Las herramientas predictivas de riesgo, una alternativa diagnóstica en la retención de caninos maxilares

Se describen, en la literatura médica, predictores radiográficos que constituyen herramientas diagnósticas útiles para la retención de los caninos maxilares. Sin embargo, en la especialidad de ortodoncia las investigaciones sobre las herramientas predictivas de riesgo son escasas. Por ello se decide realizar una revisión bibliográfica con el objetivo de recopilar información acerca de la utilidad de las herramientas predictivas de riesgo en el diagnóstico de la retención de los caninos maxilares. Se realizó una búsqueda de información de artículos en idioma español e inglés, utilizándose las bases de datos SciELO, PubMed, Cochrane y Scopus. Para lograr un tratamiento óptimo de la anomalía debe priorizarse un buen diagnóstico, basado en métodos clínicos y radiográficos, pero se hace notoria la ausencia de herramientas que identifiquen individuos con alto riesgo en la comunidad. Los modelos o escalas de riesgo pueden ser útiles en este aspecto, para detectar precozmente el trastorno eruptivo y priorizar así intervenciones preventivas, que eviten el uso excesivo de medios auxiliares de diagnóstico y la sobrecarga de los sistemas de salud. Las herramientas predictivas de riesgo constituyen una alternativa para la clasificación adecuada de la población con alto riesgo de retención de caninos maxilares. Un instrumento de tal magnitud es de gran utilidad tanto en los servicios de Estomatología General como en los de Ortodoncia.

Radiographic predictors that are useful diagnostic tools for the retention of maxillary canines are described in the literature. However, in the specialty of orthodontics, research on risk predictive tools is scarce. Therefore, it was decided to carry out a bibliographic review with the objective of collecting information about the usefulness of risk predictive tools in the diagnosis of retention of maxillary canines. A search for information on articles in Spanish and English was carried out, using the SciELO, PubMed, Cochrane and Scopus databases. To achieve optimal treatment of the anomaly, a good diagnosis should be prioritized, based on clinical and radiographic methods, but the absence of tools that identify individuals at high risk in the community is notorious. Models or risk scales can be useful in this aspect, to detect the eruptive disorder early and thus prioritize preventive interventions that avoid the excessive use of diagnostic aids and the overload of health systems. Predictive risk tools are an alternative for the adequate classification of the population with high risk of retention of maxillary canines. An instrument of this magnitude is very useful both in General Dentistry and Orthodontics services.

Diseño y validación de una escala de riesgo de parto pretérmino con enfoque periodontal / Design and validation of a preterm birth risk scale with a periodontal approach i: en

Introducción: La escala de riesgo diseñada para estimar la probabilidad de parto pretérmino con enfoque periodontal debe ser validada antes de su implementación en la práctica clínica. Objetivo: Diseñar y validar una escala de riesgo de parto pretérmino con enfoque periodontal. Métodos: Se realizó un estudio analítico, de casos y controles, de 1152 puérperas ingresadas en los hospitales maternos de la provincia de Santiago de Cuba en el período 2011-2022, para lo cual fueron seleccionadas 2 muestras: una de construcción del modelo (n=750) y otra de validación de la escala (n=402). Se determinaron los posibles predictores a través del análisis univariado y el cálculo del odds ratio, con un nivel de significación de p≤0,05; asimismo, se elaboró un modelo de regresión logística binaria multivariada y se obtuvo la escala de riesgo que fue validada por diferentes métodos. Resultados: La escala se obtuvo con 7 predictores y 2 estratos de riesgo. Esta alcanzó buena discriminación (80 %), así como buen nivel de ajuste y validez de constructo (p=0,72). Igualmente, aseguró una predicción correcta de más de 50 % de los partos pretérmino, valores de sensibilidad y especificidad aceptables (79,20 y 70,20 %, respectivamente), así como validez de contenido, validez interna y confiabilidad adecuadas. Conclusiones: La escala de riesgo para estratificar el riesgo de parto pretérmino incluye predictores de gravedad de la enfermedad periodontal, con buenos parámetros de validación para ser usada en la toma de decisiones para prevenir este tipo de parto.

