Hipertensión arterial, un reto farmacológico / Arterial hypertension, a pharmacological challenge / Hhipertensão arterial, um desafio farmacológico

La hipertensión arterial (HTA) es una enfermedad crónica que afecta a más del 30% de la población adulta en todo el mundo y se caracteriza por tener una presión arterial más alta de lo normal. Se presentan los principales fármacos para el correcto manejo de la enfermedad según la gravedad de los síntomas del paciente evaluado por SCORE de riesgo cardiovascular y por sus patologías concomitantes. Objetivo. Identificar los fármacos y el tipo de tratamiento, farmacológico o no farmacológico, empleados en la HTA en cuanto a su diagnóstico, mejorando el manejo del paciente que padece esta enfermedad. Metodología. Se realizó una revisión de tipo sistemática empleando el protocolo PRISMA para la recopilación de información en trabajos procedentes de motores de búsqueda como PubMed, Scopus, Web of Science y ELSEVIER sobre el tratamiento de la Hipertensión Arterial Primaria, publicados durante enero del año 2017 hasta diciembre del año 2022. Conclusión. La hipertensión arterial sigue siendo un reto en el campo de la farmacología debido a su alta prevalencia y su asociación con múltiples enfermedades cardiovasculares. Los tratamientos disponibles son efectivos, pero no curan la enfermedad, por lo que es necesario seguir investigando nuevas opciones terapéuticas para mejorar el control y reducir el impacto en la salud pública. La educación y la prevención son herramientas importantes para reducir la incidencia de hipertensión y mejorar el manejo de la enfermedad. Con esta investigación fue posible identificar la importancia del tratamiento farmacológico y el tratamiento de tipo no farmacológico, evaluando adecuadamente el estado del paciente.

Arterial hypertension (AHT) is a chronic disease that affects more than 30% of the adult population worldwide and is characterized by higher than normal blood pressure. The main drugs for the correct management of the disease are presented according to the severity of the patient's symptoms evaluated by SCORE of cardiovascular risk and by his concomitant pathologies. Objective. To identify the drugs and the type of treatment, pharmacological or non-pharmacological, used in HT in terms of its diagnosis, improving the management of the patient suffering from this disease. Methodology. A systematic review was performed using the PRISMA protocol for the collection of information in works from search engines such as PubMed, Scopus, Web of Science and ELSEVIER on the treatment of Primary Arterial Hypertension, published during January 2017 until December 2022. Conclusion. Arterial hypertension remains a challenge in the field of pharmacology due to its high prevalence and association with multiple cardiovascular diseases. Available treatments are effective, but do not cure the disease, so it is necessary to continue investigating new therapeutic options to improve control and reduce the impact on public health. Education and prevention are important tools to reduce the incidence of hypertension and improve disease management. With this research it was possible to identify the importance of pharmacological treatment and non-pharmacological treatment, adequately assessing the patient's condition.

A hipertensão arterial (HTA) é uma doença crônica que afeta mais de 30% da população adulta em todo o mundo e é caracterizada por pressão arterial acima do normal. Os principais medicamentos para o correto manejo da doença são apresentados de acordo com a gravidade dos sintomas do paciente, conforme avaliado pelo SCORE, risco cardiovascular e patologias concomitantes. Objetivo. Identificar os medicamentos e o tipo de tratamento, farmacológico ou não farmacológico, utilizados na hipertensão arterial em termos de seu diagnóstico, melhorando o manejo do paciente que sofre dessa doença. Metodologia. Foi realizada uma revisão sistemática utilizando o protocolo PRISMA para a coleta de informações em trabalhos de mecanismos de busca como PubMed, Scopus, Web of Science e ELSEVIER sobre o tratamento da Hipertensão Arterial Primária, publicados de janeiro de 2017 a dezembro de 2022. Conclusões. A hipertensão arterial continua sendo um desafio no campo da farmacologia devido à sua alta prevalência e associação com várias doenças cardiovasculares. Os tratamentos disponíveis são eficazes, mas não curam a doença, portanto, são necessárias mais pesquisas sobre novas opções terapêuticas para melhorar o controle e reduzir o impacto na saúde pública. A educação e a prevenção são ferramentas importantes para reduzir a incidência de hipertensão e melhorar o controle da doença. Com essa pesquisa, foi possível identificar a importância do tratamento farmacológico e do tratamento não farmacológico, avaliando adequadamente a condição do paciente.

Virus del papiloma humano de alto riesgo y factores asociados en mujeres de Ecuador / High-risk human papillomavirus and associated factors in women in Ecuador / Papilomavírus humano de alto risco e fatores associados nas mulheres equatorianas

El cáncer de cérvix en el 99% de los casos, es causado por el Virus del Papiloma Humano (VPH) de alto riesgo, su prevalencia es elevada en países de bajos ingresos debido a la escasez de recursos para realizar programas generalizados de detección precoz, inmunización y tratamiento adecuado. El objetivo de la investigación fue identificar la frecuencia y los factores de riesgo de las infecciones del VPH de alto riesgo, en mujeres de 21 a 65 años de tres cantones de la zona 6 del Ecuador, periodo 2019. Este fue un estudio analítico, de corte transversal; con una muestra de registros clínicos de 109 pacientes encuestadas a partir del proyecto de epidemiologia en la provincia de El Oro que cumplieron los criterios inclusión. Los datos se recogieron en un formulario validado por método Delphi. Se usó programa SPSS v 24, para la asociación de las variables: Intervalo de Confianza 95%, Chi cuadrado (con valor de p < 0.05), Odds Ratio. Los resultados observados fueron de 31 (28,4%) casos de pacientes con VPH AR, de estas se identificó como el genotipo más común al VPH AR 39 (11,01%) en las participantes del estudio, seguido del VPH AR 31 (8,26%). Fueron factores considerados asociados a la infección del VPH AR sin significancia estadística el inicio de la vida sexual (IVSA) antes de los 20 años (OR = 1,2); y el número de parejas sexuales igual o mayor a 2 (OR = 1,7). Se concluye que el inicio de vida sexual temprano y el numero compañeros sexuales fueron factores asociados, pero sin significancia estadística.

