Efecto de la desprogramación neuromuscular en la calidad de vida y sueño en pacientes con disfunción temporomandibular / Effect of neuromuscular deprogramming on quality of life and sleep in patients with temporomandibular dysfunction

Introduction: Neuromuscular deprogramming reduces the main symptoms such as pain by 70 to 90 percent in patients with temporomandibular dysfunction, but little information is available on the effect on quality of life and sleep. Objective: Determine the effect of neuromuscular deprogramming on quality of life and sleep in patients with temporomandibular dysfunction. Methods: 55 patients with temporomandibular dysfunction were included who were neuromuscularly deprogrammed (29 women and 26 men), with an average age of 34.9 ± 16.5 years. At the beginning and end of neuromuscular deprogramming, surveys were applied to assess the level of chronic pain, perception of quality of life related to oral health, perceived stress, quantity and quality of life, anxiety and depression. Results: In 37 patients (68 percent) pain was identified on examination, and it was confirmed in the chronic pain survey. The quality of life perception score was correlated with low sleep quality (r = 0.39; p = 0.008); pain score (r = 0.48; p = 0.003); anxiety (r = 0.55; p = 0.003) and depression (r = 0.41; p = 0.006). Neuromuscular deprogramming reduced patient-reported pain levels from 9.9 to 2.9 (p = 0.001), the percentage of patients with poor sleep quality from 60 percent to 29 percent (p < 0.0001), the quality of life score from 40.7 to 23.8 (p = 0.03), and perceived stress levels from 22.1 to 19.1 (p = 0.002). Conclusions: In patients with temporomandibular dysfunction, neuromuscular deprogramming reduces the level of pain. It is related to better perception in quality of life, higher quality of sleep and decreases perceived stress.

Introducción: La desprogramación neuromuscular reduce los síntomas principales como el dolor de 70 a 90 por ciento en los pacientes con disfunción temporomandibular, pero se dispone de escasa información sobre el efecto en la calidad de vida y sueño. Objetivo: Determinar el efecto de la desprogramación neuromuscular en la calidad de vida y sueño en pacientes con disfunción temporomandibular. Métodos: Se incluyeron 55 pacientes con disfunción temporomandibular que fueron desprogramados neuromuscularmente (29 mujeres y 26 hombres), con edad promedio de 34,9 ± 16,5 años. Al inicio y final de la desprogramación neuromuscular, se aplicaron las encuestas para evaluar el nivel de dolor crónico, percepción de calidad de vida relacionada con la salud oral, estrés percibido, cantidad y calidad de vida, ansiedad y depresión. Resultados: En 37 pacientes (68 por ciento) se identificó dolor a la exploración confirmado en la encuesta de dolor crónico. El puntaje de percepción de calidad de vida se correlacionó con baja calidad de sueño (r = 0,39; p = 0,008); el puntaje de dolor (r = 0,48; p = 0,003); ansiedad (r = 0,55; p = 0,003) y depresión (r = 0,41; p = 0,006). La desprogramación neuromuscular redujo los niveles de dolor referidos por el paciente de 9,9 a 2,9 (p = 0,001), el porcentaje de pacientes con pobre calidad de sueño de 60 por ciento a 29 por ciento (p < 0,0001), el puntaje de la calidad de vida de 40,7 a 23,8 (p = 0,03) y los niveles de estrés percibido de 22,1 a 19,1 (p = 0,002). Conclusiones: En pacientes con disfunción temporomandibular, la desprogramación neuromuscular reduce el nivel de dolor, se relaciona con mejor percepción en la calidad de vida, mayor calidad de sueño y disminuye el estrés percibido(AU)

Asymmetric Septal Hypertrophy in Appropriate for Gestational Age Infants Born to Diabetic Mothers.

OBJECTIVE: To compare the frequency of asymmetric septal hypertrophy in appropriate for gestational age infants born to diabetic mothers with those born to non-diabetic mothers. METHODS: We compared 38 full term infants born to diabetic mothers with 85 full term infants of non-diabetic mothers. 2-D echocardiography was obtained in the first 24 hours after birth. RESULTS: Asymmetric septal hypertrophy was only present in infants born to diabetic mothers (50% vs. 0%; P<0.001). Intraventricular septum thickness and intraventricular septum/posterior wall of the left ventricle ratio was also significantly higher in the first group (P<0.001). We found no correlation between mother´s glycated hemoglobin levels and intraventricular septum thickness in newborns. CONCLUSION: Asymmetric septal hypertrophy is a common finding in infants born to diabetic mothers, even if they are appropriate for gestational age.

