Test-retest reliability of Latin American Group for Maturity (GDLAM) protocol in older women.

Functional autonomy (FA) is a critical factor in determining the quality of life of older adults (OA), especially in the case of older women (OW), as they face a decline in FA in their later years of life. FA should be assessed early, using valid, reliable, and low-cost tests. This study evaluated the test-retest reliability of GDLAM and GDLAM autonomy index (GI) in OW. Thirty-nine OW (71.2 ± 6.50 years) participated in the study. A repeated measures design was used to compare the interday test-retest reliability of the five GDLAM tests (seconds) and the GI (points). The five tests represent activities of daily living, such as dressing or wandering around the house, while the GI provides a weighting of the results of the five tests. The analysis consisted of the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and coefficient of variation (CV). A CV ≤ 10% and an ICC ≥ 0.80 were considered acceptable reliability, whereas a CV ≤ 5% and an ICC ≥ 0.90 were considered high reliability. The outcome of the five tests, represented by the GI, showed high interday test-retest reliability (CV = 6.00% and ICC = 0.91). The results of this study demonstrate that the five tests of the GDLAM protocol and the GI have high interday test-retest reliability and good interday reproducibility. From a practical point of view, the GDLAM protocol allows the assessment of FA of community-dwelling OW, providing background for early diagnosis and, with it, the possibility of developing an individualized physical exercise prescription.

Environmental pollution and health in Chilean older adults: Impact on quality of life and functional autonomy.

Background and Aims: Due to increased urbanization and industry, environmental pollution is a serious public health concern. Globally, the quality of life is particularly lowered by exposure to high amounts of particulate matter (PM). Chile has five industrial zones with high pollution levels, called "sacrifice zones." However, the effect of polluted air on the quality of life and functional autonomy (FA) of older people living in industrial zones with high pollution levels is unknown. Therefore, this study aimed to determine the quality of life and FA differences between Chilean older women (OW) living in areas with lower and higher PM levels. Materials and Methods: Seventy-two OW volunteered for this study. The sample was divided into Zone 1 (PM2.5 ≤ 15 µg/m3, n = 36) and Zone 2 (PM2.5 > 15 µg/m3, n = 36). The variables were quality of life-assessed through the SF-36v2.0 questionnaire, and FA-assessed through the GDLAM protocols. Differences between zones were tested by Student's t-test and Mann-Whitney test, both for independent samples (p < 0.05). Results: All eight dimensions of quality of life were lower in Zone 2, of which the role emotional (RE) showed significant differences between zones (p < 0.05). Performance on the GDLAM protocols and the FA index were lower in Zone 2 (p ˃ 0.05). Conclusion: OW in Zone 2 showed lower quality of life and FA. PM could affect the older population's physical and mental health and, therefore, the quality of life.

Systematic Mapping Review of Orthognathic Surgery (Protocol).

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in orthognathic surgery (OS) and their outcomes. Methods: Systematic reviews (SRs), randomized controlled trials (RCTs), and observational studies that evaluate perioperative OS co-interventions and surgical modalities will be identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature will also be screened. Results: Expected results include identification of all PICO questions available in the evidence regarding OS and generation of evidence bubble maps, involving a matrix of all identified co-interventions, surgical modalities, and outcomes presented in the studies. This will achieve identification of research gaps and prioritization of new research questions. Conclusions: The significance of this review will result in a systematic identification and characterization of the available evidence, leading to a reduction in research waste and a guidance of future efforts in developing studies for unsolved questions.

Tracción de tercer molar asociado a quiste dentígero y a nervio alveolar inferior: Reporte de caso

El objetivo de este estudio es presentar un reporte de caso de un paciente que presenta un tercer molar inferior asociado a un quiste dentígero, cuya lesión desplazó el diente hasta quedar inmerso dentro del canal alveolar inferior. Caso: Paciente acude por tratamiento de un quiste dentígero asociado a un tercer molar desplazado hacia nervio alveolar inferior y borde basilar. Se realiza una descompresión del quiste, además de una tracción de la pieza con ortodoncia para posteriormente ser extraída de forma segura. Conclusión: La tracción ortodóntica de tercer molar ofrece una buena alternativa frente a estos casos. Si bien la evolución del paciente frente a este tratamiento es favorable, falta evidencia que demuestre significativamente su eficacia.

The aim of this study is to present a case report of a patient with a lower third molar associated with a dentigerous cyst, whose lesion displaced the tooth into the inferior alveolar canal. Case: Patient asks for treatment of a dentigerous cyst associated with a displaced third molar towards the inferior alveolar nerve and basilar border. A cyst decompression was performed, in addition to a traction of the tooth with orthodontics to be later extracted in a safe way. Conclusion: Traction of the third molar offers a good choice in cases such as the one presented in this article. Although the evolution of the patient is favorable, there is a lack of evidence demonstrating its efficacy.

Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery

Background: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. Material and methods: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. Results: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. Conclusions: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions. (AU)

Epidemiology of delirium in hospitalized patients in Latin America: A systematic review.