Cervical cancer in 99% of cases is caused by high-risk Human Papillomavirus (HPV), its prevalence is high in low-income countries due to the scarcity of resources for widespread early detection programs, immunization and adequate treatment. The objective of the research was to identify the frequency and risk factors of high-risk HPV infections in women aged 21 to 65 years in three cantons of zone 6 of Ecuador, period 2019. This was an analytical, cross-sectional study; with a sample of clinical records of 109 patients surveyed from the epidemiology project in the province of El Oro who met the inclusion criteria. Data were collected in a form validated by Delphi method. SPSS v 24 software was used for the association of variables: 95% confidence interval, Chi-square (with p value < 0.05), Odds Ratio. The results observed were 31 (28.4%) cases of patients with AR HPV, of which AR HPV 39 (11.01%) was identified as the most common genotype in the study participants, followed by AR HPV 31 (8.26%). Factors considered to be associated with AR HPV infection without statistical significance were sexual debut before the age of 20 years (OR = 1.2); and the number of sexual partners equal to or greater than 2 (OR = 1.7). It was concluded that early sexual debut and the number of sexual partners were associated factors, but without statistical significance.

Em 99% dos casos, o câncer cervical é causado pelo papilomavírus humano de alto risco (HPV), e sua prevalência é alta em países de baixa renda devido à escassez de recursos para a detecção precoce generalizada, imunização e programas de tratamento adequados. O objetivo da pesquisa era identificar a freqüência e fatores de risco para infecções por HPV de alto risco em mulheres entre 21-65 anos de idade em três cantões da zona 6 do Equador, período 2019. Este foi um estudo analítico de corte transversal com uma amostra de registros clínicos de 109 pacientes pesquisados do projeto de epidemiologia na província de El Oro que preenchiam os critérios de inclusão. Os dados foram coletados em um formulário validado pelo método Delphi. O software SPSS v 24 foi utilizado para a associação de variáveis: Intervalo de confiança 95%, Qui-quadrado (com valor de p < 0,05), Odds Ratio. Os resultados observados foram 31 (28,4%) casos de pacientes com AR HPV, dos quais AR HPV 39 (11,01%) foi identificado como o genótipo mais comum nos participantes do estudo, seguido por AR HPV 31 (8,26%). Fatores considerados associados à infecção por AR HPV sem significado estatístico foram a iniciação sexual (SAIV) antes dos 20 anos de idade (OR = 1,2); e número de parceiros sexuais igual ou maior que 2 (OR = 1,7). Concluímos que a estreia sexual precoce e o número de parceiros sexuais foram fatores associados, mas sem significado estatístico.

Genotipos del Virus del Papiloma Humano en citología alterada del cuello uterino / Human Papillomavirus genotypes in altered cervical cytology / Genótipos do papilomavírus humano em citologia cervical alterada

En Ecuador el cáncer de cuello uterino se ubica en el segundo lugar y, está relacionada a una infección genital persistente por el virus del papiloma humano (VPH) de alto riesgo. Objetivo general: determinar la relación entre virus del papiloma humano de alto riesgo y las lesiones intraepiteliales del cuello uterino, en mujeres de 21 a 65 años en tres cantones de la provincia de El Oro, periodo 2019. Se trata de un estudio de tipo descriptivo relacional de corte transversal. Se realizó el estudio en 109 mujeres que cumplieron los criterios de inclusión. Para la relación de las variables se utilizó los estadísticos del Chi cuadrado (con valor de p 0,05) y, la lesión más frecuente fue el de células escamosas atípicas de importancia no determinada. Se concluye que las lesiones intraepiteliales fueron más frecuentes que las reportadas en la literatura como general, y los genotipos 39, 16, 18 estuvieron presentes en las lesiones intraepiteliales de bajo grado del cuello uterino.

In Ecuador, cervical cancer is in second place and is related to persistent genital infection by high-risk human papillomavirus (HPV). General objective: to determine the relationship between high-risk human papillomavirus and cervical intraepithelial lesions in women aged 21 to 65 years in three cantons of the province of El Oro, period 2019. This is a descriptive relational cross-sectional study. The study was conducted in 109 women who met the inclusion criteria. Chi-square statistics (with p value 0.05) and the most frequent lesion was atypical squamous cell of undetermined significance. It is concluded that intraepithelial lesions were more frequent than those reported in the literature in general, and genotypes 39, 16, 18 were present in low-grade intraepithelial lesions of the cervix.

O câncer cervical é a segunda principal causa de câncer cervical no Equador e está relacionado à infecção genital persistente por papilomavírus humano de alto risco (HPV). Objetivo geral: determinar a relação entre papilomavírus humano de alto risco e lesões intra-epiteliais do colo uterino em mulheres de 21 a 65 anos de idade em três cantões da província de El Oro, período 2019. Este é um estudo descritivo, transversal e relacional. O estudo foi conduzido em 109 mulheres que preenchiam os critérios de inclusão. As estatísticas qui-quadradas (com valor p 0,05) e a lesão mais freqüente foi a célula escamosa atípica de importância indeterminada. Conclui-se que as lesões intra-epiteliais eram mais freqüentes do que as relatadas na literatura em geral, e os genótipos 39, 16, 18 estavam presentes em lesões intra-epiteliais de baixo grau do colo uterino.

"I Wish I Could Hold Your Hand": Inconsistent Interactions Between Pregnant Women and Prison Officers.