Introduction: The risk scale designed to estimate the probability of preterm birth with periodontal approach should be validated before its implementation in the clinical practice. Objective: To design and validate a risk scale of preterm birth with periodontal approach. Methods: A cases and controls analytic study of 1152 newly-delivered women admitted to maternal hospitals in Santiago de Cuba province was carried out in the period 2011 - 2022, and 2 samples were selected: one of pattern construction (n=750) and another of scale validation(n=402). The possible predictors were determined through the single varied analysis and odds ratio calculation, with a significance level of p≤0.05; also, a multivariate binary logistical regression model was elaborated and the risk scale was obtained, which was validated by different methods. Results: The scale was obtained with 7 predictors and 2 risk stratum. It reached a good discrimination (80%), as well as a good adjustment level and construction validity (p=0.72). Likewise, it assured a correct prediction of more than 50% of preterm births, acceptable sensibility and specificity values (79.20 and 70.20%, respectively), as well as adequate content validity, internal validity and reliability. Conclusions: The risk scale to stratify the risk of preterm birth includes predictors of periodontal disease severity, with good validation parameters to be used in the decisions making to prevent this type of childbirth.

Adaptación transcultural al español y validez de contenido de 3 escalas de riesgo nutricional / Cross-cultural adaptation to Spanish and content validity of three nutritional risk scales

Introducción: Existen diversas escalas diseñadas para determinar el riesgo de desnutrición al ingreso hospitalario en población infantil, sin embargo, la mayor parte de estos instrumentos se desarrollan y publican en lengua inglesa, siendo preceptiva su adaptación transcultural y validación para poder ser utilizados en nuestro país.Objetivos: Adaptar transculturalmente 3 escalas diseñadas para determinar el riesgo de desnutrición ligada a la enfermedad y determinar la validez de su contenido.Material y métodos: Adaptación transcultural mediante el método de traducción-retrotraducción de acuerdo con las recomendaciones de la International Test Commission Guidelines for Translating and Adapting Tests. Se midió la validez de contenido a través de un panel de expertos (bajo 7 criterios básicos de selección adaptados del modelo Fehring) que evaluaron cada ítem de las escalas midiendo 4 criterios: ambigüedad, sencillez, claridad y relevancia. Con la puntuación extraída se obtuvo el estadístico V de Aiken para cada ítem y para las escalas completas.Resultados: Partiendo de 3 traducciones independientes por escala se obtuvieron 3 versiones definitivas en castellano de las escalas PNRS, STRONGkids y STAMP semánticamente equivalentes a sus versiones originales. Las escalas PNRS y STRONGkids presentaron una V de Aiken superior a 0,75 en todos sus ítems, mientras que escala STAMP presentó un valor inferior a 0,75 para el ítem «peso y altura».Conclusión: Este estudio aporta las versiones en castellano adaptadas transculturalmente de las escalas PNRS, STRONGkids y STAMP. Las escalas PNRS y STRONGkids presentan un contenido válido para ser aplicadas en el contexto hospitalario estatal. STAMP requiere la adaptación de su ítem «peso y altura» para considerar adecuado su uso en población infantil española. (AU)

Introduction: There are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country.Objectives: Cross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content.Material and methods: Cross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales.Results: Starting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item “weight and height”.Conclusion: This study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item “weight and height” to consider its use in a Spanish child population adequate. (AU)

Estratificación de riesgo en pacientes con infarto agudo de miocardio mediante el uso de varias escalas

RESUMEN Introducción: Existen varias escalas a nivel mundial en la predicción de riesgo de los pacientes con infarto, pero aún no se ha encontrado la "escala ideal". Objetivos: Determinar la capacidad de discriminación para la mortalidad hospitalaria por infarto agudo de miocardio de las escalas GRACE, TIMI Risk Score, InTIME e ICR. Método: Se realizó un estudio prospectivo en el Servicio de Cardiología del Hospital General Docente Dr. Ernesto Guevara de la Serna de Las Tunas, Cuba, entre 2018 y 2019. El universo estuvo conformado por 452 pacientes ingresados en las primeras 24 horas del infarto y la muestra, por 430 casos a los cuales se les pudo recoger la totalidad de las variables en estudio. Se utilizó la estadística descriptiva. Para determinar la capacidad de discriminación de la escalas de riesgo se determinaron sensibilidad, especificidad y área bajo la curva. Resultados: El 70% de los pacientes fallecidos eran del sexo masculino y su media de edad fue 10 años mayor que en los egresados vivos. La hipertensión arterial fue el factor asociado más frecuente tanto en los pacientes fallecidos (90%) como en los egresados vivos (73.4%). El 70% de los fallecidos presentaron algún grado de disfunción sistólica del ventrículo izquierdo. El área bajo la curva de las escalas ICR, InTIME y GRACE fue de 0,683; 0,681 y 0,662, respectivamente. El TIMI Risk Score presentó un área bajo la curva de 0,598. Conclusiones: Las escalas ICR, InTime y GRACE presentaron pobre capacidad predictiva para la mortalidad hospitalaria. La escala TIMI Risk Score presentó una fallida capacidad predictiva.