Single strain versus multispecies probiotic on necrotizing enterocolitis and faecal IgA levels in very low birth weight preterm neonates: A randomized clinical trial.

BACKGROUND: According to the literature, probiotics are an attractive alternative to prevent necrotizing enterocolitis (NEC). However, due to differences in probiotic composition, randomized controlled trials are necessary to compare different probiotic mixtures. The objective of this study was to compare single strain (Lactobacillus acidophilus boucardii) versus multispecies probiotics on NEC incidence and faecal secretory Immunoglobulin A (sIgA) levels in very low preterm newborns. METHODS: We performed a double-blind randomized trial in 90 newborns. L. acidophilus boucardii strain or multispecies probiotics were randomly assigned to preterm newborns. As the primary outcome, we evaluated NEC incidence on the total length of neonatal intensive care unit (NICU) stay. As the secondary outcome, we measured the change in faecal sIgA levels from baseline to 3 weeks following the use of probiotics. RESULTS: NEC incidence was similar between groups (0% vs. 2.2% for the single strain and multispecies probiotic, respectively). Faecal sIgA levels increased significantly (p < 0.001) within groups (31% for single strain and 47% for multispecies probiotic), but this increase was not different between groups. Neonates with a faecal sIgA level increment >0.45 mg/dl showed higher gestational age, birth weight, and weight at the second and third weeks of follow up than neonates with a faecal sIgA level increment ≤0.45 mg/dl. No adverse effects were found after probiotics use. CONCLUSIONS: No difference between strains of probiotics used was found on NEC incidence or in the increase of faecal sIgA levels. Faecal sIgA levels were positively related to gestational age and body weight in very low preterm infants. ClinicalTrials.gov/NCT02245815.

Correlation between interleukin-1ß and matrix metalloproteinase-1 levels in crevicular fluid with a proposed periodontal disease index in children.

BACKGROUND: The crevicular fluid contains biomarkers that allow the identification of periodontal disease, anticipation of its risk, and prediction of its progression. PURPOSE: The purpose of this study is to correlate interleukin-1ß (IL-1ß) and matrix metalloproteinase-1 (MMP-1) levels in crevicular fluid with periodontal disease severity in schoolchildren. METHODS: A cross-sectional study was conducted in 82 schoolchildren between 9 and 12 years. The biofilm percentage, attachment level, gingival recession, dental calculus, and bleeding on probing were measured in the teeth 16, 26, 36, 41, and 46. These five parameters obtained were considered to propose a disease score between 0 and 10 points. In crevicular fluid from the tooth with the highest score, IL-1ß and MMP-1 levels were measured. RESULTS: According to the proposed score, mild gingivitis was identified in 20 schoolchildren, moderate gingivitis in 30, and severe gingivitis in 32. Biofilm percentage, IL-1ß, and MMP-1 levels increased as the severity of the disease increase. The mean and 95% confidence interval were 23.2 pg/µl (18.6-27.7), 37.3 pg/µl (27.8-46.9), and 44.6 pg/µl (34.4-58.8) (P = 0.01) for IL-1ß and 2.69 mol/min (2.51-2.87), 4.43 mol/min (3.9-4.95), and 5.59 mol/min (4.81-6.38) (P < 0.001) for MMP-1 in each group, respectively. The proposed clinical score correlated with biofilm percentage (r = 0.63), IL-1ß (r = 0.50), and MMP-1 (0.45) levels, P < 0.001 in all cases. CONCLUSIONS: The proposed clinical score for periodontal disease in children correlated with percentage of biofilm, IL-1ß, and MMP-1 levels.

[Protein intake, serum lipids and muscle strenght in the elderly]. / Ingesta de proteína, lípidos séricos y fuerza muscular en ancianos.