Much of the literature on pregnant women who are incarcerated focuses on perinatal outcomes for infants, access to and quality of medical care, mental health concerns, prison nurseries, and shackling. This research adds a unique contribution by exploring women's interactions with prison officers during pregnancy, labor, and birth. Based on in-depth interviews with 18 pregnant or postpartum women incarcerated at a maximum-security state prison, the findings suggest inconsistent interactions between women and prison officers. Officers served as gatekeepers and/or advocates. Women reported dehumanizing behaviors, yet they also experienced compassion, especially in the delivery room, though limited by prison regulations. The findings have implications for training in trauma-informed care, clear expectations for prison officers, and consideration of doula programs.

Influence of the Phenological Stage and Harvest Date on the Bioactive Compounds Content of Green Pepper Fruit.

Green pepper fruit is often consumed before it is completely ripe. However, the influence of the phenological stage in which the green pepper is consumed as a potential influencing factor in its bioactive compounds content and antioxidant capacity remains unknown. In addition, no literature is available concerning the bioactive compounds changes in 'Lamuyo' green peppers along its developmental and growth cycle. For this, two different approaches have been carried out, one using twelve different phenological stages (S1 to S12), and in the other, seven different harvest dates (from 27 February to 20 April). Moreover, bioactive compounds changes during 21 days of postharvest storage at 8 °C were investigated. In this study, bioactive compounds (ascorbic acid, dehydroascorbic acid, and total phenolic content) and the total hydrophilic and lipophilic (TAA-H and TAA-L) antioxidant activity were analysed. In addition, total soluble solids, total acidity, individual sugars, and organic acids were determined. Vitamin C levels increased along the phenological stages and harvest dates due to significant increases in ascorbic and dehydroascorbic acid levels. Our results show that the total phenol content decreases as vegetables develop and subsequently increases both as ripening begins and by the last harvest date. Furthermore, TAA-H was also greater by the phenological stage S12 and the 20 April harvest date. In conclusion, the phenological stage and harvest date are key factors that significantly influence the bioactive compounds of green peppers, and those that appear by S12 and 20 April could be more beneficial to health.

Root exposure to apple replant disease soil triggers local defense response and rhizoplane microbiome dysbiosis.

A soil column split-root experiment was designed to investigate the ability of apple replant disease (ARD)-causing agents to spread in soil. 'M26' apple rootstocks grew into a top layer of Control soil, followed by a barrier-free split-soil layer (Control soil/ARD soil). We observed a severely reduced root growth, concomitant with enhanced gene expression of phytoalexin biosynthetic genes and phytoalexin content in roots from ARD soil, indicating a pronounced local plant defense response. Amplicon sequencing (bacteria, archaea, fungi) revealed local shifts in diversity and composition of microorganisms in the rhizoplane of roots from ARD soil. An enrichment of operational taxonomic units affiliated to potential ARD fungal pathogens (Ilyonectria and Nectria sp.) and bacteria frequently associated with ARD (Streptomyces, Variovorax) was noted. In conclusion, our integrated study supports the idea of ARD being local and not spreading into surrounding soil, as only the roots in ARD soil were affected in terms of growth, phytoalexin biosynthetic gene expression, phytoalexin production and altered microbiome structure. This study further reinforces the microbiological nature of ARD, being likely triggered by a disturbed soil microbiome enriched with low mobility of the ARD-causing agents that induce a strong plant defense and rhizoplane microbiome dysbiosis, concurring with root damage.

[Diagnosis of celiac disease in clinical practice: present and future]. / Diagnóstico de enfermedad celiaca en la práctica clínica: presente y futuro.

INTRODUCTION: European guidelines for the diagnosis of celiac disease (CD) have been updated in 2020. The primary objective was to review the compliance with the diagnostic criteria for CD, according to ESPGHAN 2012. Secondarily, to describe the clinical characteristics of the patients and to assess the changes that would be implied by the application of the new 2020 criteria. PATIENTS AND METHODS: Retrospective multicenter study in which 10 centers participated. Patients from 0 to 16 years old with a new diagnosis of CD in 2018-2019 were included. Clinical, serological variables and the performance of intestinal biopsy (IB) were collected. RESULTS: 163 patients were included (57% female) with a median age of 7.6 years (SD 4.4). The form of presentation was: 47.8% classical, 30.7% no classical and 21.5% asymptomatic, with differences depending on age. Total IgA and anti-transglutaminase IgA antibodies were performed in all centers as the first diagnostic step. IgA anti-endomysial antibodies (EMA) were performed in 80%, and HLA haplotype in 95%. Of the total, 78 cases (47.9%) met criteria for not performing intestinal biopsy (IB). IB was indicated in the remaining 85 patients, but was not performed in 29 cases (17.8%). The performance of IB was lower in the secondary hospitals than in the tertiary ones (p < 0.05). If we applied the ESPGHAN 2020 criteria, we would disregard the HLA study, and 21 more patients would not have required IB (going from 47.9% to 60.7% of the total). CONCLUSIONS: Discrepancies are observed in the application of the ESPGHAN 2012 diagnostic criteria due to the different accessibility to EMA and endoscopic IB in secondary centers. With the ESPGHAN-2020 criteria, around 60% of patients will be able to be diagnosed without IB, provided that the determination of EMA is ensured.

The Role of Public-Private Partnerships to Increase Access to Contraception in an Emergency Response Setting: The Zika Contraception Access Network Program.