ABSTRACT Introduction: There are several scores worldwide for risk stratification in patients with myocardial infarction, but the "ideal score" has not yet been found. Objectives: To determine the discriminatory capacity of GRACE, TIMI Risk Score, InTIME and ICR scores for in-hospital mortality due to acute myocardial infarction. Method: A prospective study was carried out in the Department of Cardiology of the Hospital General Docente Dr. Ernesto Guevara de la Serna of Las Tunas, Cuba, between 2018 and 2019. The study's population consisted of 452 patients admitted in the first 24 hours after myocardial infarction, and the sample consisted of 430 cases from which all the variables under study could be collected. Descriptive statistics were used. Sensitivity, specificity and area under the curve were determined to be able to determine the discriminatory capacity of the risk scores as well. Results: The 70% of the deceased patients were male and their mean age was 10 years older than in the patients discharged alive. High blood pressure was the most frequent associated risk factor in both deceased patients (90%) and in those who left the hospital alive (73.4%). The 70% of deaths had certain degree of left ventricular systolic dysfunction. The area under the curve of ICR, InTIME and GRACE scores was of 0.683; 0.681 and 0.662 respectively. TIMI Risk Score had an area under the curve of 0.598. Conclusions: ICR, InTime and GRACE scores had poor predictive capacity for in-hospital mortality. TIMI Risk Score had a very poor predictive capacity.

Cardiovascular disease risk stratification by the Framigham score is markedly improved by ambulatory compared with office blood pressure.

INTRODUCTION AND OBJECTIVES: Ambulatory blood pressure (BP) better predicts cardiovascular disease (CVD) outcomes than office BP measurements (OBPM). Nonetheless, current CVD risk stratification models continue to rely on exclusively daytime OBPM along with traditional factors, eg, age, sex, smoking, dyslipidemia, and/or diabetes. METHODS: Data from 19 949 participants of the primary care-based Hygia Project assessed by 48-hour ambulatory BP monitoring (ABPM) and without prior CVD events were used to compare the diagnostic accuracy, discrimination, and performance of the original Framingham risk score (RSOFG) and its adjusted version to the Hygia Project study population (RSAFG) with that of a novel CVD risk stratification model constructed by replacing OBPM with ABPM-derived prognostic parameters (RSABPM). RESULTS: During the follow-up, lasting up to 12.7 years, 1854 participants experienced a primary CVD outcome of CVD death, myocardial infarction, coronary revascularization, heart failure, stroke, transient ischemic attack, angina pectoris, or peripheral artery disease. Asleep systolic BP (SBP) mean and sleep-time relative SBP decline were the only joint significant ABPM-derived predictive factors of CVD risk and were therefore used to substitute for in-clinic SBP in the RSABPM model. The RSABPM model, in comparison with the RSOFG and RSAFG models, showed significantly improved calibration, diagnostic accuracy, discrimination, and performance (always P<.001). The RSAFG-derived event-probabilities of 57.3% of the participants were outside the 95% confidence limits of the event probability determined by the RSABPM model. CONCLUSIONS: These collective findings reveal important limitations of CVD risk stratification when based upon OBPM, as in the Framingham score, and corroborate the clinical value of around-the-clock ABPM to properly diagnose true hypertension and reliably stratify CVD vulnerability.

Development and validation of a tool for predicting type 2 diabetes in Mexican women of reproductive age.

