able to discriminate infectious (or bacterial) diseases from the other etiologies as a group, with an area under the ROC curve of 0.63 (95% CI 0.47-0.79, p=0.15) for Pro-CT and 0.61, (95CI 0.44-0.78, p=0.23) for CRP. Sensitivity and specificity for Pro-CT varied between 0.59 and 0.67 for a cut-off point of 0.2 ng/mL and 0.03 and 1 for a cut-off point of 10.0 ng/mL. However, in subgroup analysis, Pro-CT was able to discriminate between infectious and inflammatory diseases (Welch two sample t-test t=2.39, df=44.3, p=0.021).

Peripheral and central arterial pressure and its relationship to vascular target organ damage in carotid artery, retina and arterial stiffness. Development and validation of a tool. The Vaso risk study.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) shows a better correlation to target organ damage and cardiovascular morbidity-mortality than office blood pressure. A loss of arterial elasticity and an increase in carotid artery intima-media thickness (IMT) has been associated with increased cardiovascular morbidity-mortality. Tools have been developed that allow estimation of the retinal arteriovenous index but not all studies coincide and there are contradictory results in relation to the evolution of the arteriosclerotic lesions and the caliber of the retinal vessels. The purpose of this study is to analyze the relationship between peripheral and central arterial pressure (clinic and ambulatory) and vascular structure and function as evaluated by the carotid artery intima-media thickness, retina arteriovenous index, pulse wave velocity (PWV) and ankle-brachial index in patients with and without type 2 diabetes. In turn, software is developed and validated for measuring retinal vessel thickness and automatically estimating the arteriovenous index. METHODS/DESIGN: A cross-sectional study involving a control group will be made, with a posterior 4-year follow-up period in primary care. The study patients will be type 2 diabetics, with a control group of non-diabetic individuals. Consecutive sampling will be used to include 300 patients between 34-75 years of age and no previous cardiovascular disease, one-half being assigned to each group. MAIN MEASUREMENTS: age, gender, height, weight and abdominal circumference. Lipids, creatinine, microalbuminuria, blood glucose, HbA1c, blood insulin, high sensitivity C-reactive protein and endothelial dysfunction markers. Clinic and ambulatory blood pressure monitoring. Carotid ultrasound to evaluate IMT, and retinography to evaluate the arteriovenous index. ECG to assess left ventricle hypertrophy, ankle-brachial index, and pulse wave analysis (PWA) and pulse wave velocity (PWV) with the Sphigmocor System. DISCUSSION: We hope to obtain information on the correlation of different ABPM-derived parameters and PWA to organ target damage--particularly vascular structure and function evaluated from the IMT and PWV--and endothelial dysfunction in patients with and without type 2 diabetes. We also hope to demonstrate the usefulness of the instrument developed for the automated evaluation of retinal vascularization in the early detection of alterations in vascular structure and function and in the prognosis of middle-term cardiovascular morbidity. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01325064.

Relationships of night/day heart rate ratio with carotid intima media thickness and markers of arterial stiffness.

OBJECTIVES: To analyze the relationship between office and ambulatory heart rate, and its variability, and arterial stiffness in patients with primary arterial hypertension. METHODS: A cross-sectional study was conducted in a primary care setting, with the inclusion of 356 hypertensive patients aged 30-80 years. Office and ambulatory blood pressure, heart rate, night/day heart rate ratio and the corresponding standard deviations, were determined. Arterial stiffness was assessed according to carotid intima media thickness, pulse wave velocity, the central and peripheral augmentation index, and the ambulatory arterial stiffness index. RESULTS: Carotid intima media thickness, central and peripheral augmentation index, and ambulatory arterial stiffness index were negatively correlated to office and ambulatory heart rate and its standard deviation, and positively correlated to the night/day heart rate ratio. Pulse wave velocity showed a negative correlation to 24 h standard deviation heart rate and a positive correlation to nocturnal heart rate and the night/day heart rate ratio. For each 10 bpm increment in 24 h heart rate, the pulse wave velocity increased 0.42 m/s (95%CI: 0.23-0.60) and ambulatory arterial stiffness index decreased 0.01 (95%CI: 0.01-0.02); in the case of office heart rate, the peripheral augmentation index decreased 4.74 (95%CI: 3.15-6.33) and central augmentation index decreased 3.52 (95%CI: 2.43-4.30), while for 24 h standard deviation heart rate, carotid intima media thickness decreased 0.03 mm (95%CI: 0.01-0.06). CONCLUSIONS: Office and ambulatory heart rate, and the corresponding standard deviations, are inversely associated to the arterial stiffness markers, with the exception of pulse wave velocity, where a direct correlation is observed. A greater increase in night/day ratio, i.e., a lesser decrease in nocturnal heart rate, is associated to increased arterial stiffness.