The Zika Contraception Access Network (Z-CAN) program was a short-term emergency response intervention that used contraception to prevent unintended pregnancies to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak in Puerto Rico. The Centers for Disease Control and Prevention (CDC) reported that a collaborative and coordinated response was needed from governments and private-sector partners to improve access to contraception during the Zika outbreak in Puerto Rico. In response, the National Foundation for the CDC, with technical assistance from CDC, established the Z-CAN program, a network of 153-trained physicians, that provided client-centered contraceptive counseling and same-day access to the full range of the Food and Drug Administration-approved reversible contraceptive methods at no cost for women who chose to prevent pregnancy. From May 2016 to September 2017, 29,221 women received Z-CAN services. Through Z-CAN, public-private partnerships provided a broad range of opportunities for partners to come together to leverage technical expertise, experience, and resources to remove barriers to access contraception that neither the public nor the private sector could address alone. Public-private partnerships focused on three areas: (1) the coordination of efforts among federal and territorial agencies to align strategies, leverage resources, and address sustainability; (2) the mobilization of private partnerships to secure resources from private corporations, domestic philanthropic organizations, and nonprofit organizations for contraceptive methods, physician reimbursement, training and proctoring resources, infrastructure costs, and a health communications campaign; and (3) the engagement of key stakeholders to understand context and need, and to identify strategies to reach the target population. Public-private partnerships provided expertise, support, and awareness, and could be used to help guide programs to other settings for which access to contraception could improve health outcomes.

Exploring microbial determinants of apple replant disease (ARD): a microhabitat approach under split-root design.

Apple replant disease (ARD) occurs worldwide in apple orchards and nurseries and leads to a severe growth and productivity decline. Despite research on the topic, its causality remains unclear. In a split-root experiment, we grew ARD-susceptible 'M26' apple rootstocks in different substrate combinations (+ARD: ARD soil; -ARD: gamma-irradiated ARD soil; and Control: soil with no apple history). We investigated the microbial community composition by 16S rRNA gene amplicon sequencing (bacteria and archaea) along the soil-root continuum (bulk soil, rhizosphere and rhizoplane). Significant differences in microbial community composition and structure were found between +ARD and -ARD or +ARD and Control along the soil-root continuum, even for plants exposed simultaneously to two different substrates (-ARD/+ARD and Control/+ARD). The substrates in the respective split-root compartment defined the assembly of root-associated microbial communities, being hardly influenced by the type of substrate in the respective neighbor compartment. Root-associated representatives from Actinobacteria were the most dynamic taxa in response to the treatments, suggesting a pivotal role in ARD. Altogether, we evidenced an altered state of the microbial community in the +ARD soil, displaying altered alpha- and beta-diversity, which in turn will also impact the normal development of apple rhizosphere and rhizoplane microbiota (dysbiosis), concurring with symptom appearance.

Endosoft: herramienta para el aprendizaje de las patologías pulpares y periapicales / Endosoft: a tool for learning from pulp and periapical diseases

Introducción: el empleo de software educativo es una alternativa motivadora en los diferentes escenarios docentes. Objetivo: mostrar la validación del software educativo sobre diagnóstico y tratamiento de enfermedades pulpares y periapicales para su generalización en estudiantes de Estomatología. Material y Métodos: se realizó un estudio de innovación tecnológica o producto terminado digital en la etapa comprendida desde marzo de 2018 a marzo de 2019. Se utilizó la herramienta Mediator v9.0. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y una encuesta a estudiantes y expertos en función de evaluadores externos del producto. Para evaluar la factibilidad del software se utilizó el método de Criterio de Experto y el Criterio de usuario. Las principales variables evaluadas fueron el diseño de las secciones del software, su funcionalidad, cientificidad del contenido, relación de las imágenes con el objetivo del software, así como su uso en la docencia. Resultados: el producto obtenido consta de un texto básico con hipervínculos para acceder a los demás componentes, así como galerías de imágenes y ejercicios de autoevaluación. Según Criterio de Experto la calidad técnica del producto y la calidad del contenido quedaron evaluadas en la categoría Muy Adecuado. Según Criterio de Usuario, la funcionalidad, la motivación individual y los aspectos de diseño fueron evaluados de Bien. Conclusiones: se desarrolló un software educativo que cuenta con recursos variados para el aprendizaje sobre el tema abordado(AU)

Introduction: The use of the educational software is a motivating alternative in different teaching scenarios. Objective: To validate the educational software related to the diagnosis and treatment of pulp and periapical diseases for its generalization in dental students. Material and Methods: A study linked with technological innovation or digital finished product was conducted during the period between March 2018 and March 2019. The tool used was Mediator v9.0. Theoretical methods such as historical-logical, analytical-synthetic, inductive-deductive, and systemic-structural were used; empirical methods, which included the documentary review and a survey, were applied to students and experts as external evaluators of the product. The methods of Expert Judgment and Customer Judgment were used to evaluate the feasibility of the software. The main variables evaluated were the design of software sections, its functionality, scientific content, relationship between the images and the objective of the software and its use in the teaching-learning process. Results: The product obtained is a basic text with hyperlinks to access the rest of the components, image galleries and self-evaluation exercises. According to Expert Judgment, the technical quality of the software and the quality of its content were evaluated as good. According to Customer Judgment, the functionality, self-motivation and design aspects were evaluated as optimal. Conclusions: An educational software with various resources for learning about the topic approached was developed(AU)

Is disclosure a privilege? Race and disclosure patterns of hepatitis C.

Research suggests that decisions to disclose hepatitis C status are affected by individual and interpersonal factors. However, no existing studies have examined the role of race in disclosure, despite the potential implications of being doubly marginalized on the basis of both race and hepatitis C status. Drawing on qualitative research with 53 persons with hepatitis C in the Southeastern United States, findings indicate that participants practiced four patterns of disclosure: activist disclosure, open disclosure, limited disclosure, and reluctant disclosure. The majority of African Americans in this research practiced limited and reluctant disclosure, while Whites' disclosure patterns were more varied. These findings suggest that race shapes patterns of disclosure of hepatitis C, which has important implications for prevention, help seeking, social support, exposure to discrimination, and addressing racial disparities in health.

Root growth, function and rhizosphere microbiome analyses show local rather than systemic effects in apple plant response to replant disease soil.