INTRODUCTION: Diabetes is a worldwide problem with a greater impact in developing countries, where many people are unaware of their risk. In Mexico, women show the greatest risk for T2D. Current risk scores have been developed and validated in predominantly older European cohorts. They are not the best option in Mexican women. The development of a risk model/score in this population would be useful. OBJECTIVE: To develop and validate a risk model and score that incorporates the most relevant risk factors for T2D in Mexican women of reproductive age. METHODS: The study was carried out in two phases, with the first phase being the development of the predictive model and the second phase the validation of the model in a separate independent population. A cohort of Mexican patients of reproductive age ("Derivation Cohort") was used to create the predictive model. It included data on 3161 women. Risk factors for identification were assessed using Cox proportional hazards regression. Finally a score with a range of 0 to 19 points was developed to identify the 2.4 year probability of developing DM2 in Mexican women of reproductive age. RESULTS: 147 new cases of T2D (4.6%) were identified in the Derivation Cohort model, 97 of 925 participants (10.48%) in the validation cohort. The risk factor predictors of T2D were: history of gestational diabetes (HR 2.69, 95% CI 1.10-6.58), BMI (HR 1.03, 95% CI 1.01-1.06), hypertriglyceridemia (HR 1.54, 95% CI 1.11-2.14) and fasting blood glucose (HR 1.06, 95% CI 1.05-1.08), with an AUC of 0.75. The AUC in the validation cohort was 0.91 (95% CI 0.87-0.94). The score had a sensitivity of 73% and specificity of 67% at a cutoff of ≥15. CONCLUSIONS: A predictive model and risk score was developed to detect cases at risk for incident T2D. It was generated using the characteristics of Mexican women of reproductive age. This risk score is a step forward in attempting to address the generational legacy that diabetes in pregnancy could have on women and their children.

Terapia combinada en la profilaxis de las náuseas y vómitos postoperatorios en cirugía laparoscópica / Combined therapy and prophylaxis in postoperative nausea and vomiting in laparoscopic surgery

Introducción: Las náuseas y vómitos postoperatorios representan un problema frecuente tanto para el paciente como para el médico anestesiólogo. Se estima que la incidencia está en un 25 a 30 por ciento de los pacientes postoperados. Objetivo: Profundizar en los conocimientos relacionados con la terapia combinada en la profilaxis de las náuseas y vómitos postoperatorios. Métodos: Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Desarrollo: La naturaleza multifactorial de las náuseas y vómitos postoperatorios requiere de un enfoque multimodal para su tratamiento, el cual debe ser profiláctico más que terapéutico, con el objetivo de minimizar el riesgo. No es factible modificar sustancialmente las variables dependientes del paciente y de la intervención quirúrgica, pero se puede influir directamente sobre las anestésicas. En varios estudios se han identificado los diferentes factores de riesgo para náuseas y vómitos postoperatorios y a partir de estos se han desarrollado modelos predictivos que permiten evaluar la probabilidad del evento. Conclusiones: Las náuseas y vómitos postoperatorios constituyen un fenómeno frecuente en el postoperatorio. Para su profilaxis es recomendable el uso de terapias combinadas (antidopaminérgicos, antihistamínicos, anticolinérgicos, antagonistas de la serotonina, esteroides y antagonistas de la neurokinina-1) dado su componente multifactorial. Esta forma de afrontar dicho problema permite disminuir la frecuencia de estos síntomas, las complicaciones postoperatorias y facilitar la recuperación más inmediata del paciente(AU)

ABSTRACT Introduction: Postoperative nausea and vomiting represent a frequent problem for both the patient and the anesthesiologist. It is estimated that the incidence of these are present in 25-30 percent of postoperative patients. Objective: To go deepen in the knowledge related to physiopathology and combination therapy in the prophylaxis of postoperative nausea and vomiting. Method: A bibliographic review was made of the articles published in the Pubmed, Scielo, Medline and Cochrane data bases, related to the topic, belonging to authors dedicated to the study of this problem. Development: The multifactorial nature of postoperative nausea and vomiting requires a multimodal approach to its treatment, which should be prophylactic rather than therapeutic, with the objective of minimizing risk. It is not reasonable to modify the dependent variables of the patient and of the surgical intervention, but it is possible to directly influence the anesthetics. In several studies, the different risk factors for PONV have been identified and, from these, predictive models have been developed to evaluate the probability of the event. Conclusions: postoperative nausea and vomiting are a frequent phenomenon in the postoperative period. For its prophylaxis the use of combination therapies (antidopaminergic, antihistaminic, anticholinergic, serotoninantagonists, steroids and neurokinin-1 antagonists) is recommended, givenits multifactorial component. This way of dealing with this problema allows us to reduce the frequency of these symptoms, postoperative complications and facilitate the patient's most immediate recovery(AU)

The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department.

INTRODUCTION AND OBJECTIVES: The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. METHODS: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. RESULTS: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. CONCLUSIONS: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.