INTRODUCTION: The daily protein recommendation for adults is 0.8 g/kg/day; however, several studies argue that an intake of 1.0-1.5 g protein/kg/day could benefit the health of the elderly. OBJECTIVE: We evaluated the protein intake and serum lipid levels in elderly patients with hip fracture, determining their correlation with the grip strength in both hands. METHODS: The study included 47 adult patients aged 65-85 years hospitalized for recent hip fracture. Weight, height, lipid profile and muscle strength of both hands were measured, and MNA was also used to evaluate the nutritional status. RESULTS: The elderly, predominantly women and with a homogeneous age of 80 years on average, were malnourished or at risk of malnutrition in 93% of cases according to the MNA. Men consumed significantly more protein than women. Muscle strength negatively associated with triglyceride levels; 36% of the elderly had triglyceride levels above 150 mg/dl. CONCLUSIONS: TG levels associated inversely with muscle strength in elderly patients with hip fracture. According to these results, which should be validated in other populations, elevated TG levels are a factor of metabolic syndrome and are associated with low muscle strength in the elderly. This is relevant because obesity prevention and metabolic syndrome are one priority through the promotion of healthier lifestyles and nutrition policies that could be widely implemented.

Ingesta de proteína, lípidos séricos y fuerza muscular en ancianos / Protein intake, serum lipids and muscle strenght in the elderly

Introducción: la recomendación diaria de proteína para adultos es de 0,8 g/kg/día. Sin embargo, varios estudios argumentan que una ingesta de 1,0-1,5 g proteína/kg/día podría beneficiar la salud de los ancianos. Objetivo: evaluamos la ingesta de proteína y los niveles de lípidos séricos en ancianos con fractura de cadera determinando su correlación con la fuerza de prensión en ambas manos. Métodos: el estudio incluyó a 47 pacientes adultos de 65-85 años hospitalizados por reciente fractura de cadera. Se midió peso, talla, perfil de lípidos y fuerza muscular de ambas manos, y también se aplicó el Mini Nutritional Assessment (MNA) para evaluar el estado de nutrición. Resultados: de acuerdo al MNA, el 93% de los ancianos estaban malnutridos o en riesgo de malnutrición. Los ancianos eran predominantemente mujeres y con una edad homogénea de 80 años. Los hombres consumieron significativamente más proteína que las mujeres. La fuerza muscular se asoció negativamente con los niveles de triglicéridos (TG) y el 36% de los ancianos tuvieron niveles de triglicéridos superiores a 150 mg/dl. Conclusiones: los niveles de TG se asociaron inversamente con la fuerza muscular en ancianos con fractura de cadera. Estos resultados, que deberán validarse en otras poblaciones, consideran que los niveles elevados de TG son un factor de síndrome metabólico y se asocian a baja fuerza muscular en ancianos, esto es relevante debido a que la prevención de la obesidad y el síndrome metabólico son una prioridad a través de la promoción de estilos de vida más saludables y políticas de alimentación que podrían implementarse ampliamente (AU)

Introduction: The daily protein recommendation for adults is 0.8 g/kg/day; however, several studies argue that an intake of 1.0-1.5 g protein/kg/day could benefit the health of the elderly. Objective: We evaluated the protein intake and serum lipid levels in elderly patients with hip fracture, determining their correlation with the grip strength in both hands. Methods: The study included 47 adult patients aged 65-85 years hospitalized for recent hip fracture. Weight, height, lipid profile and muscle strength of both hands were measured, and MNA was also used to evaluate the nutritional status. Results: The elderly, predominantly women and with a homogeneous age of 80 years on average, were malnourished or at risk of malnutrition in 93% of cases according to the MNA. Men consumed significantly more protein than women. Muscle strength negatively associated with triglyceride levels; 36% of the elderly had triglyceride levels above 150 mg/dl. Conclusions: TG levels associated inversely with muscle strength in elderly patients with hip fracture. According to these results, which should be validated in other populations, elevated TG levels are a factor of metabolic syndrome and are associated with low muscle strength in the elderly. This is relevant because obesity prevention and metabolic syndrome are one priority through the promotion of healthier lifestyles and nutrition policies that could be widely implemented (AU)

[Cartilage island versus temporalis fascia in high-risk tympanic perforation]. / Cartílago en isla frente a fascia temporal en la perforación de membrana timpánica de alto riesgo.