Apple replant disease (ARD) is the phenomenon of soil decline occurring after repeated planting of apple trees at the same site. This study aimed to elucidate whether ARD is systemic, i.e. whether the contact of parts of the root system with ARD soil causes the whole plant to show poor shoot and root growth. A split-root experiment was conducted with seedlings of 'M26', offering the same plant for its root system the choice between the substrates ARD soil (+ARD), γ-sterilized ARD soil (-ARD) or soil from a grass parcel (Control) with the following combinations: +ARD/+ARD, -ARD/-ARD; +ARD/-ARD; +ARD/Control. Root growth was analysed throughout the 34-day growing period. Samples from bulk, rhizosphere and rhizoplane soil were collected separately for each compartment, and analysed by fingerprints of 16S rRNA gene or ITS fragments amplified from total community (TC) DNA. The response of the plant to +ARD was not systemic as root growth in -ARD compartment was always superior to root growth in +ARD soil. Crosswise 15N-labelling of the N-fertilizer applied to the split-root compartments showed that nitrate-N uptake efficiency was higher for roots in -ARD soil compared to those in +ARD. Bacterial and fungal community composition in the rhizoplane and rhizosphere of the same plants differed significantly between the compartments containing +ARD/-ARD or +ARD/Control. The strongest differences between the bacterial fingerprints were observed in the rhizoplane and rhizosphere. Bacterial genera with increased abundance in response to ARD were mainly Streptomyces but also Sphingobium, Novosphingobium, Rhizobium, Lysobacter and Variovorax. The strongest differences between the fungal fingerprints were observed in bulk soil. Our data showed that the response of the apple plant to ARD soil is local and not systemic.

Hipoacusia en niños con conducto auditivo interno agrandado / Hearing loss and enlarged internal auditory canal in children

Introducción: Entre las anomalías del hueso temporal que pueden encontrarse en el estudio etiológico de la hipoacusia neurosensorial (HANS) infantil mediante pruebas de imagen, las relacionadas con el conducto auditivo interno (CAI) se hallan entre las menos frecuentes. De ellas, la más prevalente y relacionada con HANS es el CAI estenótico por su asociación a deficiencias del nervio coclear. Menos frecuente y menos concomitante con HANS es el hallazgo de un CAI agrandado (> 8 mm). Métodos: Estudio retrospectivo y descriptivo de las asociaciones clínicas, estudios de imagen, patrones audiológicos y opciones de tratamiento de 9 niños diagnosticados de hipoacusia en el periodo 1999-2012 con un CAI agrandado. Resultados: Se describen 2 grupos de pacientes. El primero, sin asociación con displasias cocleovestibulares: 2 pacientes con HANS sin otras alteraciones de hueso temporal o sistémicas, una hipoacusia mixta bilateral con cromosomopatía por deleción 18q, una hipoacusia genética DFN 3 ligada a X, una hipoacusia unilateral en neurofibromatosis tipo 2 con neurinoma del acústico bilateral, y una hipoacusia unilateral con déficit de nervio coclear unilateral; y un segundo grupo con asociación a displasias cocleovestibulares: una hipoacusia mixta bilateral moderada en síndrome branquio-oto-renal, una HANS profunda unilateral con meningitis recurrentes, y una HANS bilateral profunda con hipotiroidismo congénito. Conclusiones: La presencia de un CAI agrandado en niños puede encontrarse en diferentes contextos clínicos y audiológicos, con relevancias que pueden variar desde situaciones con riesgo vital como en meningitis recurrentes, hasta hipoacusias aisladas sin otras asociaciones (AU)

Introduction: Among the temporal bone abnormalities that can be found in the etiological study of paediatric sensorineural hearing loss (SNHL) by imaging techniques, those related to the internal auditory canal (IAC) are the least frequent. The most prevalent of these abnormalities that is associated with SNHL is stenotic IAC due to its association with cochlear nerve deficiencies. Less frequent and less concomitant with SNHL is the finding of an enlarged IAC (> 8 mm). Methods: Retrospective and descriptive review of clinical associations, imaging, audiological patterns and treatment of 9 children with hearing loss and enlarged IAC in the period 1999 to 2012. Results: Two groups of patients are described. The first, without association with vestibulocochlear dysplasias, consisted of: 2 patients with SNHL without other temporal bone or systemic abnormalities, one with bilateral mixed HL from chromosome 18q deletion, one with a genetic X-linked DFN3 hearing loss, one with unilateral hearing loss in neurofibromatosis type 2 with bilateral acoustic neuroma, and one with unilateral hearing loss with cochlear nerve deficiency. The second group, with association with vestibulocochlear dysplasias, was comprised of: one patient with moderate bilateral mixed hearing loss in branchio-oto-renal syndrome, one with profound unilateral SNHL with recurrent meningitis, and another with profound bilateral SNHL with congenital hypothyroidism. Conclusions: The presence of an enlarged IAC in children can be found in different clinical and audiological settings with relevancies that can range from life-threatening situations, such as recurrent meningitis, to isolated hearing loss with no other associations (AU)

Hearing loss and enlarged internal auditory canal in children.

INTRODUCTION: Among the temporal bone abnormalities that can be found in the etiological study of paediatric sensorineural hearing loss (SNHL) by imaging techniques, those related to the internal auditory canal (IAC) are the least frequent. The most prevalent of these abnormalities that is associated with SNHL is stenotic IAC due to its association with cochlear nerve deficiencies. Less frequent and less concomitant with SNHL is the finding of an enlarged IAC (>8mm). METHODS: Retrospective and descriptive review of clinical associations, imaging, audiological patterns and treatment of 9 children with hearing loss and enlarged IAC in the period 1999 to 2012. RESULTS: Two groups of patients are described. The first, without association with vestibulocochlear dysplasias, consisted of: 2 patients with SNHL without other temporal bone or systemic abnormalities, one with bilateral mixed HL from chromosome 18q deletion, one with a genetic X-linked DFN3 hearing loss, one with unilateral hearing loss in neurofibromatosis type 2 with bilateral acoustic neuroma, and one with unilateral hearing loss with cochlear nerve deficiency. The second group, with association with vestibulocochlear dysplasias, was comprised of: one patient with moderate bilateral mixed hearing loss in branchio-oto-renal syndrome, one with profound unilateral SNHL with recurrent meningitis, and another with profound bilateral SNHL with congenital hypothyroidism. CONCLUSIONS: The presence of an enlarged IAC in children can be found in different clinical and audiological settings with relevancies that can range from life-threatening situations, such as recurrent meningitis, to isolated hearing loss with no other associations.