Impact of smoking cessation on estimated cardiovascular risk in Spanish type 2 diabetes mellitus patients: The DIABETES study. / Impacto de la cesación tabáquica en el riesgo cardiovascular estimado de pacientes con diabetes mellitus tipo 2: El estudio DIABETES.

AIMS: To assess the cardiovascular risk according to the UKPDS risk engine; Framingham function and score comparing clinical characteristics of diabetes mellitus type 2 (DM2) patients according to their habits status. PATIENTS AND METHODS: A descriptive analysis was performed. A total of 890 Spanish patients with DM2 (444 smokers and 446 former-smokers) were included in a cross-sectional, observational, epidemiological multicenter nationwide study. Coronary heart disease risk at 10 years was calculated using the UKPDS risk score in both patient subgroups. Results were also compared with the Spanish calibrated (REGICOR) and updated Framingham risk scores. RESULTS: The estimated likelihood of coronary heart disease risk at 10 years according to the UKPDS score was significantly greater in smokers compared with former-smokers. This increased risk was greater in subjects with poorer blood glucose control, and was attenuated in women ≥60 years-old. The Framingham and UKPDS scores conferred a greater estimated risk than the REGICOR equation in Spanish diabetics. CONCLUSIONS: Quitting smoke in patients with DM2 is accompanied by a significant decrease in the estimated risk of coronary events as assessed by UKPDS. Our findings support the importance of quitting smoking among diabetic patients in order to reduce cardiovascular risk.

Cardiovascular risk prediction in chronic kidney disease patients. / Predicción del riesgo cardiovascular en pacientes con enfermedad renal crónica.

INTRODUCTION: Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population. MATERIAL AND METHODS: Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed. RESULTS: Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, P<.001, HR 3.1 [95% CI: 1.3-7.1] P: 0.006 and ASCVD log-rank 8.5 P<.001, HR 3.2 [95% CI: 1.1-9.4] P: 0.03) were independent predictors adjusted to renal function, albuminuria and previous cardiovascular events. CONCLUSION: The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events.

Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. / Náuseas y vómitos postoperatorios: fisiopatología, factores de riesgo, profilaxis y tratamiento.

Recognising the importance of the prevention and early treatment of postoperative nausea and vomiting (PONV) is essential to avoid postoperative complications, improve patient satisfaction and enable the development of major outpatient surgery and fast-track surgery. The topic of PONV might seem to have become stagnant, but we are moving forward. New concepts and problems like post-discharge nausea and vomiting, new risk factors and new drugs are appearing. However, there continue to be mistaken notions about PONV, such as the association between PONV and post-anaesthesia care unit stays, or assuming that it is a risk factore characteristic of the patient, anaesthesia or surgery when it is not. Perhaps, now is the moment to tackle PONV in a different manner, implementing guidelines and going for more aggressive prophylaxis in some groups of patients. We present an extensive review of this topic.

Evaluación del riesgo anestésico en cirugía electiva torácica y abdominal de gran envergadura / Anesthetic risk assessment in major elective thoracic and abdominal surgery

Introducción: establecer la estratificación del riesgo, en algunas ocasiones es difícil, encontrándose implícitos algunos factores de riesgo individual que pueden ser interpretados de diferente forma. Una evolución global de las condiciones preoperatorias del paciente puede predecir en determinado momento la conducta anestésica, quirúrgica y posoperatorio.Objetivo: valorar el riesgo en cirugía mayor electiva torácica y abdominal mediante el empleo de escalas. Métodos: estudio prospectivo de serie de casos, conformado por 70 pacientes intervenidos de cirugía torácica y abdominal de gran envergadura, a los cuales se les aplicó diferentes escalas con vistas a identificar el riesgo y la aparición de eventos adversos perioperatorios, los cuales cumplieron los criterios de inclusión establecidos por la investigadora, donde se complementó la metodología cualitativa y cuantitativa.Resultados: el índice de riesgo cardiopulmonar preoperatorio fue de 0- 5 puntos, en 35 pacientes lo que representó el 50 por ciento del total. Al relacionar el índice de riesgo cardiopulmonar con eventos adversos la mayor incidencia estuvo representada por los trastornos hemodinámicos (22,9 por ciento). Cuando se relacionaron los eventos adversos perioperatorios y diferentes escalas como la de Capacidad funcional, expresada en niveles de equivalentes metabólicos, la del Estado Físico de la Sociedad Americana de Anestesiología y Clasificación Funcional de Riesgo Cardiovascular de la Sociedad de Cardiología de Nueva York, se evidenció un predominio de los trastornos hemodinámicos que representó en los grupos de 2-5 equivalentes metabólicos, ASA III y NYHA II con un 26,6 por ciento, 26,7 por ciento y 30,7 por ciento respectivamente. Conclusiones: la estratificación del riesgo con la aplicación de diferentes escalas en pacientes que fueron operados por cirugía mayor electiva, torácica y abdominal con vistas a realizar una valoración integral del paciente ...(AU)

