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1.
BMJ ; 368: m134, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937593
2.
Isr Med Assoc J ; 22(1): 5-7, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927797

RESUMEN

BACKGROUND: Many procedures requiring sedation in the pediatric emergency department are performed by consultants from outside the department. This team usually includes orthopedic surgeons and general surgeons. As sedation is now a standard of care in such cases, we evaluated consultants' views on sedation. OBJECTIVES: To evaluate consultants' views on sedation. METHODS: A questionnaire with both open-ended questions and Likert-type scores was distributed to all orthopedic surgeons and general surgeons performing procedures during the study period. The questionnaire was presented at three medical centers. RESULTS: The questionnaire was completed by 31 orthopedic surgeons and 16 general surgeons. Although the vast majority (93-100%) considered sedation important, a high percentage (64-75%) would still perform such procedures without sedation if not readily available. CONCLUSIONS: Sedation is very important for patients and although consultants understand its importance, the emergency department staff must be vigilant in both being available and not allowing procedures to "escape" the use of sedation.


Asunto(s)
Sedación Consciente , Consultores/estadística & datos numéricos , Servicio de Urgencia en Hospital , Actitud del Personal de Salud , Niño , Sedación Consciente/métodos , Sedación Consciente/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Cirujanos Ortopédicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Encuestas y Cuestionarios
3.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927798

RESUMEN

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos
4.
Isr Med Assoc J ; 22(1): 13-16, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927799

RESUMEN

BACKGROUND: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. OBJECTIVES: To evaluate the learning curve of vNOTES hysterectomy by experienced gynecologists based on surgical times and short-term outcomes. METHODS: A retrospective study was conducted of the first 25 vNOTES hysterectomy surgeries performed from July to December 2018 at Rambam Health Care Campus by a single surgeon. The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, postoperative pain, and need for analgesia. Socio-demographic and clinical data were retrieved from patient electronic medical charts. RESULTS: Median age was 64.5 years (range 40-79). Median hysterectomy time was 38 minutes (range 30-49) from the first cut until completion. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 subsequent procedures demonstrated a significant decrease in median total time: 45 minutes (range 41-49) vs. 32 minutes (range 30-38), respectively (P = 0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the subsequent procedures (P = 0.011). CONCLUSIONS: vNOTES hysterectomy is feasible by an experienced gynecologist, with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, and short hospitalization. vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery.


Asunto(s)
Ginecología/educación , Histerectomía Vaginal/educación , Curva de Aprendizaje , Cirugía Endoscópica por Orificios Naturales/educación , Adulto , Anciano , Femenino , Humanos , Histerectomía Vaginal/métodos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/métodos , Tempo Operativo , Estudios Retrospectivos , Resultado del Tratamiento
5.
Isr Med Assoc J ; 22(1): 17-21, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927800

RESUMEN

BACKGROUND: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) is associated with decreased perioperative morbidity and mortality. OBJECTIVES: To report the outcomes of EVAR among patients older than 80 years of age. METHODS: In this retrospective study, we reviewed patients older than 80 years of age who underwent elective EVAR at our institution between 2007 and 2017. The demographics, perioperative morbidity and mortality, and long-term results are reported. RESULTS: During the study period, 444 patients underwent elective EVAR for AAAs. Among them 128 patients (29%) were > 80 years of age. Mean age was 84 ± 3.4 (range 80-96) years, and 110 patients (86%) were male. The EVAR was technically successful in 127 patients (99%) and there were intraoperative mortalities. Within 30 days of the surgery, nine patients (7%) died. Major and minor adverse events occurred in 26 (20%) and 59 (46%) patients, respectively. Factors associated with increased risk of perioperative morbidity and mortality included chronic kidney disease, peripheral artery disease, and the existence of three or more co-morbidities. CONCLUSIONS: EVAR in the elderly can be performed with a high rate of success; however, it is associated with a substantial rate of morbidity and mortality, particularly when patients present with multiple co-morbidities. When performing EVAR in this population group, the risk of rupture must be considered opposed to the life expectancy of these patients and the risk of perioperative morbidity and mortality.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/efectos adversos , Factores de Edad , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/mortalidad , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Masculino , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
6.
Isr Med Assoc J ; 22(1): 22-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927801