Desired social distance from people who have hepatitis C virus: an exploration among staff in health care, dentistry, drug treatment, and tattoo/body piercing.

Staff who work in facilities such as health care, dentistry, drug treatment, and tattoo/body piercing are likely to encounter persons with hepatitis C virus (HCV) and be privy to their HCV status. The purpose of this paper is to assess staff comfort with varying levels of intimacy (i.e., social distance) with people who have HCV. We examine how previous contact with persons with HCV and knowledge of HCV including HCV specific training affect desire for social distance. Data are from a 2007 sample of 82 individuals working in health care, dentistry, drug treatment, or tattoo/body-piercing studios located in the Pacific Northwest region of the United States. Multivariate analyses indicate that staff desire social distance from persons with HCV, but contact of certain types reduce desire for social distance. We discuss how the findings have implications for people employed in these fields, as they point to the need to dispel myths and reduce fear among staff working in facilities that may serve persons with HCV.

Intervención educativo-curativa para la prevención de caries dental en niños de cinco a 12 años / Intervención educativo-curativa para la prevención de caries dental en niños de cinco a 12 años / Educational-curative intervention for dental caries prevention in children from five to 12 years / Educational-curative intervention for dental caries prevention in children from five to 12 years

La correcta higiene bucal y los cuidados deben mantenerse por siempre, pero es la etapa prenatal y hasta la adolescencia el período en el cual es fundamental el desarrollo de hábitos preventivos. Objetivo: evaluar la efectividad de la intervención educativa curativa para la prevención de caries dental en los niños de cinco a 12 años de edad. Método: se realizó un estudio experimental a través de una intervención comunitaria en los consultorios 12 y 36 del Policlínico Joaquín Agüero perteneciente a la ciudad de Camagüey desde enero de 2007 a julio de 2008. El universo se constituyó por 95 niños y la muestra se integró por 50 infantes que cumplieron con los criterios de inclusión y exclusión. Resultados: predominó el grupo de edad de cinco a ocho años con un 58%; el factor de riesgo que prevaleció fue la higiene bucal deficiente con un 90% y la dieta cariogénica con un 86%. Al finalizar la intervención casi la totalidad de los padres y los niños se evaluaron de bien en cuanto al nivel de información sobre caries dental. La percepción de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas, ya que observaron cambios positivos en su salud bucal. Conclusiones: la gran mayoría de los niños alcanzaron la calificación de bien en relación con el nivel de información y a la higiene bucal al finalizar la intervención. Casi la totalidad de los padres obtuvieron una evaluación de bien en cuanto al nivel de información. La apreciación de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas (AU)

La correcta higiene bucal y los cuidados deben mantenerse por siempre, pero es la etapa prenatal y hasta la adolescencia el período en el cual es fundamental el desarrollo de hábitos preventivos. Objetivo: evaluar la efectividad de la intervención educativa curativa para la prevención de caries dental en los niños de cinco a 12 años de edad. Método: se realizó un estudio experimental a través de una intervención comunitaria en los consultorios 12 y 36 del Policlínico Joaquín Agüero perteneciente a la ciudad de Camagüey desde enero de 2007 a julio de 2008. El universo se constituyó por 95 niños y la muestra se integró por 50 infantes que cumplieron con los criterios de inclusión y exclusión. Resultados: predominó el grupo de edad de cinco a ocho años con un 58%; el factor de riesgo que prevaleció fue la higiene bucal deficiente con un 90% y la dieta cariogénica con un 86%. Al finalizar la intervención casi la totalidad de los padres y los niños se evaluaron de bien en cuanto al nivel de información sobre caries dental. La percepción de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas, ya que observaron cambios positivos en su salud bucal. Conclusiones: la gran mayoría de los niños alcanzaron la calificación de bien en relación con el nivel de información y a la higiene bucal al finalizar la intervención. Casi la totalidad de los padres obtuvieron una evaluación de bien en cuanto al nivel de información. La apreciación de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas (AU)

The correct oral hygiene and cares should keep forever, but it is the prenatal stage and until the adolescence, period in which it is important the development of preventive habits. Objective: to assess the effectiveness of the educational-curative intervention for dental caries prevention in children from five to 12 years. Methods: an experimental study through a community intervention in the doctors offices 12 and 36 of the Polyclinic Joaquín de Agüero belonging to Camagüey city from January 2007 to July 2008. The universe was constituted by 95 children and the sample was integrated for 50 infants that fulfilled the inclusion and exclusion criteria. Results: the age group from five to eight years with 58% prevailed; the risk factor that prevailed was deficient oral hygiene with 90% and the cariogenic diet with 86%. When concluding the intervention almost the totality of parents and children were evaluated of well as for the information level on dental caries. The perception of children was favorable with regard to the application of affective-participative techniques, since they observed positive changes in their oral health. Conclusions: the great majority of children reached the qualification of well in connection with the information level and to the oral hygiene when concluding the intervention. Almost the totality of parents obtained an evaluation of well as for the information level. The appreciation of children was favorable with regard to the application of affective-participative techniques (AU)

