Factores determinantes para la atención clínica odontológica de pacientes con discapacidad / Determining factors for the clinical dental care of patients with disabilities

Objetivo: identificar los factores, inherentes a la práctica clínica, que determinan la atención odontológica de pacientes con discapacidad. Métodos: realización de estudio descriptivo, de alcance explicativo, cuantitativo y corte transversal; aplicación de en-cuesta dirigida a odontólogos que ejercen como profesionales independientes, con la cual se midieron variables de caracterización, conocimientos, habilidades, percepción, infraestructura y atención del paciente con discapacidad. También, se desarrolló un análisis descriptivo, correlacional y multivariado. Resultados: no todos los odontólo-gos recibieron formación para la atención clínica de personas con discapacidad; algu-nos conocen los métodos de comunicación alternativa y aumentativa y, de estos, una mayoría representativa no los sabe manejar. Sobre la infraestructura, se identificó que esta cumple parcialmente con la normatividad y que la mayoría de los profesionales se sienten medianamente preparados para llevar a cabo esta atención, por lo que el 67,3% (99) afirmó atender esta población con sus protocolos clínicos habituales, pero, el 83,7% (123) manifestó brindar la atención solo en casos de urgencia odontológica. Los factores que determinan la atención del paciente con discapacidad están relacio-nados con la cantidad de pacientes asistentes, las experiencias negativas previas, las habilidades en el manejo de la consulta, la sensación de preparación y los años de ex-periencia clínica. Conclusiones: las experiencias negativas previas en la práctica clínica con pacientes con discapacidad son determinantes; para su disminución se sugiere la urgente implementación de técnicas comunicativas, la adecuación de infraestructura y el desarrollo de habilidades para la atención integral e inclusiva.

Objective: Identify the factors that establish dental clinic care for patients with disabilities, that are inherent to the professional and to the clinical practice. Methods:A descriptive study of explanatory quantitative cross-cutting score was done. It was applied to dentists that worked independently where characterization variables, abilities, perception, infrastructure were measured, and attention to the patient in a situation of disability. A descriptive, correlational, multivariate analysis. Results: Only some dentists received the I information for the clinic care of patients in a situation of disability. Only some of them know the methods of alternative and augmentative communication and most of them don't know how to work with them. The infrastructure partially complies with the regulations and most of the professionals feel moderately prepared, so 67,3%(99) attend those patients in their usual clinical practice, but 83,7%(123) would attend them only in an emergency case. The factors that establish dental clinic care for patients with disabilities are related with the quantity of patients in a situation of disability, the previous, negative experiences, management skills in the consult, preparation sensation and the years of clinical experience. Conclusions: The previous negative experiences in the clinical practice with patients in a situation of disability are the most important factor for the dental clinic care for patients with disabilities, these experiences should decrease a from implementation of communication techniques, infrastructure adjustments and the development of abilities for the comprehensive and inclusive attention.

Preparation of Stable Nitrogen Mustard DNA Interstrand Cross-Link Analogs for Biochemical and Cell Biological Studies.

Nitrogen mustards (NMs) react with two bases on opposite strands of a DNA duplex to form a covalent linkage, yielding adducts called DNA interstrand cross-links (ICLs). This prevents helix unwinding, blocking essential processes such as replication and transcription. Accumulation of ICLs causes cell death in rapidly dividing cells, especially cancer cells, making ICL-forming agents like NMs valuable in chemotherapy. However, the repair of ICLs can contribute to chemoresistance through a number of pathways that remain poorly understood. One of the impediments in studying NM ICL repair mechanisms has been the difficulty of generating site-specific and stable NM ICLs. Here, we describe two methods to synthesize stable NM ICL analogs that make it possible to study DNA ICL repair. As a proof of principle of the suitability of these NM ICLs for biochemical and cell biological studies, we use them in primer extension assays with Klenow polymerase. We show that the NM ICL analogs block the polymerase activity and remain intact under our experimental conditions.