RESUMEN

BACKGROUND: Prophylactic cranial irradiation (PCI) exclusion in favor of brain magnetic resonance imaging (MRI) staging and surveillance in the management of small cell lung cancer (SCLC) is controversial yet accepted by some centers. The use of MRI suggests performing stereotactic radiosurgery (SRS) treatment for limited brain metastases. Data regarding SRS efficacy in this setting is limited. OBJECTIVES: To assess intracranial objective response rate (iORR), progression-free survival (iPFS), intracranial failure patterns, overall survival (OS) and time-to-whole-brain radiation therapy (WBRT)/death, whichever occurred first (TTWD) with SRS in SCLC. METHODS: The study comprised 10 consecutive SCLC patients with brain metastases treated with SRS and followed-up at Davidoff Cancer center between Aug 2012 and March 2019. Brain MRI images were reviewed by a neuro-radiology specialist. RESULTS: iORR was 57% as assessed by response assessment in neuro-oncology brain metastases. Intracranial progression developed in 8 patients. Median iPFS was 4.0 months (95% confidence interval [95%CI] 1.7-7.2). In-site, off-site and combined pattern of intracranial failure was seen in 0, 5, and 3 patients, respectively; median number of new brain lesions following SRS was 4 (range, 1-12). SRS was performed 10 additional times in 6 patients (median number of lesions irradiated per round was 1, range 1-5). WBRT was administered in 3 patients. Median TTWD was 20.9 months (95% CI, 1.9-26.8). Median OS since SRS administration was 23.2 months (95% CI, 4.2-not reached). CONCLUSIONS: MRI surveillance with multiple rounds of SRS may serve a reasonable alternative to PCI or therapeutic WBRT in SCLC.


Asunto(s)
Neoplasias Encefálicas/secundario , Neoplasias Pulmonares/patología , Radiocirugia , Carcinoma Pulmonar de Células Pequeñas/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Supervivencia sin Progresión , Radiocirugia/métodos , Resultado del Tratamiento
7.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927802

RESUMEN

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Asunto(s)
Lesiones Encefálicas/embriología , Feto/diagnóstico por imagen , Cardiopatías Congénitas/etiología , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/embriología , Encéfalo/patología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/patología , Estudios de Casos y Controles , Ecocardiografía , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Neuroimagen , Embarazo , Diagnóstico Prenatal/métodos
8.
Isr Med Assoc J ; 22(1): 32-36, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927803

RESUMEN

BACKGROUND: Evaluation of mismatch repair (MMR) deficiency is conducted via immunohistochemistry or by microsatellite instability (MSI) analysis. Heterogeneous immunohistochemistry staining for MMR proteins may show different patterns; however, according to current guidelines, all of those patterns should be interpreted as MMR proficient. This conclusion might lead to false negative results because although most cases of heterogeneity stem from technical factors and biological variability, other types of heterogeneity represent true MMR deficiency. OBJECTIVES: To identify a unique heterogeneity pattern that is associated with true MMR loss. METHODS: We analyzed 145 cases of colorectal carcinoma. Immunohistochemistry staining for MLH1, PMS2, MSH2, and MSH6 were performed. We defined geographic heterogeneity as areas of tumor nuclear staining adjacent to areas of loss of tumor nuclear staining with intact staining in the surrounding stroma. All cases were evaluated for the presence of geographic heterogeneity. In addition, 24 cases were also evaluated by MSI testing. RESULTS: Of the 145 cases, 24 (16.5%) were MMR deficient. Of the 24 cases for which MSI analysis was also available, 10 cases (41.7%) demonstrated biological heterogeneity, 5 (20.8%) demonstrated technical heterogeneity, and 2 (8.3%) demonstrated geographic heterogeneity. Only the two cases with geographic heterogeneity were MSI-high via MSI analysis. In addition, a germline mutation in MSH-6 was identified in one of these cases. CONCLUSIONS: Geographic heterogeneity may raise a suspicion for a MMR-deficient case, which should be further analyzed using additional methodologies such as MSI analysis.