BACKGROUND: The tympanoplasty for high-risk tympanic membrane perforation is a challenge. It is necessary to compare the most useful and feasible surgical technics in our environment for these patients. The objective was to compare the cartilage island tympanoplasty for the treatment of high-risk tympanic membrane perforations versus the use of temporalis fascia. METHODS: Randomized controlled clinical trial in 69 patients of ten years or older, diagnosed with high-risk tympanic membrane perforation in a third level hospital. The MERI index was determined and an initial audiometry was obtained. 7, 30 and 60 days after the tympanoplasty the tympanic graft integrity was evaluated. The audiometry was only repeated at 60 days. RESULTS: 69 patients were included, 33 received cartilage island (group 1) and 36 temporalis fascia (group 2). 93.9% was the success rate for group 1 at 30 and 60 days and 83.3% for group 2 (p = 0.17). Hearing improvement was neither different between groups (33.1 vs. 33.6 dB; p = 0.88), for group 1 and 2, respectively. CONCLUSION: No difference in morphological and audiological outcomes using cartilage island tympanoplasty or temporalis fascia for the treatment of high-risk tympanic membrane perforation was found.

Introducción: la timpanoplastía para la perforación timpánica de alto riesgo es un reto. Es necesario comparar las técnicas más útiles y factibles en nuestro medio para estos pacientes. El objetivo fue comparar la timpanoplastía con cartílago en isla para tratamiento de perforación de membrana timpánica de alto riesgo frente al uso de fascia temporal. Métodos: ensayo clínico aleatorizado y controlado en 69 pacientes mayores de 10 años, con perforación timpánica de alto riesgo en un hospital de tercer nivel. Se estadificó el índice MERI (Middle Ear Risk Index) y se realizó audiometría inicial. A los 7, 30 y 60 días postoperatorios se valoró integración del injerto. La audiometría se repitió solo a los 60 días. Resultados: de los 69 pacientes, 33 recibieron cartílago en isla (grupo 1) y 36 fascia temporal (grupo 2). La tasa de éxito en el grupo 1 fue de 93.9% a los 30 y 60 días y de 83.3% en el grupo 2 (p = 0.17). Tampoco fue diferente la ganancia auditiva entre los grupos: 33.1 frente a 33.6 dB, en los grupos 1 y 2, respectivamente (p = 0.88). Conclusión: no hay diferencia en los resultados morfológicos y audiométricos con timpanoplastía con cartílago en isla frente a fascia temporal en el tratamiento de perforaciones timpánicas de alto riesgo.

[Correlation of heart rate variability with SYNTAX II on chronic angina]. / Correlación de la variabilidad de la frecuencia cardiaca con SYNTAX II en angina crónica.

BACKGROUND: The heart rate variability (HRV) is a prognostic value of cardiovascular risk. It is unknown the correlation between HRV and coronary severity on patients with chronic angina. The objective was to determine the correlation between HRV and the SYNTAX II score in chronic angina. METHODS: Cross-sectional study in patients of 18 years or older with stable angina and indication of coronary angiography who went to a third level center. The SYNTAX II score was established by using coronary angiography, while HRV was obtained by a 24-hour Holter ECG. The correlation between SYNTAX II and HRV was performed with Pearson's test. Values of SDNN < 100 ms and RMSSD < 15 ms were considered risk factors. RESULTS: 61 patients were included. 45 had a decreased value of SDNN (73.77%) and eight had a decreased value of RMSSD (13.11%). There was no correlation between HRV and SYNTAX II score. There were more events of ventricular tachycardia in the group of patients with low SDNN than in those with normal SDNN (15.5% vs. 0.0%; p = 0.04). CONCLUSIONS: There was no correlation between HRV and the severity of coronary artery disease in stable chronic ischemic heart disease. However, those patients with low HRV showed more events of ventricular tachycardia.

Introducción: la variabilidad de la frecuencia cardiaca (VFC) es un valor pronóstico de riesgo cardiovascular. Se desconoce su correlación con la severidad de la cardiopatía isquémica estable. El objetivo fue conocer la correlación de la VFC con la puntuación SYNTAX II en angina crónica. Métodos: estudio transversal en pacientes mayores de 18 años con angina estable e indicación de coronariografía diagnóstica que asistieron a un centro de tercer nivel. Mediante coronariografía se estableció la puntuación SYNTAX II y se obtuvo la VFC por Holter de 24 horas. La correlación de las mediciones se obtuvo con la prueba de Pearson. Un valor de SDNN < 100 ms y de RMSSD < 15 ms se consideró de riesgo. Resultados: se incluyeron 61 pacientes. De ellos, 45 tenían disminución de los valores de SDNN (73.77%) y solo 8 tenían disminución de los valores RMSSD (13.11%). No hubo correlación de ningún parámetro de VFC con SYNTAX II. Hubo mayor frecuencia de taquicardia ventricular en el grupo SDNN bajo en comparación con SDNN normal (15.5 frente a 0.0%; p = 0.04). Conclusiones: no identificamos correlación de parámetros de VFC con la severidad de cardiopatía isquémica crónica. Sin embargo, aquellos pacientes con menor VFC presentaron mayor proporción de taquicardia ventricular.