La imagenologia médica en el laboratorio de morfología: iconografía / Medical imaging laboratory Morphology: iconography of bicéfalo fetus / A imagiologia médica no laboratório de morfologia: iconografia do feto bicéfalo

El nacimiento de gemelos siameses es un fenómeno extraño en las salas de parto de todo el mundo, son producto de un mismo óvulo que por alguna extraña razón no llegó a dividirse; se presenta 1/50.000 o 1/120.000 nacimientos; se estima que el 50% nace muerto y el 35% muere el primer día de vida; y el 70% son de génerofemenino. Un feto bicéfalo es un producto desarrollado con dos cabezas que se unen entre sí por medio de sus porciones temporo-parietales mediales, estando conectados vascularmente y compartiendo o no órganos entre sí; son de tipo monocigóticos y producidos por la separación anormal o incompleta de la porción axial del disco germinativo bilaminar en etapas avanzadas del desarrollo embrionario. En el presente trabajo se expone un caso de siameses bicéfalo de sexo femenino, cuyo espécimen hacía parte de las colecciones de embriología del Laboratorio de Morfología de la Universidad Tecnológica de Pereira, el cual por registro de Historia Clínica y Consentimiento Informado de la madre, quien lo entregó a la Universidad, fue sometido a descripción anatomopatológica con el fin de exponer aspectos relacionados con las posibles causas que los originaron, así como el diagnóstico prenatal de estos defectos congénitos y su diagnóstico Imagineológico postmortem.

The birth of conjoined twins is a strange phenomenon in the delivery rooms around the world, are the product of a single egg that for some reason did not divide; is presenta1 / 50,000 or 1 / 120,000 births; is estimated that 50% stillborn and 35% die on the first day of life; and 70% are female. A two-headed fetus is a product developed with two heads that are joined together through their temporoparietal medial portions being connected vascularized organs and sharing with each other or not; are monozygotic type and produced by abnormal or incomplete separation of the axial portion of the bilaminar germ disc in advanced stages of embryonic development. In this paper a case of two-headed Siamese female, whose specimen was part of the collections of Morphology Embryology Laboratory of the Technological University of Pereira, who for record medical history and informed consent of the mother who is exposed delivered to the University underwent pathological description to explain aspects of the possible causes of these accidents and the prenatal diagnosis of these congenital defects and postmortem imaging diagnosis.

O nascimento de gêmeos siameses é um fenômeno estranho nas salas de parto de todo o mundo. São produto de um mesmo óvulo, que por alguma estranha razão não chegou a dividir-se; se apresenta em 1/50.000 ou 1/120.000 nascimentos. Estima-se que 50% nascem mortos e 35% morre ao primeiro dia de vida; e 70% são do gênero feminino.Um feto bicéfalo é um produto desenvolvido com duas cabeças que se unem entre si por meio de suas porções temporão-parietais mediais, estando conectados vascular-mente e compartilham ou não órgãos entre si; são de tipo monozigóticos e produzi-dos pela separação anormal ou incompleta da porção axial do disco germinativo bi laminar em etapas avançadas do desenvolvimento embrionário. Neste trabalho se expõe o caso de siamesas bicéfalas do sexo feminino, cujo espéci-men fazem parte das coleções de embriologia do Laboratório de Morfologia da Uni-versidade Tecnológica de Pereira, que por registro de Historia Clínica e Consenti-mento Informado da mãe, que o entregou à Universidade, foi submetido a descrição anatomopatológica com o fim de expor aspectos relacionados às possíveis causas que os originaram, assim como o diagnóstico pré-natal destes defeitos congênitos e seu diagnóstico Imagiológico post-mortem.

Polycationic glycosides.