Asunto(s)
Reparación de la Incompatibilidad de ADN/genética , Proteínas MutS/genética , Adenoma/genética , Adenoma/patología , Adulto , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Colorantes , Heterogeneidad Genética , Humanos , Masculino
9.
Isr Med Assoc J ; 22(1): 37-42, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927804

RESUMEN

BACKGROUND: There is a need for standardized and objective methods to measure postural instability (PI) and gait dysfunction in Parkinson's disease (PD) patients. Recent technological advances in wearable devices, including standard smartphones, may provide such measurements. OBJECTIVES: To test the feasibility of smartphones to detect PI during the Timed Up and Go (TUG) test. METHODS: Ambulatory PD patients, divided by item 30 (postural stability) of the motor Unified Parkinson's Disease Rating Scale (UPDRS) to those with a normal (score = 0, PD-NPT) and an abnormal (score ≥ 1, PD-APT) test and a group of healthy controls (HC) performed a 10-meter TUG while motion sensor data was recorded from a smartphone attached to their sternum using the EncephaLog application. RESULTS: In this observational study, 44 PD patients (21 PD-NPT and 23 PD-APT) and 22 HC similar in age and gender distribution were assessed. PD-APT differed significantly in all gait parameters when compared to PD-NPT and HC. Significant difference between PD-NPT and HC included only turning time (P < 0.006) and step-to-step correlation (P < 0.05). CONCLUSIONS: While high correlations were found between EncephaLog gait parameters and axial UPDRS items, the pull test was least correlated with EncephaLog measures. Motion sensor data from a smartphone can detect differences in gait and balance measures between PD with and without PI and HC.


Asunto(s)
Enfermedad de Parkinson/diagnóstico , Balance Postural , Teléfono Inteligente , Anciano , Estudios de Casos y Controles , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología
10.
Isr Med Assoc J ; 22(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927805

RESUMEN

BACKGROUND: Temporary abdominal closure (TAC) surgical technique relates to a procedure in which the post-surgical abdominal wall remains open in certain indications. The Bogota bag (BB) technique is a tension-free TAC method that covers the abdominal contents with a sterilized fluid bag. There are very few reports of pediatric patients treated with this technique. OBJECTIVES: To describe our institution's 15 years of experience using the BB technique on pediatric patients. METHODS: A retrospective cohort study describing our experience treating patients with BB was conducted. The medical files of 17 pediatric patients aged 0-18 years were reviewed. RESULTS: Between January 2000 and December 2014, 17 patients were treated with BB at our medical center (6 females, median age 12 years). Indications for BB were a need for a surgical site re-exploration, mechanical inability for primary abdominal closure, and high risk for ACS development. Median BB duration was 5 days and median bag replacement was 2 days. Median ICU length of stay (LOS) was 10 days and hospital LOS was 27 days. The ICU admission and BB procedure was tolerated well by 6 patients who were discharged home without complications. Of the remaining 11 patients, 6 patients died during the admission (35%) and the others presented with major complications not related to the BB but to the patient's primary disease. CONCLUSIONS: This report represents the largest series of children treated with BB. The technique is simple to perform, inexpensive, and has very few complications.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Abdomen/cirugía , Pared Abdominal/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
11.
Isr Med Assoc J ; 22(1): 48-52, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927806

RESUMEN

BACKGROUND: Nasal polyps are three-dimensional structures arising from the mucosa of the upper airway. Due to their complexity, the reliability of single-layer cell cultures and animal systems as research models is limited. OBJECTIVES: To evaluate the feasibility of an ex vivo organ culture of human polyps, preserving tissue structure and function. METHODS: Nasal polyps were excised during routine endoscopic sinus surgery for chronic rhinosinusitis and polyposis. Fresh tissue samples were used for pathological evaluation and for the preparation of 250-500 µm sections, which were incubated in culture media. Tissue viability was assessed by visualisation of cilia motility, measurement of glucose uptake, and an infectivity assay. Cytokine secretion was evaluated by enzyme-linked immunosorbent assay and real-time polymerase chain reaction before and after the introduction of steroids. RESULTS: Polyp tissue viability was retained for 2-3 days as demonstrated by cilia motility, glucose uptake and preserved cellular composition. Tissue samples maintained their capacity to respond to infection by herpes simplex virus 1 and adenovirus. Introduction of dexamethasone to cultured tissue samples led to suppression of interferon-g production. CONCLUSIONS: The ex vivo nasal polyp organ culture reproduces the physiological, metabolic, and cellular features of nasal polyps. Furthermore, it shows a preserved capacity for viral infection and response to drugs. This system is a useful tool for the investigation nasal-polyps and for the development of novel therapies.