BACKGROUND: Accurate epidemiological data are essential for the planning of policies aimed at the identification, prevention, and management of delirium. The reported occurrence of delirium in hospitalized patients varies widely among studies, ranging between 5% to more than 80% in the international literature. The exact occurrence in Latin America is not well described. OBJECTIVE: The aim of this study is to conduct a systematic analysis of the published data on the epidemiology of delirium in hospitalized patients in Latin America. METHODS: We conducted a systematic review following PRISMA guidelines. Both MEDLINE and LILACS databases were searched for original research articles reporting the occurrence of delirium among adult hospitalized patients in Latin American countries. Studies including pediatric populations were excluded from this analysis. Two authors independently applied eligibility criteria, assessed quality, and extracted data. The corresponding authors of the original articles were contacted to obtain relevant information about the study when this was not present in the published manuscripts. RESULTS: Seven hundred and eighteen original articles were identified. After screening titles and abstracts, 149 studies were included in the final analysis. The occurrence of delirium varied depending on the clinical scenario: (1) in the general medico-surgical wards, it ranged from 2.1% to 60.4%, (2) in the Intensive Care Units (ICUs), from 9.6% to 94.8%, (3) in the post-operatory population, from 5.45% and 52.3%, and (4) it was found to be between 10.7% and 62% in the emergency department setting. The most used delirium assessment tools were the "Confusion Assessment Method" (CAM; in the general population), and the "Confusion Assessment Method for the ICU" (CAM-ICU). Fourteen out of 149 studies were conducted in clinical settings who actively implemented some form of non-pharmacological delirium prevention bundles, most of them as part of ICU sedation-analgesia protocols. CONCLUSION: Delirium occurs frequently in hospitalized patients in Latin America throughout a variety of clinical scenarios, including ICU, general wards, post-operatory populations, and among the emergency department setting. The CAM and the CAM-ICU are the most used delirium assessment tools. Bundles of non-pharmacological interventions to prevent delirium are not universally implemented.

Relationship between Asymmetries and Functional Autonomy in Older Chilean Adults.

The objectives of this study were: (a) to determine asymmetries, both lower limb (LL) and upper limb (UL), in Chilean older adults, and (b) to relate asymmetries to FA in both LL and UL. Forty-one older adults voluntarily participated in this study (mean ± standard deviation [SD]: age 72.0 ± 8.0 years, LL asymmetries 13.78 ± 14.87%, UL asymmetries 10.70 ± 8.85%, FA 40.35 ± 16.26 points). The variables were: (1) asymmetries of LL and UL, assessed through a force platform and handgrip, respectively; (2) FA, assessed through the Latin American Group for Maturity (GDLAM) and the GDLAM index of autonomy (GI) protocol. The relationship between the variables was performed through Spearman's correlation. The analysis showed that 39% of the participants presented asymmetries above 15% in the LL. Likewise, this 39% of older adults presented a lower FA than their peers with asymmetries below 15% in the LL (≤15%: 35.64 ± 12.26 points vs. >15%: 47.69 ± 19.23 points, p = 0.003). The analysis showed a small correlation between LL and GI asymmetries (r = 0.27, p = 0.07) and a small but negative correlation between UL and GI (r = -0.21). The mean values of asymmetries of both LL and UL are within 'normal' parameters. However, several older adults were identified as being at risk. In parallel, older adults who presented a higher level of asymmetries in LL showed a lower level of FA.

Systematic mapping review of orthognathic surgery.

STUDY DESIGN: Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS: Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS: Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION: Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.

Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise.

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

Value of Color Doppler Ultrasound Assessment of Sacroiliac Joints in Patients with Inflammatory Low Back Pain.

OBJECTIVE: To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP). METHODS: Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard. RESULTS: There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%). CONCLUSION: CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.

Prevalence of biologics monotherapy in a cohort of patients with Rheumatoid Arthritis in daily clinical practice.

BACKGROUND: Real-life registry data reveal approximately one-third of patients taking biologic agents use them as monotherapy, in spite that combination therapy with Disease Modifying Drugs is more efficacious than monotherapy. The aim of our study was to assess the prevalence of biologics monotherapy in a cohort of patients with RA followed at a single center, and to analyze the reasons for monotherapy, including patients with prescriptions that do not take the medication. METHODS: All patients with Rheumatoid Arthritis, with biologic therapy followed at our Rheumatology Unit were included. Prevalence and reasons for biologics monotherapy was calculated in general, for each biologic course and for each biologic. Prescription data was obtained from the Electronic Medical Record, and drugs acquisition was obtained from the Hospital Administrative database. Drug survival was also calculated and compared between monotherapy and combination therapy. RESULTS: Seventy nine patients with 115 courses of biologic treatments were included. In 40 (35 %, 95 % CI: 26-44 %) of all biologics courses, biologics were initiated as monotherapy. In 27 courses (23 %, 95 % CI: 16-32 %) biologic monotherapy was prescribed by the treating rheumatologists, and in the other 13 (11 %, 95 % CI: 6-18 %) it was initiated as such by decision of the patient regardless of the physician indication. Reasons for prescription of biologic monotherapy by the treating rheumatologists were adverse events with previous DMARDs in 55.5 %, and was not specified in the remaining courses. Only 25 % of biologics' courses were monotherapy from the beginning to the end of the biologic therapy. The overall survival on biologics was 45 % (95 % CI: 35-55 %) at 3 years. There were no statistically differences in biologics survival by modality (monotherapy vs combination) (p = 0.543), course (p = 0.4454), or by biologic drug (p = 0.9612). CONCLUSIONS: Almost 1/3 of patients on biologics use them as monotherapy. This is due to physician's preferences in 60 % of the cases, and to patients not compliance with the indication in around 40 % of the cases. Better communications is needed to assure that physicians and patients agree on the prescribed and used medication.