Permanencia del efecto de una intervención de mejora de calidad en el seguimiento prolongado de pacientes hipertensos (CICLO-RISK STUDY) / Durability of the effects of a quality improvement intervention in hypertensive patients on long-term follow-up (CICLO-RISK study)

ObjetivoEvaluar la permanencia de los efectos conseguidos con una intervención de mejora de calidad en los factores de riesgo cardiovascular (FRCV) y el riesgo cardiovascular (RCV), como resultados intermedios, en pacientes hipertensos con seguimiento en atención primaria.DiseñoEstudio cuasiexperimental.EmplazamientoDos centros de salud urbanos.Participantes419 y 430 hipertensos en los grupos intervención (GI) y control (GC) respectivamente.IntervenciónPrograma combinado que incluyó auditoría, retroalimentación y sesiones de formación sobre guías clínicas de FRCV y RCV con los profesionales sanitarios responsables de los hipertensos del GI.MedicionesCriterios de evaluación de resultados intermedios (presión arterial, colesterol de las lipoproteínas de baja densidad [cLDL], glucohemoglobina [HbA1c], tabaquismo, índice de masa corporal [IMC] y RCV), realizadas en hipertensos de los dos grupos en marzo de 2002, 2004 y 2006.ResultadosLa permanencia del efecto medio (diferencias entre GI y GC) fue: la presión arterial sistólica disminuyó de 8,9 a 4,3mmHg y la diastólica, de 3,9 a 2,3mmHg (p<0,05). El cLDL disminuyó de 10 a 1,1mg/dl. El riesgo coronario disminuyó de 2,9 a 1,2 y el riesgo de mortalidad cardiovascular, de 0,6 a 0,4 puntos porcentuales. El porcentaje de pacientes con presión arterial<140/90mmHg y con IMC<30pierden la significación estadística en la evaluación final y únicamente la mantiene la proporción de pacientes con riesgo coronario<20%, referidos a los resultados de 2004 y 2006 respectivamente.ConclusionesLa intervención de mejora de calidad se asoció a una reducción de los FRCV y el RCV en la evaluación tras la intervención, con tendencia a que el efecto conseguido disminuya en la evaluación final(AU)

ObjectiveTo evaluate the durability of the effects achieved with a quality improvement intervention on cardiovascular risk factors and cardiovascular risk, as intermediate outcomes, in hypertensive patients on long-term follow-up long time primary health care.DesignQuasi-experimental study.SettingTwo urban primary care health centres.ParticipantsThe study included 419 and 430 hypertensive patients in the intervention (IG) and control group (CG), respectively.InterventionsQuality improvement intervention consisted of a combined program including, an audit, feedback, training sessions on the main cardiovascular risk factors clinical guidelines.MeasurementsEvaluation of intermediate outcomes (blood pressure, LDL-cholesterol, HbA1c, smoking, BMI and cardiovascular risk), were measured in both groups in March 2002, 2004 and 2006.ResultsThe mean of the durability effect (differences between IG and CG means) was: systolic blood pressure decreased from 8.9 to 4.3 and the diastolic from 3.9 to 2.3mmHg (p<0.05). LDL-cholesterol decreased from 10 to 1.1mg/dl (p>0.05). Coronary risk fell from 2 to 1.2 percentage points and cardiovascular mortality risk from 0.6 to 0.4 percentage points (p<0.05). The percentage of patients with blood pressure<140/90mmHg and BMI<30 lost statistical significance in the end evaluation and only remains in the percentage of patients with coronary risk less than 20% in the 2004 and 2006 results.ConclusionsQuality improvement intervention was associated with reductions in cardiovascular risk factors and cardiovascular risk in post intervention evaluations with a tendency to decrease the effect achieved in the end evaluation(AU)

