Conflictos éticos en un contexto de gestión pública: objeción de conciencia y aborto en la red sanitaria pública española

En este artículo se sostiene, en primer lugar, que (1) la persistencia a nivel internacional de debates éticos en torno al estatus moral del nasciturus y (2) el tradicional compromiso deontológico de los profesionales sanitarios con la salud, tanto de la embarazada como del hijo que espera, dotan de pleno sentido y vigencia al derecho a la objeción de conciencia de dichos profesionales. Sin embargo, donde el aborto legal se configura como prestación sanitaria, surge entonces la dificultad de gestionar esa prestación y, al tiempo, el conflicto moral que expresa la objeción de conciencia. Si en una institución sanitaria pública la objeción es generalizada, se plantea una disyuntiva con implicaciones éticas entre derivar a las gestantes a otras instituciones o aplicar estrategias de integración de personal a nivel de servicio de salud. En el caso de España, se ha aprobado este año una reforma de la Ley Orgánica de salud sexual y reproductiva y de la interrupción voluntaria del embarazo (LOSSRIVE), que manifiesta una voluntad más taxativa de que la objeción de conciencia no impida el acceso al aborto en las instituciones sanitarias públicas, estableciéndose previsiones específicas al efecto. A partir de los trabajos parlamentarios identificamos los principales puntos de discrepancia política que remiten a dispares posiciones de fondo sobre el aborto y afectan al propio planteamiento de la reforma, así como a otros elementos no siempre novedosos -algunos de ellos ya estaban en la LOSSRIVE o se venían aplicando a nivel autonómico con el plácet del Constitucional.

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements -some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Este artigo argumenta, em primeiro lugar, que (1) a persistência, em nível internacional, de debates éticos sobre o status moral do nascituro e (2) o tradicional compromisso deontológico dos profissionais de saúde com a saúde da gestante e do filho que ela espera, dão pleno sentido e vigência ao direito à objeção de consciência desses profissionais. Entretanto, quando o aborto legal é configurado como um serviço de saúde, surge a dificuldade de gerir esse serviço e, ao mesmo tempo, gerir o conflito moral expresso pela objeção de consciência. Se, em uma instituição de saúde pública, a objeção for generalizada, haverá uma escolha com implicações éticas entre encaminhar as gestantes a outras instituições ou aplicar estratégias de integração de pessoal no nível do serviço de saúde. No caso da Espanha, foi aprovada este ano uma reforma da Lei Orgânica de Saúde Sexual e Reprodutiva e a Interrupção Voluntária da Gravidez (LOSSRIVE) que expressa uma vontade mais constrangedora de garantir que a objeção de consciência não impeça o acesso ao aborto em instituições públicas de saúde, estabelecendo disposições específicas para esse fim. Com base no trabalho parlamentar, identificamos os principais pontos de discrepância política, que remetem a diferentes posições de fundo sobre aborto e afetam a própria aproximação da reforma, assim como outros elementos que nem sempre são novos -alguns deles já estavam no LOSSRIVE ou já estavam sendo aplicados em nível regional com a aprovação do Tribunal Constitucional-.

Arginine methylation of SM-LIKE PROTEIN 4 antagonistically affects alternative splicing during Arabidopsis stress responses.

Arabidopsis (Arabidopsis thaliana) PROTEIN ARGININE METHYLTRANSFERASE5 (PRMT5) post-translationally modifies RNA-binding proteins by arginine (R) methylation. However, the impact of this modification on the regulation of RNA processing is largely unknown. We used the spliceosome component, SM-LIKE PROTEIN 4 (LSM4), as a paradigm to study the role of R-methylation in RNA processing. We found that LSM4 regulates alternative splicing (AS) of a suite of its in vivo targets identified here. The lsm4 and prmt5 mutants show a considerable overlap of genes with altered AS raising the possibility that splicing of those genes could be regulated by PRMT5-dependent LSM4 methylation. Indeed, LSM4 methylation impacts AS, particularly of genes linked with stress response. Wild-type LSM4 and an unmethylable version complement the lsm4-1 mutant, suggesting that methylation is not critical for growth in normal environments. However, LSM4 methylation increases with abscisic acid and is necessary for plants to grow under abiotic stress. Conversely, bacterial infection reduces LSM4 methylation, and plants that express unmethylable-LSM4 are more resistant to Pseudomonas than those expressing wild-type LSM4. This tolerance correlates with decreased intron retention of immune-response genes upon infection. Taken together, this provides direct evidence that R-methylation adjusts LSM4 function on pre-mRNA splicing in an antagonistic manner in response to biotic and abiotic stress.