The correct oral hygiene and cares should keep forever, but it is the prenatal stage and until the adolescence, period in which it is important the development of preventive habits. Objective: to assess the effectiveness of the educational-curative intervention for dental caries prevention in children from five to 12 years. Methods: an experimental study through a community intervention in the doctors offices 12 and 36 of the Polyclinic Joaquín de Agüero belonging to Camagüey city from January 2007 to July 2008. The universe was constituted by 95 children and the sample was integrated for 50 infants that fulfilled the inclusion and exclusion criteria. Results: the age group from five to eight years with 58% prevailed; the risk factor that prevailed was deficient oral hygiene with 90% and the cariogenic diet with 86%. When concluding the intervention almost the totality of parents and children were evaluated of well as for the information level on dental caries. The perception of children was favorable with regard to the application of affective-participative techniques, since they observed positive changes in their oral health. Conclusions: the great majority of children reached the qualification of well in connection with the information level and to the oral hygiene when concluding the intervention. Almost the totality of parents obtained an evaluation of well as for the information level. The appreciation of children was favorable with regard to the application of affective-participative techniques (AU)

Intervención educativo-curativa para la prevención de caries dental en niños de cinco a 12 años / Educational-curative intervention for dental caries prevention in children from five to 12 years

Fundamento: la correcta higiene bucal y los cuidados deben mantenerse por siempre, pero es la etapa prenatal y hasta la adolescencia el período en el cual es fundamental el desarrollo de hábitos preventivos. Objetivo: evaluar la efectividad de la intervención educativa curativa para la prevención de caries dental en los niños de cinco a 12 años de edad. Método: se realizó un estudio experimental a través de una intervención comunitaria en los consultorios 12 y 36 del Policlínico Joaquín Agüero perteneciente a la ciudad de Camagüey desde enero de 2007 a julio de 2008. El universo se constituyó por 95 niños y la muestra se integró por 50 infantes que cumplieron con los criterios de inclusión y exclusión. Resultados: predominó el grupo de edad de cinco a ocho años con un 58 por ciento; el factor de riesgo que prevaleció fue la higiene bucal deficiente con un 90 por ciento y la dieta cariogénica con un 86 por ciento. Al finalizar la intervención casi la totalidad de los padres y los niños se evaluaron de bien en cuanto al nivel de información sobre caries dental. La percepción de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas, ya que observaron cambios positivos en su salud bucal. Conclusiones: la gran mayoría de los niños alcanzaron la calificación de bien en relación con el nivel de información y a la higiene bucal al finalizar la intervención. Casi la totalidad de los padres obtuvieron una evaluación de bien en cuanto al nivel de información. La apreciación de los niños fue favorable con respecto a la aplicación de las técnicas afectivo-participativas.

Background: the correct oral hygiene and cares should keep forever, but it is the prenatal stage and until the adolescence, period in which it is important the development of preventive habits. Objective: to assess the effectiveness of the educational-curative intervention for dental caries prevention in children from five to 12 years. Methods: an experimental study through a community intervention in the doctor’s offices 12 and 36 of the Polyclinic Joaquín de Agüero belonging to Camagüey city from January 2007 to July 2008. The universe was constituted by 95 children and the sample was integrated for 50 infants that fulfilled the inclusion and exclusion criteria. Results: the age group from five to eight years with 58 percent prevailed; the risk factor that prevailed was deficient oral hygiene with 90 percent and the cariogenic diet with 86 percent. When concluding the intervention almost the totality of parents and children were evaluated of well as for the information level on dental caries. The perception of children was favorable with regard to the application of affective-participative techniques, since they observed positive changes in their oral health. Conclusions: the great majority of children reached the qualification of well in connection with the information level and to the oral hygiene when concluding the intervention. Almost the totality of parents obtained an evaluation of well as for the information level. The appreciation of children was favorable with regard to the application of affective-participative techniques.

Hipoacusia en niños con acueducto vestibular dilatado. Estudio de 55 casos / Enlarged vestibular aqueduct syndrome. A review of 55 paediatric patients

Introducción: El acueducto vestibular dilatado (AVD) es la anomalía congénita más frecuentemente encontrada en técnicas de imagen en hipoacusia neurosensorial infantil. Nuestro objetivo es describir las características clínicas y audiológicas de los niños hipoacúsicos con hallazgo de AVD. Métodos: Estudio retrospectivo de 55 niños diagnosticados de AVD en el periodo 2000–2009. Se analizaron las pruebas audiológicas objetivas y/o subjetivas estándar realizadas según la edad de desarrollo de los niños. Se describen los hallazgos y concomitancias clínicas y audiológicas. Resultados: Treinta y siete pacientes (67,27%) presentaban AVD bilateral y 18 (32,72%) unilateral. La hipoacusia era bilateral en 46 (83,63%) casos y unilateral en 9 (16,36%). La media de edad resultó 3,78 años. Presentaron hipocausa neurosensorial 53 (96,36%) casos (28 bilaterales y profundas), y 2 (3,63%) casos hipoacusia mixta. Tres casos fueron progresivos, 2 fluctuantes, 2 asimétricas y 2 presentaron síntomas vestibulares. Se evidenciaron otras anomalías radiológicas asociadas (6 hipoplasias cocleares, 2 conductos auditivos internos agrandados, 1 vestíbulo dilatado y 1 conducto semicircular horizontal hipoplásico), y 6 síndromes clínicos concomitantes (2 Down, 1 Jacobsen, 1 Pendred, 1 Waardenburg, 1 branquio-oto-renal). Un caso resultó positivo a la mutación GJB2. Se encontró historia familiar de hipoacusia en 12 (21,8%) casos. Conclusión: La presentación clínica de la hipoacusia infantil en el AVD se caracteriza por su variabilidad. Debe incluirse en el diagnóstico diferencial de la hipoacusia mixta. La asociación familiar y sindrómica del AVD deben considerarse en el estudio diagnóstico. Es necesario conocer la historia natural de la enfermedad con fines de información pronóstica a los padres (AU)