[Comparison of epicardial fat thickness in diabetic patients compared to non-diabetics with acute myocardial infarction and ST-segment elevation (AMI-STEMI)]. / Comparación del grosor de la grasa epicárdica entre pacientes diabéticos versus no diabéticos con infarto agudo al miocardio con elevación del segmento ST (IAM CEST).

INTRODUCTION: Visceral fat has deleterious metabolic effects and has been associated with myocardial ischemia. OBJECTIVE: To compare epicardial fat thickness in diabetic versus non-diabetic patients with acute myocardial infarction with ST-segment elevation. MATERIAL AND METHODS: We performed a cross-sectional study in 60 patients with acute myocardial infarction with ST-segment elevation (30 diabetic and 30 non-diabetic). Cardiovascular risk factors and Thrombolysis in Myocardial Infarction (TIMI) score were registered. Using echocardiography, left ventricle ejection fraction and epicardial fat measured in the interventricular septum, right ventricle outflow tract, apex, and right ventricle free wall was evaluated. RESULTS: Epicardial fat at the apex (6.1 vs. 5.8 mm; p = 0.038) and in the interventricular septum (7.0 vs. 5.7 mm; p = 0.033) was higher in diabetic versus non-diabetic patients. In diabetic patients, plasmatic glucose correlated with TIMI score (R: 0.49; p = 0.005) and body mass index (R: -0.50; p = 0.004). The TIMI score (4.5 vs. 3.4; p = 0.04), body mass index (29.3 vs. 26.4; p = 0.008), epicardial fat in the interventricular septum (6.8 vs. 4.7; p = 0.000004) and in the right ventricle outflow tract (6.8 vs. 5.0; p = 0.000042) were higher in patients with fat in apex ≥ 6 mm. CONCLUSIONS: In diabetic patients with acute myocardial infarction with ST-segment elevation, interventricular septum and apex epicardial fat was higher compared with non-diabetic patients.

Omega 3 Fatty Acids Supplementation and Oxidative Stress in HIV-Seropositive Patients. A Clinical Trial.

HIV-seropositive patients show high incidence of coronary heart disease and oxidative stress has been described as relevant key in atherosclerosis development. The aim of this study was to assess the effect of omega 3 fatty acids on different markers of oxidative stress in HIV-seropositive patients. We performed a randomized parallel controlled clinical trial in The Instituto Mexicano del Seguro Social, a public health hospital. 70 HIV-seropositive patients aged 20 to 55 on clinical score A1, A2, B1 or B2 receiving highly active antiretroviral therapy (HAART) were studied. They were randomly assigned to receive omega 3 fatty acids 2.4 g (Zonelabs, Marblehead MA) or placebo for 6 months. At baseline and at the end of the study, anthropometric measurements, lipid profile, glucose and stress oxidative levels [nitric oxide catabolites, lipoperoxides (malondialdehyde plus 4-hydroxialkenals), and glutathione] were evaluated. Principal HAART therapy was EFV/TDF/FTC (55%) and AZT/3TC/EFV (15%) without difference between groups. Treatment with omega 3 fatty acids as compared with placebo decreased triglycerides (-0.32 vs. 0.54 mmol/L; p = 0.04), but oxidative stress markers were not different between groups.

Pulse oximetry as a screening test for critical congenital heart disease in term newborns.

BACKGROUND: Pulse oximetry has been suggested as a screening test for congenital heart disease (CHD) in asymptomatic newborns. However, most newborns in Mexico are discharged from the hospital without this evaluation. OBJECTIVE: To evaluate pulse oximetry as a screening test for critical congenital heart disease (CCHD) in term newborns. METHODS: We conducted a cross-sectional study in term newborns between July 2010 and April 2011. Pulse oximetry was determined before hospital discharge; in case of post-ductal oxygen saturation < 95%, a Doppler echocardiogram was performed. RESULTS: From 1,037 newborns screened, two had CCHD, one had pulmonary atresia and ventricular septal defect, and one Ebstein´s anomaly. Minor CHD was present in 10 babies. The overall prevalence of CHD was 11.5 per 1000 live births, and the prevalence of CCHD was 3.9 per 1000 live births. For those with critical disease, pulse oximetry had a sensitivity of 100%, specificity 98.8%, positive predictive value 14.2%, negative predictive value 100%, and positive likelihood ratio of 86.2. In regression analysis, oxygen saturation, respiratory frequency, and postnatal age were related with CCHD. CONCLUSIONS: Pulse oximetry had a good sensitivity and specificity for the identification of critical congenital heart disease in term newborns. Low oxygen saturation, higher respiratory frequency, and early postnatal age were related with congenital heart disease.