Introduction: establishing risk stratification is sometimes difficult, as long as some individual risk factors can be found to be interpreted differently. A global evolution of the patient's preoperative conditions can sometimes be predictive of both surgical and postoperative anesthesia behavior. Objective: To assess the risk in major elective thoracic and abdominal surgery by using scales. Methods: A prospective case series was carried out, consisting of 70 patients who were performed major thoracic and abdominal surgery and applied different scales, in order to identify the risk and onset of perioperative adverse events, and who also met the criteria inclusions established by the researcher, where qualitative and quantitative methodology supplemented each other. Results: the rate of preoperative cardiopulmonary risk was 0-5 points in 35 patients, which represented 50 percent of the total. On relating the rate of cardiopulmonary risk with the adverse events, the highest incidence was represented by hemodynamic disorders (22.9 percent). When we related the perioperative adverse events and different scales, such as that of functional capacity, expressed in levels of metabolic equivalents, the American Society of Anesthesiologists (ASA) Physical Status, and the New York Heart Association (NYHA) Functional Classification of Cardiovascular Risk, a predominance was shown in the hemodynamic disorders represented in the groups of 2-5 metabolic equivalents, ASA III and NYHA II, with 26.6 percent, 26.7 percent and 30.7 percent, respectively. Conclusions: risk stratification with the application of different scales in patients who were performed major elective thoracic and abdominal surgery, in order to make a comprehensive assessment of surgical patients with prognostic value, provided the risk estimation and prediction of perioperative adverse events(AU)

[Acute coronary syndrome in nonagenarians: clinical evolution and validation of the main risk scores]. / Síndrome coronario agudo en nonagenarios: evolución clínica y validación de las principales escalas de riesgo.

INTRODUCTION: Several risk scores regarding the probability of death/complications in the acute setting and during the follow-up of patients admitted with acute coronary syndromes (ACS) have been published, such as the GRACE, TIMI and ZWOLLE risk score. Our objective was to assess the prognosis of nonagenarians admitted to a coronary care unit with an ACS, as well as the usefulness of each of these scores. MATERIAL AND METHODS: A retrospective analysis was performed on nonagenarians with an ACS admitted between 2003 and 2011. Vital status was determined at 14, 30 days, and 6 months after the ACS, and later during the follow-up. The risk scores were evaluated by area under the curve ROC (AUC). RESULTS: A total of 45 patients with an ACS, 26 (57.8%) with ST-segment elevation and 19 (42.2%) with non-ST elevation. The GRACE- AUC for in-hospital mortality was excellent, 0.91, (95% CI: 0.82-1; P<.001), and for the combined event (in-hospital mortality and re-infarction) was 0.83 (95% CI: 0.66-1.0; P<.01). However, the GRACE-AUC at 6 months for mortality was 0.34 (95% CI: 0.09-0.58; P=.45), and for the combined event it was 0.51 (95% CI: 0.26-0.77; P=.95). The TIMI-AUC and ZWOLLE-AUC did not reach statistical significance. CONCLUSIONS: It is useful calculate the GRACE risk score in order to estimate risk and survival in the acute phase of ACS in nonagenarians. This can help appropriate in making invasive or conservative treatment decisions.

The TIMI risk score for STEMI predicts in-hospital mortality and adverse events in patients without cardiogenic shock undergoing primary angioplasty / La escala de riesgo TIMI para infarto del miocardio con elevación del segmento ST predice mortalidad y eventos adversos intrahospitalarios en pacientes sin choque cardiogénico sometidos a angioplastía coronaria