Introduction: Enlarged vestibular aqueduct (EVA) is the commonest congenital anomaly found with imaging techniques in paediatric sensorineural hearing loss (SNHL). Our aim was to describe clinical and audiological findings in paediatric hearing loss associated to EVA. Methods: Retrospective review of 55 children with imaging-technique EVA findings from 2000 to 2009. Subjective and/or objective audiological tests were analysed and audiological findings related to clinical features were described. Results: Thirty-seven patients (67.27%) showed bilateral EVA and 18 (32.72%) were unilateral. Hearing loss was bilateral in 46 (83.63%) patients and unilateral in 9 (16.36%). Mean age at diagnosis was 3.78 years. Fifty-three (96.36%) children showed SNHL (28 bilateral and profound), while 2 (3.63%) patients had mixed hearing loss. There were 3 cases of hearing loss progression, 2 fluctuations, 2 of them were asymmetric and 2 patients suffered from vestibular symptoms. Concomitant image findings were 6 cochlear hypoplasia, 2 enlarged internal auditory canals, 1 enlarged vestibule and 1 hypoplastic lateral semicircular canal. Six clinical syndromes were found (2 cases of Down's, and 1 each of Jacobsen, Pendred, Waardenburg and branchio-oto-renal). One child was positive for GJB2 mutation. Familial hearing loss was demonstrated on 12 (21.8%) cases. Conclusion: The clinical picture of hearing loss associated to EVA is characterised by great variability. It should be included in the differential diagnosis of unexplained mixed hearing loss. Familial and syndromic findings have to be taken into consideration in the diagnostic evaluations of such patients. Knowledge about the natural history of this illness is needed so as to give parents prognostic information (AU)

[Enlarged vestibular aqueduct syndrome. A review of 55 paediatric patients]. / Hipoacusia en niños con acueducto vestibular dilatado. Estudio de 55 casos.

INTRODUCTION: Enlarged vestibular aqueduct (EVA) is the commonest congenital anomaly found with imaging techniques in paediatric sensorineural hearing loss (SNHL). Our aim was to describe clinical and audiological findings in paediatric hearing loss associated to EVA. METHODS: Retrospective review of 55 children with imaging-technique EVA findings from 2000 to 2009. Subjective and/or objective audiological tests were analysed and audiological findings related to clinical features were described. RESULTS: Thirty-seven patients (67.27%) showed bilateral EVA and 18 (32.72%) were unilateral. Hearing loss was bilateral in 46 (83.63%) patients and unilateral in 9 (16.36%). Mean age at diagnosis was 3.78 years. Fifty-three (96.36%) children showed SNHL (28 bilateral and profound), while 2 (3.63%) patients had mixed hearing loss. There were 3 cases of hearing loss progression, 2 fluctuations, 2 of them were asymmetric and 2 patients suffered from vestibular symptoms. Concomitant image findings were 6 cochlear hypoplasia, 2 enlarged internal auditory canals, 1 enlarged vestibule and 1 hypoplastic lateral semicircular canal. Six clinical syndromes were found (2 cases of Down's, and 1 each of Jacobsen, Pendred, Waardenburg and branchio-oto-renal). One child was positive for GJB2 mutation. Familial hearing loss was demonstrated on 12 (21.8%) cases. CONCLUSION: The clinical picture of hearing loss associated to EVA is characterised by great variability. It should be included in the differential diagnosis of unexplained mixed hearing loss. Familial and syndromic findings have to be taken into consideration in the diagnostic evaluations of such patients. Knowledge about the natural history of this illness is needed so as to give parents prognostic information.

Promoción de salud para la prevención de caries en niños de 5 a 12 años / Health promotion for caries prevention in children from 5 to 12 years

En Cuba la caries dental es una de las enfermedades bucales de mayor prevalencia y la tendencia a padecerla en los menores de quince años, ha seguido un comportamiento similar al descrito por otros países. Objetivo: evaluar la influencia de las técnicas afectivo-participativas en la prevención de caries dental en niños de cinco a doce años. Método: se realizó un estudio experimental de intervención comunitaria en el consultorio diez, área norte, perteneciente a la Clínica Estomatológica Docente “La Vigía”, municipio Camagüey, durante el período comprendido de junio de 2006 a junio de 2007. La muestra quedó conformada por los treinta y siete niños comprendidos en estas edades. La investigación se realizó en tres fases donde se identificaron los principales factores de riesgo y se aplicaron las técnicas afectivo-participativas a padres y niños en los primeros seis meses. Luego se realizó la evaluación desde el punto de vista cuantitativo y cualitativo. Resultados: fueron satisfactorios pues el 84% de los niños incrementó el nivel de información sobre caries dental. Conclusiones: la higiene bucal fue evaluada de bien en casi todos los niños y hubo una percepción favorable de ellos con respecto a la aplicación de las técnicas afectivo-participativas así como un impacto positivo de las mismas en la salud buco dental (AU)

In Cuba dental caries is one of the oral diseases of more prevalence and the tendency to suffer it in those smaller than fifteen years, it has followed a similar behavior to the one described by other countries. Objective: to evaluate the influence of the affective-participatory techniques in the prevention of dental caries in children from five to twelve years. Method: an experimental study of community intervention in the doctor´s office ten, north area, belonging to the Teaching Odontology Clinic "La Vigía", of Camagüey municipality, was performed from june 2006 to june 2007. The sample was conformed by thirty seven children comprised in these ages. The investigation was carried out in three phases where the main risk factors were identified and the affective-participatory techniques were applied to parents and children in the first six months. Then the evaluation from the quantitative and qualitative point of view was carried out. Results: were satisfactory, since 84% of children increased the level of information on dental caries. Conclusions: oral hygiene was evaluated of well in almost all the children and there was a favorable perception of them with regard to the application of the affective-participatory techniques as well as a positive impact of them in the bucco- dental health (AU)