[Durability of the effects of a quality improvement intervention in hypertensive patients on long-term follow-up (CICLO-RISK study)]. / Permanencia del efecto de una intervención de mejora de calidad en el seguimiento prolongado de pacientes hipertensos (CICLO-RISK STUDY).

OBJECTIVE: To evaluate the durability of the effects achieved with a quality improvement intervention on cardiovascular risk factors and cardiovascular risk, as intermediate outcomes, in hypertensive patients on long-term follow-up long time primary health care. DESIGN: Quasi-experimental study. SETTING: Two urban primary care health centres. PARTICIPANTS: The study included 419 and 430 hypertensive patients in the intervention (IG) and control group (CG), respectively. INTERVENTIONS: Quality improvement intervention consisted of a combined program including, an audit, feedback, training sessions on the main cardiovascular risk factors clinical guidelines. MEASUREMENTS: Evaluation of intermediate outcomes (blood pressure, LDL-cholesterol, HbA(1c), smoking, BMI and cardiovascular risk), were measured in both groups in March 2002, 2004 and 2006. RESULTS: The mean of the durability effect (differences between IG and CG means) was: systolic blood pressure decreased from 8.9 to 4.3 and the diastolic from 3.9 to 2.3 mmHg (p<0.05). LDL-cholesterol decreased from 10 to 1.1mg/dl (p>0.05). Coronary risk fell from 2 to 1.2 percentage points and cardiovascular mortality risk from 0.6 to 0.4 percentage points (p<0.05). The percentage of patients with blood pressure<140/90 mmHg and BMI<30 lost statistical significance in the end evaluation and only remains in the percentage of patients with coronary risk less than 20% in the 2004 and 2006 results. CONCLUSIONS: Quality improvement intervention was associated with reductions in cardiovascular risk factors and cardiovascular risk in post intervention evaluations with a tendency to decrease the effect achieved in the end evaluation.

[Cardiovascular risk of hypertensive people with long-range monitoring. The effect of aging (Ciclo Risk Study)]. / Riesgo cardiovascular del paciente hipertenso con seguimiento prolongado en atención primaria. El efecto del envejecimiento (Ciclo Risk Study).

BACKGROUND: The evolution of estimated cardiovascular risk can be for evaluating the effectiveness of the different treatment interventions which are carried out on patients with regular follow-up by family physicians. This study is aimed at evaluating the effect of aging on the evolution of cardiovascular risk among hypertensive patients with long-range Primary Care monitoring. METHODS: Longitudinal, descriptive study with monitoring of 842 hypertensive patients within the 34-70 age range at two primary care centers, with a quality improvement intervention (improvement cycle) during the last year at one of these centers. The main variables were age and gender, blood pressure, lipids, smoking habit, diabetes and cardiovascular risk (CVR) (Framingham-Wilson) in the real-life situation and considering the age constant in the first case, and the risk factors in the second, plus the relative risk. RESULTS: A drop was found in the systolic and diastolic blood pressure from 11.78 mmHg (95 IC: 10.51-13.05) and 8.83 mmHg (95 CI: 8.13-9.53), respectively, and LDL Cholesterol 15.94 mg/dl (95 CI: 11.77-20.12), a rise in HDL-Cholesterol of 7.53 mg/dl (95C1: 6.39-8.66), decreased smoking habit of 31% and an increase in diabetics. The Coronary risk decreased 1.40 percent points, Coronary risk with age constant decreased 3.84 (95 CI: 3.35-4.33), having increased with constant risk factors by 3.06(95 CI: 2.82-3.29). The Relative risk dropped from 2.50 to 1.85. CONCLUSIONS: Aging may mask the effect achieved by health care in the absolute cardiovascular risk check. The relative risk could be an alternative for monitoring the follow-up.