Introduction: Patients with ST elevation acute myocardial infarction (STEMI) comprise a heterogeneous population with respect to the risk for adverse events. Primary percutaneous coronary intervention (PCI) has shown to be better, mainly in high-risk patients. Objective: The purpose of this study was to determine if the Thrombolysis in Myocardial Infarction (TIMI) risk score for STEMI applied to patients undergo primary PCI identifies a group of patients at high risk for adverse events. Methods: We identifed patients with STEMI without cardiogenic shock on admission, who were treated with primary PCI. The TIMI and CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) risk scores were calculated to determine their predictive value for in hospital mortality. Patients were divided into two groups according to their TIMI risk score, low risk being 0-4 points and high risk ≥5 points, and the frequency of adverse events was analyzed. Results: We analyzed 572 patients with STEMI. The c-statistics predictive value of the TIMI risk score for mortality was 0.80 (p=0.0001) and the CADILLAC risk score was 0.83, (p=0.0001). Thirty-two percent of patients classifed as high risk (TIMI ≥5) had a higher incidence of adverse events than the low-risk group: mortality 14.8% vs. 2.1%, (p=0.0001); heart failure 15.3% vs. 4.1%, (p=0.0001); development of cardiogenic shock 10.9% vs. 1.5%, (p=0.0001); ventricular arrhythmias 14.8% vs. 5.9%, (p=0.001); and no-refow phenomenon 22.4% vs. 13.6%, (p=0.01). Conclusions: The TIMI risk score for STEMI prior to primary PCI can predict in hospital mortality and identifes a group of high-risk patients who might develop adverse events.

Introducción: Los pacientes con infarto agudo del miocardio con elevación del segmento ST (IAM CEST), son una población heterogénea por lo que toca al riesgo de eventos adversos. La intervención coronaria percutánea (ICP) primaria mostró ser mejor, principalmente en los pacientes de riesgo alto. Objetivo: La propuesta de este estudio fue determinar si la escala de riesgo de trombólisis en infarto del miocardio (TIMI) para IAM CEST, aplicado a los pacientes sometidos a ICP primaria, identifica a grupos de pacientes de riesgo alto de eventos adversos. Métodos: Se identificaron a pacientes con IAM CEST sin choque cardiogénico al ingreso, quienes fueron tratados con ICP primaria. Se calcularon las escalas de riesgo TIMI y CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications), para determinar su valor predictivo de mortalidad intrahospitalaria. Los pacientes se dividieron en dos grupos de acuerdo a su escala de riesgo TIMI, riesgo bajo con 0-4 puntos y riesgo alto con ≥5 puntos, se analizó la frecuencia de eventos adversos. Resultados: Se analizaron 572 pacientes con IAM CEST. El valor predictivo del estadístico C de la escala de riesgo TIMI para mortalidad fue de 0.80 (p=0.0001), y la escala de riesgo CADILLAC fue de 0.83, (p=0.0001). El 32% de los pacientes clasificados como riesgo alto (TIMI ≥5), tuvo una alta incidencia de eventos adversos comparada con el grupo de riesgo bajo: la mortalidad 14.8% vs. 2.1%, (p=0.0001); falla cardiaca 15.3% vs. 4.1%, (p=0.0001); desarrollo de choque cardiogénico 10.9% vs. 1.5%, (p=0.0001); arritmias ventriculares 14.8% vs. 5.9%, (p=0.001), y fenómeno de no reflujo 22.4% vs. 13.6%, (p=0.01). Conclusiones: La escala de riesgo TIMI para IAM CEST, previo a ICP primaria puede predecir mortalidad intrahospitalaria e identificar a un grupo de pacientes de riesgo alto, los cuales pueden desarrollar eventos adversos.

Factores de mayor riesgo para maloclusiones dentarias desde la dentición temporal: revisión bibliográfica / High risk factors for dental malocclusions from temporary teething: bibliographical review

Se realizó una revisión bibliográfica sobre los factores de riesgo que pueden relacionarse con la aparición de maloclusiones dentarias en escolares desde la dentición temporal, haciendo énfasis en aquellos factores que con frecuencia aparecen en el medio, para así actualizar a los profesionales de la salud que se relacionan con su control y erradicación desde edades tempranas, lo que contribuirá a la disminución de las maloclusiones en las denticiones mixtas y permanentes; se propone implementar una escala de riesgo para maloclusiones dentarias desde la dentición temporal, y dispensarizar a los escolares con alto riesgo de padecerla y tratarlos de manera integral.

A bibliographical revision was carried out on the risk factors that can be related to the appearance of dental malocclusions in students from temporary teething, making emphasis in those factors that appear in means frequently, for this way to update the professionals health which their control and eradication are related to from early ages, which will contribute to malocclusions decrease in mixed and permanent teethings; we propose to implement a risk scale for dental malocclusions from temporary teething, and to dispensarize the students with high risk of suffering it and treat them in an integral way.