Alacranismo, aportes de la ciencia y la tecnología a la salud pública en los municipios de Quilmes y La Plata / Alacranism, contributions of science and technology to public health in the municipalities of Quilmes and La Plata

Los escorpiones son arácnidos que pueden causar graves problemas de salud con sus picaduras, especialmente si se trata de especies de la familia Buthidae, como el Tityus trivittatus, que es el más peligroso de Argentina. En la Provincia de Buenos Aires, se ha observado un aumento de la presencia de estos animales en los ámbitos urbanos, lo que implica un mayor riesgo para la población. Sin embargo, no hay un protocolo unificado que permita identificar, registrar y monitorear a los escorpiones de interés sanitario, ni mapas que indiquen su distribución geográfica en cada municipio. Se exponen los resultados del convenio de trabajo realizado entre el municipio de Quilmes y el CEPAVE con el fin de obtener un mapeo de la distribución de escorpiones de interés sanitario y focalizar capacitaciones de promoción de salud y prevención de picaduras. Este trabajo permitió conocer la diversidad, la abundancia y la distribución de las especies de escorpiones en Quilmes, así como también las características de los ambientes donde se los encontró, siendo el puntapié inicial para replicarlo en toda la Provincia.

Brazilian Clinical Strains of Actinobacillus pleuropneumoniae and Pasteurella multocida: Capsular Diversity, Antimicrobial Susceptibility (In Vitro) and Proof of Concept for Prevention of Natural Colonization by Multi-Doses Protocol of Tildipirosin.

One hundred Actinobacillus pleuropneumoniae (App) and sixty Pasteurella multocida subsp. multocida serogroup A (PmA) isolates were recovered from porcine pneumonic lungs collected from eight central or southern states of Brazil between 2014 and 2018 (App) or between 2017 and 2021 (PmA). A. pleuropneumoniae clinical isolates were typed by multiplex PCR and the most prevalent serovars were 8, 7 and 5 (43, 25% and 18%, respectively). In addition, three virulence genes were assessed in P. multocida isolates, all being positive to capA (PmA) and kmt1 genes, all negative to capD and toxA, and most of them (85%) negative to pfhA gene. The susceptibility of both pathogens to tildipirosin was investigated using a broth microdilution assay. The percentage of isolates susceptible to tildipirosin was 95% for App and 73.3% for PmA. The MIC50 values were 0.25 and 1 µg/mL and the MIC90 values were 4 and >64 µg/mL for App and PmA, respectively. Finally, a multiple-dose protocol of tildipirosin was tested in suckling piglets on a farm endemic for both pathogens. Tildipirosin was able to prevent the natural colonization of the tonsils by App and PmA and significantly (p < 0.0001) reduced the burden of Glaesserella parasuis in this tissue. In summary, our results demonstrate that: (i) tildipirosin can be included in the list of antibiotics to control outbreaks of lung disease caused by App regardless of the capsular type, and (ii) in the case of clinical strains of App and PmA that are sensitive to tildipirosin based on susceptibility testing, the use of this antibiotic in eradication programs for A. pleuropneumoniae and P. multocida can be strongly recommended.

Temperature regulation of auxin-related gene expression and its implications for plant growth.