Riesgo cardiovascular del paciente hipertenso con seguimiento prolongado en Atención Primaria. El efecto del envejecimiento (Ciclo risk study) / Cardiovascular risk of hypertensive people with long-range monitoring. The effect of aging (Ciclo risk study)

Fundamento La evolución del riesgo cardiovascular estimado, puede servir para valorar la efectividad de las diferentes intervenciones terapéuticas que se realizan en pacientes con seguimiento habitual en las consultas del médico de familia. El objetivo de este trabajo es comparar diferentes sistemas de evaluación del efecto de las intervenciones preventivas en la evolución del riesgo coronario en el seguimiento a largo plazo de personas hipertensas en Atención Primaria. Métodos: Estudio descriptivo longitudinal con seguimiento de 8.42 pacientes hipertensos de 34 a 70 años durante 6 años en dos centros de atención primaria, con una intervención de mejora de calidad (ciclo de mejora) en el último año en uno de ellos. El seguimiento mínimo en atención primaria previo al inicio del estudio fue de dos años. Las variables principales fueron edad y sexo, presión arterial, lípidos, tabaquismo, diabetes y riesgo cardiovascular (RCV)(Framingham-Wilson) en la situación real y considerando constante la edad en el primer supuesto y los factores de riesgo en el segundo y el riesgo relativo. Resultados: Se encontró un descenso de la presión arterial sistólica y diastólica de 11,78 mmHg (IC95%:10,51-13,05) y 8,83 mmHg (IC95%:8,13-9,53) respectivamente y LDL-Colesterol 15,94 mg/dl (IC95%:11,77-20,12), un ascenso del HDLColesterol de 7,53 mg/dl (IC95:6,39-8,66), disminución del tabaquismo del 31% y un aumento de diabéticos. El riego coronario disminuyó 1,40(IC95%:0,87-1,93) puntos porcentuales, el RCV con edad constante descendió 3,84(IC95%:3,35-4,33) y con factores de riesgo constantes incrementó 3,06(IC95%:2,82- 3,29). El Riesgo relativo descendió de 2,50 a 1,85. Conclusiones: El envejecimiento puede enmascarar el efecto logrado por la atención sanitaria en el control del riesgo cardiovascular absoluto. El riesgo relativo podría ser una alternativa para monitorizar el seguimiento (AU)

Background: The evolution of estimated cardiovascular risk can be for evaluating the effectiveness of the different treatment interventions which are carried out on patients with regular follow-up by family physicians. This study is aimed at evaluating the effect of aging on the evolution of cardiovascular risk among hypertensive patients with long-range Primary Care monitoring. Methods: Longitudinal, descriptive study with monitoring of 842 hypertensive patients within the 34-70 age range at two primary care centers, with a quality improvement intervention (improvement cycle) during the last year at one of these centers. The main variables were age and gender, blood pressure, lipids, smoking habit, diabetes and cardiovascular risk (CVR) (Framingham-Wilson) in the real-life situation and considering the age constant in the first case, and the risk factors in the second, plus the relative risk. Results: A drop was found in the systolic and diastolic blood pressure from 11.78 mmHg (95 IC: 10.51-13.05) and 8.83 mmHg (95 CI: 8.13-9.53), respectively, and LDL Cholesterol 15.94 mg/dl (95 CI: 11.77-20.12), a rise in HDL-Cholesterol of 7.53 mg/dl (95CI: 6.39-8.66), decreased smoking habit of 31% and an increase in diabetics. The Coronary risk decreased 1.40 percent points, Coronary risk with age constant decreased 3.84 (95 CI: 3.35-4.33), having increased with constant risk factors by 3.06(95 CI: 2.82-3.29). The Relative risk dropped from 2.50 to 1.85. Conclusions: Aging may mask the effect achieved by health care in the absolute cardiovascular risk check. The relative risk could be an alternative for monitoring the follow-up (AU)