Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy.

BACKGROUND: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. MATERIAL AND METHODS: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. STUDY DESIGN: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. RESULTS: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). CONCLUSIONS: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality.

A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is a permanent neurological disorder accompanied by secondary musculoskeletal masticatory disorder, with repercussion on chewing and deglutition functions. In these conditions, the liquids ingestion is compromised resulting in salivary osmolality alteration. The objective of this study was to compare salivary osmolality, caries experience and caries risk between normoreactive individuals and patients with CP. MATERIAL AND METHODS: The participants were 4-20 years old: 52 patients with CP treated at a reference rehabilitation centre (study group, SG), and 52 normoreactive individuals (control group, CG). Saliva was collected for five minutes using cotton rolls. Following centrifugation, salivary osmolality was determined by freezing point depression osmometry. Evaluations included caries experience (DMFT index), and caries risk based on a caries-risk assessment tool (CAT). Descriptive and inferential statistics (Chi square and Student t tests) were used to compare the groups. Receiver operating characteristic (ROC) analyses were performed and the area under the ROC curve (Az) was calculated. The level of significance was set at 5%. RESULTS: The groups were homogeneous for sex (p=0.843) and age (p=0.128). In the SG, spastic type CP was the most prevalent (80.8%), and patients showed significantly higher salivary osmolality values compared with the CG (p<0.001). No significant differences in caries experience (p=0.159) or caries risk (p=0.297) were observed. ROC curve analysis determined a salivary osmolality cutoff point of >74 for the SG and >54 for the CG in the presence of dental caries. A significant correlation was verified between salivary osmolality and the DMFT index for the SG (p≤0.05). CONCLUSIONS: Although patients with CP showed higher salivary osmolality values, higher caries experience and caries risk were not observed compared with normoreactive individuals.

Three kinds of cysts in the same patient.

An 18-year-old male patient presented with a swelling in the neck with presumptive diagnosis of epidermal cyst (EC) that was enucleated, histopathological examination confirmed the diagnosis. Four years later the patient presented with another swelling with similar clinical features. It was located on the midline of the neck at the hyoid bone. Excision of cyst was done and microscopically it showed features of thyroglossal duct cyst (TDC). Two months later a new swelling was noted on the right side of the neck. A complete surgical excision was done and the lesion was diagnosed as a lymphoepithelial cyst. The purpose of this report was to analyze each of the entities that were present in this case; since, the presence of three different cervical cystic lesions in the same patient is uncommon.

Metadona en el tratamiento del dolor crónico oncológico / No disponible

No disponible

Características clínicas de dos poblaciones diagnosticadas de enfermedad pulmonar obstructiva crónica por criterios espirométricos GOLD o por el límite inferior de la normalidad / Clinical characteristics of two populations diagnosed of chronic obstructive pulmonary disease with GOLD spirometric criteria or by lower limit of normality

Objetivo: Evaluar la relevancia clínica de modificar el criterio diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) utilizando el límite inferior de la normalidad (LIN) en una cohorte de pacientes diagnosticados de EPOC. Material y métodos: La población de estudio se reclutó entre pacientes previamente diagnosticados de EPOC por criterio GOLD y con un seguimiento previo por el médico responsable superior a un año. Resultados: Cuando la EPOC se definió por criterio LIN se identificaron pacientes con mayor repercusión clínica y funcional que cuando se utilizó el criterio GOLD. Los pacientes con EPOC por criterio LIN presentaban valores significativamente más bajos de volumen espiratorio forzado en el primer segundo (FEV1) sobre la capacidad vital forzada (FVC) FEV1/FVC: 0,52 (0,9) frente a 0,67 (0,2), p = 0,000; de FEV1: 49,5% (16,5) frente a 62% (14,2), p = 0,0000; de FVC 69,4 (18,7) frente a 73,3, p = 0,04; mayor grado de disnea valorada mediante la escala del Medical Research Council (MRC) 2,98 (1,1) frente a 2,67 (1,12), p = 0,003; un mayor número de exacerbaciones anuales 2,32 (1,5) frente a 1,84 (0,9), p = 0,001; más visitas a Urgencias 2,17 (1,6) frente a 1,45 (0,74), p = 0,001; y más ingresos hospitalarios 1,75 (1,2) frente a 1,1 (80,4), p = 0,005. Sin embargo, los pacientes no incluidos como EPOC por el criterio LIN presentaron grados clínicamente relevantes de disnea y un elevado consumo de recursos sanitarios. Utilizando el criterio del LIN para establecer el diagnóstico, la EPOC no se asoció con un incremento del riesgo cardiovascular, cerebrovascular ni del riesgo de enfermedad vascular periférica. Conclusiones: El uso del LIN como criterio para establecer el diagnóstico de EPOC, frente al criterio GOLD, excluye un elevado número de pacientes con repercusión clínica y con un elevado consumo de recursos sanitarios. El uso de este criterio no proporciona información adicional a la hora de establecer una posible relación entre EPOC y enfermedad vascular (AU)