Twenty-five years ago, a seminal paper demonstrated that warm temperatures increase auxin levels to promote hypocotyl growth in Arabidopsis thaliana. Here we highlight recent advances in auxin-mediated thermomorphogenesis and identify unanswered questions. In the warmth, PHYTOCHROME INTERACTING FACTOR 4 (PIF4) and PIF7 bind the YUCCA8 gene promoter and, in concert with histone modifications, enhance its expression to increase auxin synthesis in the cotyledons. Once transported to the hypocotyl, auxin promotes cell elongation. The meta-analysis of expression of auxin-related genes in seedlings exposed to temperatures ranging from cold to hot shows complex patterns of response. Changes in auxin only partially account for these responses. The expression of many SMALL AUXIN UP RNA (SAUR) genes reaches a maximum in the warmth, decreasing towards both temperature extremes in correlation with the rate of hypocotyl growth. Warm temperatures enhance primary root growth, the response requires auxin, and the hormone levels increase in the root tip but the impacts on cell division and cell expansion are not clear. A deeper understanding of auxin-mediated temperature control of plant architecture is necessary to face the challenge of global warming.

Source apportionment of PM10 and health risk assessment related in a narrow tropical valley. Study case: Metropolitan area of Aburrá Valley (Colombia).

This study investigates spatio-temporal variations of PM10 mass concentrations and associated metal(oid)s, δ13C carbon isotope ratios, polycyclic aromatic hydrocarbons (PAHs), total organic carbon (TOC) and equivalent black carbon (eBC) concentrations over a half year period (from March 2017 to October 2017) in two residential areas of Medellín (MED-1 and MED-2) and Itagüí municipality (ITA-1 and ITA-2) at a tropical narrow valley (Aburrá Valley, Colombia), where few data are available. A total of 104 samples were analysed by using validated analytical methodologies, providing valuable data for PM10 chemical characterisation. Metal(oid)s concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS) after acid digestion, and PAHs concentrations were measured by Gas Chromatography-Mass Spectrometry (GC-MS) after Pressurised Hot Water Extraction (PHWE) and Membrane Assisted Solvent Extraction (MASE). Mean PM10 mass concentration ranged from 37.0 µg m-3 to 45.7 µg m-3 in ITA-2 and MED-2 sites, respectively. Al, Ca, Mg and Na (from 6249 ng m-3 for Mg at MED-1 site to 10,506 ng m-3 for Ca at MED-2 site) were the major elements in PM10 samples, whilst As, Be, Bi, Co, Cs, Li, Ni, Sb, Se, Tl and V were found at trace levels (< 5.4 ng m-3). Benzo[g,h,i] perylene (BghiP), benzo[b + j]fluoranthene (BbjF) and indene(1,2,3-c,d)pyrene (IcdP) were the most profuse PAHs in PM10 samples, with average concentrations of 0.82-0.86, 0.60-0.78 and 0.47-0.58 ng m-3, respectively. Results observed in the four sampling sites showed a similar dispersion pattern of pollutants, with temporal fluctuations which seems to be associated to the meteorology of the valley. A PM source apportionment study were carried out by using the positive matrix factorization (PMF) model, pointing to re-suspended dust, combustion processes, quarry activity and secondary aerosols as PM10 sources in the study area. Among them, combustion was the major PM10 contribution (accounting from 32.1 to 32.9% in ITA-1 and ITA-2, respectively), followed by secondary aerosols (accounting for 13.2% and 23.3% ITA-1 and MED-1, respectively). Finally, a moderate carcinogenic risk was observed for PM10-bound PAHs exposure via inhalation, whereas significant carcinogenic risk was estimated for carcinogenic metal(oid)s exposure in the area during the sampling period.

Measuring confidence in physician: Adaptation and validation of TPS in HIV individuals from Mexico / Evaluar confianza en el médico: Adaptación y validación del Trust in Physician Scale (TPS) en personas mexicanas que viven con VIH