Asunto(s)
Pólipos Nasales/diagnóstico , Técnicas de Cultivo de Órganos/métodos , Adulto , Quimiocinas/metabolismo , Citocinas/metabolismo , Glucosa/metabolismo , Humanos , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Pólipos Nasales/cirugía , Reacción en Cadena en Tiempo Real de la Polimerasa
12.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927807

RESUMEN

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Asunto(s)
Neoplasias Retroperitoneales/diagnóstico , Anciano , Femenino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagen , Ganglioneuroma/patología , Ganglioneuroma/cirugía , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagen , Lipoma/patología , Lipoma/cirugía , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Neurilemoma/cirugía , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagen , Neurofibroma/patología , Neurofibroma/cirugía , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagen , Paraganglioma/patología , Paraganglioma/cirugía , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
13.
Isr Med Assoc J ; 22(1): 60-63, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927808

RESUMEN

BACKGROUND: In this review, the authors re-examine the role of aspirin in the primary prevention of cardiovascular disease. They discuss the history of the use of aspirin in primary prevention, the current guidelines, and the recent evidence surrounding aspirin use as primary prevention in special populations such as those with moderate cardiovascular risk, diabetes mellitus, and the elderly.


Asunto(s)
Aspirina/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Fibrinolíticos/uso terapéutico , Aspirina/efectos adversos , Fibrinolíticos/efectos adversos , Humanos , Guías de Práctica Clínica como Asunto , Prevención Primaria/métodos
14.
Isr Med Assoc J ; 22(1): 64-65, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927809

RESUMEN

BACKGROUND: Falling from a height accounts for 14.1% of all hospital admissions for traumatic injury. In 5% of cases, the injury is severe or critical, and in 1.5%, it is fatal. The dangers of falling have been recognized since time immemorial. Indeed, the Bible instructs us to build a parapet around the roof of our home so that, "…you may not bring the guilt of bloodshed on your house if someone falls from it" (Deuteronomy 22:8). This commandment highlights the relatively simple and practical means by which we can prevent falls. It is also one of a series of ethical laws that are presented to help us understand and obey the larger Biblical precepts of loving one's neighbor and guarding the sanctity of life. The concept teaches us that it is the responsibility of all individuals to be cognizant of others and to avoid harming people through negligence or carelessness. The aim of this article is to explain the commandment to build a parapet in the context of the risk of falling from a height and to expand on its wider implications. The present work was prompted in part by the alarming increase in fatal and near-fatal accidents in Israel in two particular populations.


Asunto(s)
Accidentes por Caídas/prevención & control , Arquitectura y Construcción de Instituciones de Salud , Códigos de Edificación/legislación & jurisprudencia , Arquitectura y Construcción de Instituciones de Salud/legislación & jurisprudencia , Humanos , Israel , Judaísmo
16.
Monogr Oral Sci ; 28: 125-133, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940617

RESUMEN

Due to the increasing focus on host inflammatory processes with regard to the aetiology of periodontal disease, diet has become an important factor in host modulation. Recent investigations showed that the industrialized western diet, which is characterized by highly processed foods (processed carbohydrates like sugar, white flour, and processed fatty acids like trans fats) and a low micronutrient density, promotes gingival and periodontal inflammation. On the other hand, a plant-based diet rich in low-glycaemic, complex carbohydrates (like in fruits, vegetables, legumes), Omega-3 fatty acids, micronutrients (like vitamins, minerals), phytochemicals, plant nitrates, and fibres seems to bring benefits as well for periodontal inflammation as for caries, and general health. This chapter aims to present the underlying studies and possible mechanisms.


Asunto(s)
Dieta , Enfermedades Periodontales , Humanos , Micronutrientes , Verduras , Vitaminas
17.
Monogr Oral Sci ; 28: 114-124, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940618

RESUMEN

Malnutrition can significantly affect oral health, and poor oral health in turn can result in malnutrition. This co-dependent relationship, therefore, relies on good nutritional health promoting good oral health and vice versa. A diet lacking nutrients can lead to disease progression of the oral cavity through altered tissue homeostasis, reduced resistance to microbial biofilm, and a decrease in tissue healing. It may also affect the development of the oral cavity. In the absence of contributing factors, health professionals should consider poor nutritional status with periodontitis, poor healing response to surgical procedures, or recurrent oral disease. This is particularly evident amongst elderly patients and patients in long-stay care. The role of nutrition in oral health and its effects on the immune system and inflammatory pathways has attracted a recent increase in research. This chapter will explore the oral manifestations that can occur with nutritional deficiencies, the association of periodontitis with nutritional deficiencies in vitamins C and D, and the effect of vitamin D deficiency and tooth development.