Purpose: The purpose of this study has been to evaluate the clinical importance of modifying the COPD diagnostic criterion using the lower limit of normality (LLN) in a cohort of COPD diagnosed patients. Material and methods: The study population was recruited among patients previously diagnosed COPD with the GOLD criterion who had a previous follow-up by their attending position greater than one year. Results: When the COPD was defined by a LLN criterion, patients were identified with greater clinical and functional repercussion then when the GOLD criterion was used. The patients with COPD by the LLN criterion had significantly lower values of FEV1/FVC: 0.52 (0.9) vs 0.67 (0.2), p = 0.000; of FEV1: 49.5% (16.5) vs 62% (14.2), p = 0.0000; of FVC 69.4 (18.7) vs 73.3, p = 0,04; greater grade of dyspnea evaluated with the Medical Research Council (MRC) scale 2.98 (1.1) vs 2.67 (1.12), p = 0.003; a higher number of yearly exacerbations 2.32 (1.5) vs 1.84 (0.9), p = 0.001; more visits to the emergency service 2.17 (1.6) vs 1.45 (0.74), p = 0.001; and more hospital admissions 1.75 (1.2) vs 1.1 (80.4), p = 0.005. However, patients not included as COPD by the LLN criterion had clinically relevant grades of dyspnea and elevated use of health care resources. Using the LLN criterion to establish the diagnoses, COPD was not associated with an increased cardiovascular, cerebrovascular risk or risk of peripheral vascular disease. Conclusions: The use of the LLN as a criterion to establish the diagnosis of COPD versus the GOLD criterion excludes an elevated number of patients with clinical repercussions and with elevated use of health care resources. The use of this criterion does not provide additional information when establishing a possible relationship between COPD and vascular disease (AU)

Enfermedad periodontal y su relación con estallido respiratorio de los leucocitos polimorfonucleares en pacientes pediátricos con síndrome de Down / No disponible

Objetivo. Comparar el estallido respiratorio de los leucocitos pollimorfonucleares en sangre periférica y conocer su asociación con enfermedad periodontal (EP) en pacientes con síndrome de Down (SD), teniendo un grupo control de sujetos sanos con y sin EP. Métodos. Se efectuó un estudio transversal analítico, incluyendo tres grupos de pacientes: A. 20 pacientes con SD con EP

Objective. To compare the metabolic burst activity of polymorphonuclear leukocytes in peripheral blood and to know its association with periodontal disease (PD) in patents with Down síndrome (DS), having a control group of healthy subjects with and without PD. Methods. A cross sectional study was carried out; patients were divided in three groups: A. 20 DS patients with PD, B. 20 patients without DS but with PD, and C. 20 patients without DS and without PD. To evaluate periodontal disease the following indexes were used: plaque, calculus, gingival, mobility, attachment level, bleeding on probing and marginal bone loss. Burst activity of polymorphonuclear leukocytes in peripheral blood was estimated by flow cytometric assay. Results. Means of final and increased fluorescence showed that there was a statistically significant difference among groups (p=0.0001). All indexes related with PD were increased in DS group; these data shown that DS patients have a diminished function of polymorphonuclear leukocytes. Pronostic stratification indicated that PD is closely associated with SD, independently of the oral hygiene degree. Conclusion. High prevalence and severity of PD in patients with DS suggested that there is a compromised host response that could increase the risk of PD and other oral infections (AU)

Diagnóstico y tratamiento de un caso de vértigo posicional paroxístico benigno del canal horizontal / Diagnosis and treatment of a case of horizontal canal positional vertigo

Presentamos un caso de vértigo posicional paroxístico benigno (VPPB) del canal horizontal que presentaba un nistagmo ageotrópico de dirección cambiante, en el que empleamos una prueba diagnóstica consistente en la hiperflexión cervical que nos orientó sobre el lado en que realizar la maniobra de recolocación de partículas específica (AU)

A horizontal canal positional vertigo with apogeotropic and persistent directional changing nystagmus is reported. A new procedure consisting in cervical hiperflexion was used to determine the affected side in order to perform a particle repositioning manoeuvre (AU)

Resultados videonistagmográficos en un grupo de sujetos sanos de edad avanzada / Videonystagmographics finding in healthy elderly subjects

Se presentan los resultados obtenidos en una muestra de 44 sujetos sanos de edades comprendidas entre 64 y 87 años, estratificados en sexo y edad que fueron sometidos a un estudio protocolizado, utilizando como herramienta la videonistagmoscopia y su estudio cuantitativo mediante videonistagmografía, para buscar valores normales en ese grupo de población. En el 15,9 por ciento de los sujetos (7/44) se encuentran nistagmo espontáneo y provocado en alguna de las posiciones estudiadas. El nistagmo encontrado con más frecuencia fue el vertical, seguido del horizontal y la posición en la que aparecieron correspondió a la hiperextensión cervical y la prueba de Dix-Hallpike, en donde sólo encontramos un nistagmo torsional. En ninguno de los sujetos detectamos nistagmo en posición sentada, ni nistagmo evocado por la mirada, ni en la maniobra de agitación cefálica (AU)

This study investigated 44 healthy elderly subjects aged between 64 and 87, who were analysed with videonystagmoscopy and quantitative videonystagmography, for establishing new standards for normal limits into this new diagnostic tool. 15.9% of the subjects were found to have spontaneous and provoked nystagmus at least in one position studied. Vertical nystagmus in head hanging position was the most frequent finding. In the Dix-Hallpike test we found one case of torsional nystagmus. No subject had seated position nystagmus. Nystagmus after head shaking and evoked nystagmus were not found (AU)

Geographic Distribution of Endangered Species in the United States

Geographic distribution data for endangered species in the United States were used to locate "hot spots" of threatened biodiversity. The hot spots for different species groups rarely overlap, except where anthropogenic activities reduce natural habitat in centers of endemism. Conserving endangered plant species maximizes the incidental protection of all other species groups. The presence of endangered birds and herptiles, however, provides a more sensitive indication of overall endangered biodiversity within any region. The amount of land that needs to be managed to protect currently endangered and threatened species in the United States is a relatively small proportion of the land mass.