Abstract Introduction Patient-physician relationship is associated with ART adherence and medical follow-up in people living with HIV (PLWH). Patient's trust in their doctor is a key component of patient-physician relationship, so adequate and reliable instruments to measure this component are important to evaluate its impact on health outcomes. Objective To evaluate the psychometric properties of a translated and adapted version of Trust in Physician Scale (TPS) in Mexican PLWH. Method A cross-sectional study was carried out in PLWH. Scale was translated to Spanish and culturally adapted. Sociodemographic and TPS data were collected online due to COVID-19 pandemic. Exploratory (EFA) and confirmatory (CFA) factor analysis were carried out in two different samples. Results Data from 215 participants was used to EFA. Five items were eliminated due to low correlation with total scale. Final Cronbach's alpha was .93. A single-factor structure explained 68.8% of the variance. CFA in a sample of 140 participants confirmed adequate fit indices (χ2[7] = 13.015 p = .072, CFI = .997, RMSEA = .057, SMRS = .0015). Discussion and conclusion The final scale was unifactorial and it is made up of six items instead of 11. It seems to be a valid and reliable scale to measure patient's trust in doctors in Mexican PLWH. Further studies are recommended to provide evidence of convergent validity to the instrument.

Resumen Introducción La relación médico-paciente está asociada a la adherencia al tratamiento antirretroviral y al seguimiento médico en las personas que viven con VIH (PVVS). La confianza de los pacientes en sus médicos es un componente clave de la relación médico-paciente, por lo que es importante disponer de instrumentos adecuados y fiables para medir este componente y evaluar su impacto en los resultados de salud. Objetivo Evaluar las propiedades psicométricas de una versión traducida y adaptada de la Trust in Physician Scale (TPS) en PVVS mexicanas. Método Se realizó un estudio transversal en adultos con VIH. La escala fue traducida al español y adaptada culturalmente. Los datos sociodemográficos y de la TPS se recogieron en línea debido a la pandemia de COVID-19. Se realizaron análisis factoriales exploratorios (AFE) y confirmatorios (AFC) en dos muestras diferentes. Resultados Se utilizaron los datos de 215 participantes para el AFE. Se eliminaron cinco ítems debido a la baja correlación con la escala total. El alfa de Cronbach final fue de .93. Una estructura unifactorial explicó el 68.8% de la varianza. El AFC en una muestra de 140 participantes confirmó la adecuación del modelo mostrando índices de ajuste adecuados (χ2[7] = 13.015 p = .072, CFI = .997, RMSEA =.057, SMRS = .0015). Discusión y conclusión La escala final fue unifactorial y se compuso de seis ítems en lugar de 11. Parece ser una escala válida y fiable para medir la confianza del paciente en los médicos en PVVS mexicanas. Se recomiendan más estudios para buscar evidencia de validez convergente del instrumento.

Características clínicas, tratamiento y evolución de una serie de niños con síndrome inflamatorio multisistémico asociado a SARS-CoV-2 hospitalizados en dos centros de salud / Clinical characteristics, treatment and evolution of a series of children with multisystemic inflammatory syndrome associated with SARS-CoV-2 hospitalized in two health centers / Características clínicas, tratamento e evolução de uma série de crianças com síndrome inflamatória multissistêmica associada ao SARS-CoV-2 internadas em dois centros de saúde

Introducción: en marzo del 2021 se registró el pico de incidencia de COVID-19 en Uruguay y un aumento de la infección en pediatría. Objetivo: describir las características clínicas, el tratamiento y la evolución de una serie de menores de 15 años con SIM-Ped S hospitalizados en dos centros de salud. Metodología: estudio descriptivo, retrospectivo, de los niños hospitalizados entre el 1/3 y el 31/6 de 2021 que cumplieron los criterios diagnósticos de SIM-Ped de la OMS. Se analizan variables clínicas, paraclínicas, tratamiento y evolución. Resultados: se incluyeron 12 niños, mediana de edad 7 años (22 meses-10 años). Se presentaron complicación posinfecciosas en 8 y en el curso de la infección en 4. Las manifestaciones fueron: fiebre (media 6 días, rango 3-10), digestivas 10 y mucocutáneas 7. Se presentaron como enfermedad Kawasaki símil 5 y como shock 2. La infección por SARS CoV-2 se confirmó por PCR en 6, serología 4 y test antigénico 2. Recibieron tratamiento en cuidados moderados 8 e intensivos 4: inmunoglobulina 9, corticoides 11, heparina 7 y ácido acetilsalicílico 7. Presentaron dilatación de arterias coronarias 2, alteraciones valvulares 2, disminución de la FEVI 2 y derrame pericárdico 2. Todos evolucionaron favorablemente. Conclusiones: en estos centros, los primeros casos de SIMS-Ped S coincidieron con el pico de incidencia de COVID-19 en el país. Predominaron las formas postinfecciosas en escolares con manifestaciones digestivas. Este estudio puede contribuir al reconocimiento de esta entidad y adecuar los algoritmos nacionales de manejo.