Parameters of lung inflammation in asthmatic as compared to healthy children in a contaminated city.

BACKGROUND: The impact of air pollution on the respiratory system has been estimated on the basis of respiratory symptoms and lung function. However; few studies have compared lung inflammation in healthy and asthmatics children exposed to high levels of air pollution. The aim of the study was to elucidate the modulatory effect of air pollution on Cysteinyl-leukotrienes (Cys-LTs) levels in exhaled breath condensate (EBC) among healthy and asthmatic children. METHODS: We performed a cross-sectional comparative study. Children between 7-12 years of age, asthmatics and non-asthmatics, residents of a city with high levels of PM10 were included. In all cases, forced spirometry, Cys-LTs levels in EBC, and the International Study of Asthma and Allergies in Childhood questionnaire were evaluated. We also obtained average of PM10, CO, SO2 and O3 levels during the period of the study by the State Institute of Ecology. RESULTS: We studied 103 children (51 asthmatics and 52 non-asthmatics). Cys-LTs levels were higher in asthmatics than in non-asthmatics (77.3 ± 21.6 versus 60.3 ± 26.8 pg/ml; p = 0.0005). Also, Cys-LTs levels in children with intermittent asthma were lower than in children with persistent asthma (60.4 ± 20.4 versus 84.7 ± 19.2 pg/ml; p = 0.0001). In the multiple regression model, factors associated with levels of Cys-LTs were passive smoking (ß = 13.1, p 0.04) and to be asthmatic (ß = 11.5, p 0.03). CONCLUSIONS: Cys-LTs levels are higher in asthmatic children than in healthy children in a contaminated city and its levels are also associated with passive smoking.

[Difficult for intubation in a simulator with laryngoscope with and without mirror]. / Dificultad de la intubación con y sin espejo en la hoja del laringoscopio.

BACKGROUND: The mirror laryngoscope blade (Siker blade) is used often in patients with anatomical variations, because it improves the visibility of epiglottis, shortening the intubation time. The objective was to compare the degree of difficulty in intubation with Macintosh blade versus Siker blade in a simulator, among anesthesiologists and residents in training. METHODS: A comparative study in 29 medical residents in training and 21 anesthesiologists was conducted. They had three attempts of 30 seconds to perform intubation with each laryngoscope in two different stages. The time and the intubation attempt, in which a successful intubation was performed, were registered. The data were processed using Statistica software, version 6. RESULTS: there was no difference for intubation between anesthesiologists and residents. Siker blade required more number of attempts (normal airway p 〈 0.001, difficult airway p = 0.02) and longer time for intubation (normal airway p 〈 0.0001, difficult airway p = 0.003). With a greater proportion of anesthesiologists, 20 % of the sample failed the intubation with Siker blade. CONCLUSIONS: It was more difficult for anesthesiologists and residents in training the use of the Siker blade in both stages, with normal or difficult airway on a simulator.

INTRODUCCIÓN: el laringoscopio con espejo es usado frecuentemente en pacientes con variaciones anatómicas porque mejora la visibilidad de la epiglotis y acorta el tiempo de intubación. El objetivo de esta investigación fue comparar el grado de dificultad de la intubación con laringoscopio dotado de hoja curva sin espejo (Macintosh) adversus laringoscopio con espejo (Siker) en un simulador, en anestesiólogos de diferentes categorías. MÉTODOS: estudio transversal comparativo de 29 residentes y 21 médicos de base, quienes tuvieron tres intentos de 30 segundos cada uno para intubar con cada laringoscopio en dos escenarios distintos. Se registró el tiempo y el número de intento en el que se logró la intubación exitosa. Los datos se procesaron en el programa Statistica versión 6. RESULTADOS: no hubo diferencias en la intubación entre los médicos de base y los residentes. Con el laringoscopio con espejo se requirieron más intentos (p 〈 0.001 vía aérea normal y p = 0.02 vía aérea difícil) y mayor tiempo (p 〈 0.0001 vía aérea normal y p = 0.003 vía aérea difícil) para la intubación. El 20 % de la muestra falló en la intubación con el laringoscopio con espejo, con mayor proporción de los médicos de base. CONCLUSIONES: se requirió mayor tiempo y número de intentos para la intubación con el laringoscopio con espejo en los dos escenarios planteados. Los médicos de base tuvieron mayor proporción de intubación fallida.