Factores de mayor riesgo para maloclusiones dentarias desde la dentición temporal: revisión bibliográfica / High risk factors for dental malocclusions from temporary teething: bibliographical review

Se realizó una revisión bibliográfica sobre los factores de riesgo que pueden relacionarse con la aparición de maloclusiones dentarias en escolares desde la dentición temporal, haciendo énfasis en aquellos factores que con frecuencia aparecen en el medio, para así actualizar a los profesionales de la salud que se relacionan con su control y erradicación desde edades tempranas, lo que contribuirá a la disminución de las maloclusiones en las denticiones mixtas y permanentes; se propone implementar una escala de riesgo para maloclusiones dentarias desde la dentición temporal, y dispensarizar a los escolares con alto riesgo de padecerla y tratarlos de manera integral(AU)

A bibliographical revision was carried out on the risk factors that can be related to the appearance of dental malocclusions in students from temporary teething, making emphasis in those factors that appear in means frequently, for this way to update the professionals health which their control and eradication are related to from early ages, which will contribute to malocclusions decrease in mixed and permanent teethings; we propose to implement a risk scale for dental malocclusions from temporary teething, and to dispensarize the students with high risk of suffering it and treat them in an integral way(AU)

Cirugía de revascularización miocárdica en pacientes con síndrome coronario agudo: análisis de resultados / Coronary artery bypass graft surgery in patients with acute coronary syndrome: analysis of results

Objetivo: identificar los principales factores de riesgo que influyen en el pronóstico, resultados, tipo y tasas de morbilidad y mortalidad de los pacientes con síndrome coronario agudo sometidos a cirugía de revascularización miocárdica. Material y métodos: se trató de un estudio retrospectivo de pacientes sometidos a cirugía por síndrome coronario agudo de enero de 2000 a diciembre de 2003. Se identificaron factores demográficos, indicación de cirugía, enfermedades intercurrentes, resultados de la intervención, morbilidad y mortalidad, y se compararon con escalas internacionales. Resultados: fueron 73 varones y 23 mujeres, la edad osciló entre 46 y 88 años. Predominó la angina inestable (42.7 %). Dos pacientes fueron operados por angioplastia coronaria percutánea fallida y 28 por complicaciones mecánicas del infarto del miocardio. La cirugía fue realizada como urgencia en 90.6 %. La mayoría de los pacientes estuvieron en clasificación Killip-Kimball y Forrester I y II. Los factores de riesgo detectados fueron falla del ventrículo izquierdo, complicaciones mecánicas, cirugía de emergencia, diabetes y falla respiratoria o renal. La mortalidad perioperatoria fue de 14.5 % y la morbilidad de 41.6 %, que comparadas con la clasificación de riesgo de nuestros pacientes fueron más bajas que las esperadas, según las escalas de Parsonnet y Tuman. Conclusiones: aunque el mayor número de factores de riesgo y valores más altos en las escalas de riesgo empeoran en forma importante el pronóstico, en nuestro centro los resultados obtenidos con el tratamiento quirúrgico en síndrome coronario agudo muestran resultados favorables.

BACKGROUND: The objective of this work was to determine the main risk factors that influence prognosis, results, morbidity and mortality rates and causes in patients with acute coronary syndrome requiring surgical myocardial revascularization. METHODS: This was a retrospective study including patients in our hospital with acute coronary syndrome requiring coronary artery bypass-graft surgery between January 2000 and December 2003. The following were identified and compared with international values: demographic factors, indications for surgery, intercurrent pathologies, results of the procedures, morbidity and mortality rates and causes. RESULTS: There were 73 males and 23 females with an age range of 46 to 88 years old. The main cause of surgery was unstable angina (42.7%). In two patients, surgery was indicated for percutaneous coronary angioplasty failure and in 28 patients due to mechanical complications of acute myocardial infarction. The procedure was urgent in 90.6%. The majority of patients were in Killip-Kimball or Forrester class I or II. Risk factors detected were left ventricular failure, mechanical complications, emergency surgery, diabetes and respiratory or renal failure. Perioperative mortality was 14.5% and morbidity was 41.6%, both compared with risk classification scales and were lower than expected according to Parsonet and Tuman evaluations. CONCLUSIONS: With a major number of risk factors and the high-risk associated with surgery, in our center surgical treatment for acute coronary syndromes showed favorable results.