Cationic lipids have long been known to serve as antibacterial and antifungal agents. Prior efforts with attachment of cationic lipids to carbohydrate-based surfaces have suggested the possibility that carbohydrate-attached cationic lipids might serve as antibacterial and antifungal pharmaceutical agents. Toward the understanding of this possibility, we have synthesized several series of cationic lipids attached to a variety of glycosides with the intent of generating antimicrobial agents that would meet the requirement for serving as a pharmaceutical agent, specifically that the agent be effective at a very low concentration as well as being biodegradable within the organism being treated. The initial results of our approach to this goal are presented.

Polycations. 17. Synthesis and properties of polycationic derivatives of carbohydrates.

In our continuing investigation of polycationic salts for purposes of antimicrobial action, ion-channel blocking, and construction of ionic liquids, we have prepared several series of polycationic salts derived from carbohydrate precursors. These salts are currently being investigated for optimal efficacy as antibacterials and antifungals, as well as for other applications. The syntheses of such series of salts are described here along with preliminary antibacterial testing results and a discussion of their properties indicating their potential utility for several purposes.

Caffeine challenge in insomniac patients after total sleep deprivation.

BACKGROUND AND PURPOSE: This study compared the effects of caffeine in patients with primary insomnia and normal volunteers. The main goal was to determine the differences in sensitivity to caffeine between the groups. We investigated the effects on daytime sleep of placebo or caffeine after a night of total sleep deprivation (SD). We hypothesized that insomniacs would be more affected by caffeine, which would suggest a change in adenosine receptor (number or sensitivity) in primary insomniacs. PATIENTS AND METHODS: Six primary insomnia patients (Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) and six normal volunteers with no sleep complaints participated in a double-blind study with caffeine or placebo administered under a cross-over design with each subject serving as his or her own control. The participants did not have a history of drinking coffee or caffeinated beverages. Data from all-night polysomnography and multiple sleep latency test (MSLT) were collected in the sleep research laboratory of National Institute of Medical Sciences and Nutrition Salvador Zubirán. RESULTS: During the baseline night, patients with insomnia had significantly less delta sleep and less total sleep time than the normal volunteers. Mean sleep latency under basal MSLT did not differ between the groups. However, insomnia patients had significantly less total sleep during each nap compared to normal volunteers. After one night of total SD and under caffeine administration, the insomniacs had significantly longer sleep latency and less total sleep time in MSLT compared to normal volunteers. After SD, healthy volunteers reduced sleep latencies in MSLT with or without caffeine. CONCLUSIONS: Patients with insomnia had a higher sensitivity to the diurnal awakening effect of caffeine even after one night of SD. This suggests that changes in the adenosine receptors could, in part, be responsible for the hyperarousal state that has been reported in primary insomnia.

Abnormal SPECT myocardial perfusion imaging during periods of obstructive sleep apnea in morbid obese patients without known heart disease.

OBJECTIVE: Determine the myocardial perfusion characteristics in obstructive sleep apnea and its possible role in cardiovascular damage. METHODS AND PROCEDURES: Fourteen patients from the Obesity Clinic weighing less than 130 kg underwent myocardial perfusion studies using single photon emission computed tomography with technetium 99m-labeled sestamibi during nighttime polysomnographic recordings. Coronary angiograms were performed on patients with suspect of severe coronary obstruction according nighttime myocardial perfusion studies or pharmacological stress carried out during waking hours. RESULTS: All 14 patients manifested myocardial perfusion defects during sleep, affecting an average of 5.5 segments/patient, although only 8 presented ischemic ST segment changes and none demonstrated rhythm or conduction disturbances. Angiographic examination of the 10 patients with the most severe perfusion defects did not reveal significant coronary obstruction, and fewer perfusion defects were documented during daytime scintigraphy. DISCUSSION: In obese patients with obstructive sleep apnea, myocardial perfusion defects appear to occur with highest frequency and severity during nighttime sleep, justifying further investigation in a larger number of patients with obstructive sleep apnea and more significant obesity.