A parent motivational interviewing program for dental care in children of a rural population.

OBJECTIVES: To determine the effectiveness of a motivational interviewing-based educational program in reducing the number and intensity of new caries and bacterial dental plaque levels at 6 months post randomization. STUDY DESIGN: A randomized and single blind clinical trial in 100 schoolchildren between 6-10 years of age presenting the highest risk score of caries according to the Caries Management by Risk Assessment (CAMBRA) criteria was performed. These patients were randomized to two groups: control (in which the mothers initially received an oral prevention informative session) and experimental (in which the mothers received the initial informative session, followed by individual motivational interviewing sessions during a period of 6 months). The International Caries Detection and Assessment System (ICDAS) scores and bacterial plaque were evaluated at baseline, at 6 and 12 months. RESULTS: After 12 months, children in the experimental group had 2.12 ± 0.8 new caries versus 3.5 ± 0.9 in the control group (t=7.39; p<0.001). Caries in the experimental group was seen to be limited to the enamel, with a median intensity of 2 (range 0-3) versus 3 (0-6) in the control group (U=1594; p<0.0001). Bacterial plaque determined by the O'Leary index decreased in both groups; however, it decreased more in the experimental than in the control group (34.3 vs. 20.6; t=-3.12, p= 0.002) respectively. CONCLUSIONS: Motivational interviewing is better than traditional educational programs in preventing caries and decreasing bacterial plaque. Key words:Health educational, motivational interviewing, caries risk.

Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy.

Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (χ (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

Study on simple reaction and choice times in patients with type I diabetes.

A study on simple reaction time (SRT) and choice reaction time in patients having diabetes is described in this paper. The study was applied to fourteen patients with type I diabetes, as well as to fourteen non-diabetic persons. The research is based on two visual signal perception experiments, both implemented on a computer based environment. The SRT experiment consisted on measuring participants' reaction times to a light change event in a simulated traffic light scenario. The choice reaction time was studied through the performance indexes (d') achieved by participants in a two alternative forced experiment, where a known visual signal is identified from two noisy images. According to the obtained results, the diabetic patients' SRTs were an average of 24% longer than the reaction time of non-diabetic persons, in the same way a significant average difference of 41% was obtained in the efficient index d' too. A positive correlation of 0.6594 between the time periods since diabetes has been diagnosed and the average SRTs of diabetic patients was obtained, also significant correlation differences between age of all experiments participants and resulting variables, SRTs and d', were observed; for instance the correlation factor between participants' ages and their average SRTs was -0.8529 for diabetic patients, meanwhile a value of -0.2905 was obtained for non-diabetic persons. The evidence suggests that the time period since diabetes has been diagnosed notably affects motor and sensorial systems maturity, and consequently conduction speed of sural and peroneal nerves.

Long-term consequences for offspring of paternal diabetes and metabolic syndrome.

BACKGROUND: Recent studies have reported an increase in the prevalence of obesity and metabolic syndrome in children and adolescents. However, few have focused how diabetes mellitus and metabolic syndrome together in parents can influence on obesity and metabolic disturbances in offspring. OBJECTIVE: To know the risk obesity and metabolic disturbance in children, adolescents, and young adults whose parents have diabetes mellitus and metabolic syndrome. METHODS: A comparative survey was made in healthy children of parents with diabetes mellitus and metabolic syndrome compared with offspring of healthy parents. We performed anthropometry and evaluated blood pressure, glucose, total cholesterol, HDL cholesterol, and triglycerides levels in plasma. We registered parent antecedents to diabetes mellitus and metabolic syndrome and investigated the prevalence of overweight, obesity, and metabolic disturbances in offspring. RESULTS: We studied 259 subjects of 7 to 20 years of age. The prevalence of overweight and obesity was 27% and 37%, respectively. The highest proportion of BMI >95th of the entire group was found in offspring with both diabetic parents. Glucose and total cholesterol levels were lower in the group with healthy parents compared with the group with diabetic mother and metabolic syndrome but with healthy father. HDL cholesterol was higher in the group with both healthy parents than in the group with diabetic mother and metabolic syndrome but healthy father. CONCLUSIONS: The offspring of parents with diabetes plus metabolic syndrome showed higher proportion of variables related to metabolic syndrome compared with healthy parents.