Asunto(s)
Estado Nutricional , Salud Bucal , Anciano , Dieta , Humanos , Nutrientes , Vitaminas
18.
Monogr Oral Sci ; 28: 59-67, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940621

RESUMEN

Vitamins are essential organic compounds that catalyze metabolic reactions. They also function as electron donors, antioxidants or transcription effectors. They can be extracted from food and supplements, or in some cases, synthesized by our body or gut microbiome. Severe vitamin deficiencies result in systemic complications, including the development of scurvy, rickets, pellagra, and beriberi. Some moderate and severe deficiencies also result in oral conditions. A lower intake of vitamin A has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia and periodontitis. Vitamin D deficiency during tooth development may result in non-syndromic amelogenesis and dentinogenesis imperfecta, enamel and dentin hypoplasia, and dysplasia. Clinical studies have demonstrated an association between vitamin D's endocrine effects and periodontitis. On the other hand, no significant association has been found between cariogenic activity and vitamin D deficiency. Vitamin C deficiency results in changes in the gingivae and bone, as well as xerostomia; while vitamin B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, cheilosis, cheilitis, halitosis, gingivitis, glossitis, atrophy of the lingual papillae, stomatitis, rashes around the nose, dysphagia, and pallor. The effects of vitamins E and K on oral health are not as clear as those of other vitamins. However, vitamin K has a systemic effect (increasing the risk of haemorrhage), which may affect individuals undergoing oral surgery or suffering an oral injury. Health care professionals need to be aware of the effects of vitamins on oral health to provide the best available care for their patients.


Asunto(s)
Avitaminosis , Vitaminas , Humanos , Salud Bucal , Vitamina A , Vitamina K
19.
Monogr Oral Sci ; 28: 22-31, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940622

RESUMEN

The foods in the diet contain a wide range of organic and inorganic compounds. Considering these from an elemental perspective, 5 so-called macroelements, calcium, potassium, sodium, phosphorus and chlorine, are contained in comparatively large quantities in foods compared to all other elements. This chapter attempts to review the importance of these dietary macroelements on oral health, and in particular their role in tooth loss, dental caries, erosive tooth wear and periodontal disease. Calcium and phosphate make up the bulk of the mineralized human tissues. Adequate intake of both is therefore of crucial importance in maintaining the health, function and retention of teeth and bones. Supplementation of the diet with calcium has also been shown to aid in maintaining and improving oral health. Several attempts have been made to lessen the erosive potential of beverages through calcium supplementation. Adequate calcium intake is also crucial for maintaining periodontal health. In many areas, however, the evidence is still emerging or controversial. Phosphate supplementation of the diet was once thought to decrease caries incidence, although studies in children were not successful. Furthermore, little attention has been paid to the other macroelements, highlighting the need for more well-controlled and comprehensive studies.


Asunto(s)
Caries Dental , Calcio , Niño , Cloro , Dieta , Humanos , Minerales , Sodio
20.
Monogr Oral Sci ; 28: 14-21, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940623

RESUMEN

An improvement in oral health, not least dental caries and periodontal disease, has been seen during the last 50 years. Oral health is essential for both general health and quality of life. The mouth is a window into the health of the body and signs of nutritional deficiencies can be seen in the mouth at an early stage. Dental caries still constitutes the most common oral condition worldwide. It is the net result of an ecological imbalance in the oral biofilm where metabolism of fermentable carbohydrates may result in demineralisation. Early diagnosis of disease symptoms and preventive strategies are important for disease management. Dental erosion, where loss of tooth substance is a result of exposure to acidic substances, has become a common condition. Intrinsic factors, including diet/drinks and intake habits, are common etiological causes. Periodontal diseases constitute chronic, biofilm-initiated inflammatory conditions with multifactorial origin including inherited and acquired risk factors. Preventive strategies focus on mechanisms, which may influence the amount and composition of the subgingival biofilm. Oral cancer is one of the most commonly found forms of malignancies worldwide. It is a highly complex condition where lifestyle factors, particularly smoking cessation and moderate alcohol consumption, play a major role as deterrents. Hyposalivation is of multifactorial aetiology and may influence oral health as well as various aspects of quality of life. To control oral health, it is important to increase our knowledge of oral disease aetiology and focus on oral health promotion and preventive strategies including the control of diet and nutritional risk factors.


Asunto(s)
Caries Dental , Enfermedades de la Boca , Enfermedades Periodontales , Humanos , Salud Bucal , Calidad de Vida
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