[Breast feeding and systemic blood pressure in infants]. / La alimentación al seno materno y la presión arterial sistémica en el lactante.

INTRODUCTION: Blood pressure levels in childhood influence these levels in adulthood, and breastfeeding has been considered such as a cardioprotective. We evaluated the association between blood pressure levels and feeding type in a group of infants. MATERIAL AND METHODS: We conducted a comparative cross-sectional study in term infants with appropriate weight at birth, to compare blood pressure levels in those children with exclusively breastfeeding, mixed-feeding and formula feeding. The comparison of groups was performed using ANOVA and multiple regression analysis was used to identify variables associated with mean arterial blood pressure levels. A p value < 0.05 was considered significant. RESULTS: We included 20 men and 24 women per group. Infant Formula Feeding had higher current weight and weight gain compared with the other two groups (p < 0.05). Systolic, diastolic and mean blood pressure levels, as well as respiratory and heart rate were higher in the groups of exclusively formula feeding and mixed-feeding than in those with exclusively breastfeeding (p < 0.05). Multiple regression analysis identified that variables associated with mean blood pressure levels were current body mass index, weight gain and formula feeding. CONCLUSIONS: Infants in breastfeeding show lower blood pressure, BMI and weight gain.

Insulin and Leptin Levels in Appropriate-for-Gestational-Age Infants of Diabetic Mother.

OBJECTIVE: Intensified management of gestational diabetes mellitus can normalize birth weight. However, it is still unknown whether intrauterine exposure to maternal diabetes is a risk factor for changing hormone levels involved in the development of insulin resistance in these infants. We compared insulin and leptin levels in appropriate for gestational age (AGA) infants of diabetic and non diabetic mothers. METHODS: We performed a cross-sectional study in the department of Neonatology of the Hospital of Gynecology-Pediatrics, in Leon, Mexico. We evaluated 182 full term AGA newborns (86 infants of diabetic and 96 of non-diabetic mothers). A venous blood sample was taken from cord blood immediately after the separation of the placenta and glucose, insulin and leptin levels were measured. In all diabetic mothers HbA1c was also evaluated immediately post-partum. FINDINGS: Leptin, insulin and insulin resistance index were significantly higher in infants of diabetic mothers. Leptin levels were positive correlated with insulin, parents' body mass index and age in the entire group. In infants of diabetic mothers only insulin levels showed a significantly correlation, whereas in those of non-diabetic mothers only mothers' age was significantly correlated with leptin levels. CONCLUSION: AGA infants of diabetic mothers showed higher leptin, insulin levels and insulin resistance index than those of non-diabetic mothers.

Daytime sleepiness and quality of life: are they associated in obese pregnant women?

OBJECTIVE: To know the relationship between daytime sleepiness and quality of life during pregnancy according to the weight gain and baseline weight. METHODS: We studied 216 pregnant women (108 obese and 108 non-obese). At first and third trimester of pregnancy they completed the 12-item short-form health survey (SF-12) and the Epworth Sleepiness Scale (ESS). Furthermore, in both visits, we evaluated blood pressure, body mass index (BMI), and reviewed all medical charts to identify pregnancy complications. RESULTS: Weight gain and mental component of quality of life (MCS-12) in both trimesters were lower in the obese group, whereas ESS was higher. The physical component of quality of life (PCS-12) was only lower in the same group at third trimester. Those women with ESS ≥ 10 at third trimester showed a higher baseline BMI and ESS score, but lower MCS-12 and PCS-12 at third trimester. Baseline and final BMI were positively associated with ESS at third trimester, whereas PCS-12 value in both trimesters was negatively related. CONCLUSIONS: Obesity at the beginning of pregnancy but not weight gain was related to low quality of life and daytime sleepiness at the third trimester of gestation. High BMI but low PCS-12 during pregnancy was associated with daytime sleepiness.