Introduction: in March 2021, there was a peak incidence of COVID-19 and an increase in pediatric infections in Uruguay. Objective: describe the clinical characteristics, treatment and evolution of a group of children under 15 years of age with SIM-Ped S hospitalized in two health centers. Methodology: descriptive, retrospective study of children hospitalized between 3/1 and 6/31 of 2021 who met the WHO diagnostic criteria for SIM-Ped. Clinical and paraclinical variables, as well as treatment and evolution were analyzed. Results: 12 children were included, median age 7 years (22 months-10 years). Eight of them showed post-infectious complications and 4 of them had complications during the course of the infection. The manifestations were: fever (mean 6 days, range 3-10), digestive symptoms 10 and mucocutaneous 7. Five of them presented a Kawasaki-like disease and 2 of them shock. SARS CoV-2 infection was confirmed by PCR in 6 cases, serology in 4 and antigenic test in 2. Eight of them received treatment in moderate care and 4 of them in intensive care: immunoglobulin 9, corticosteroids 11, heparin 7 and acetylsalicylic acid 7. Two of them presented dilated arteries coronary , valvular alterations 2, decreased LVEF 2 and pericardial effusion 2. All progressed favorably. Conclusions: in these centers, the first cases of SIMS-Ped S coincided with the peak incidence of COVID-19 in the country. Post-infectious forms predominated in schoolchildren who showed digestive manifestations. This study may contribute to the recognition of this entity and to the adaptation of national management algorithms.

Introdução: em março de 2021, foi registrado no Uruguai um pico de incidência da COVID-19 e um aumento dos casos da infecção pediátrica. Objetivo: descrever as características clínicas, tratamento e evolução de uma série de crianças menores de 15 anos com SIM-Ped S internadas em dois centros de saúde. Metodologia: estudo descritivo, retrospectivo, de crianças internadas entre 1/3 e 31/6 de 2021 que preencheram os critérios diagnósticos da OMS para o SIM-Ped. Foram analisadas variáveis clínicas e para-clinicas, tratamento e evolução. Resultados: foram incluídas 12 crianças, com idade média de 7 anos (22 meses-10 anos). Oito delas apresentaram complicações pós-infecciosas e 4 delas durante o curso da infecção. As manifestações foram: febre (média de 6 dias, intervalo 3-10), digestivas 10 e mucocutânea 7. Cinco delas apresentaram doença de Kawasaki-like e 2 delas sofreram Shock. A infecção por SARS CoV-2 foi confirmada por PCR em 6, sorologia em 4 e teste antigênico em 2. Oito delas receberam tratamento em cuidados moderados e 4 delas em cuidados intensivos: imunoglobulina 9, corticosteroides 11, heparina 7 e ácido acetilsalicílico 7. Duas delas apresentaram artérias coronárias dilatadas 2, alterações valvares 2, diminuição da FEVE 2 e derrame pericárdico 2. Todas evoluíram favoravelmente. Conclusões: nesses centros, os primeiros casos de SIMS-Ped S coincidiram com um pico de incidência de COVID-19 no país. As formas pós-infecciosas predominaram em escolares com manifestações digestivas. Este estudo pode contribuir para o reconhecimento desta entidade e adaptar algoritmos nacionais de gestão.

Concordancia entre diferentes observadores en la evaluación de las restauraciones dentales en radiografías panorámicas / Agreement among different observers in the evaluation of dental restorations in panoramic radiographs

El objetivo fue evaluar la concordancia entre dife-rentes docentes del Hospital Odontológico Universi-tario de la Facultad de Odontología de la Universidad de Buenos Aires en la evaluación de restauraciones dentales en radiografías panorámicas. Se diseñó un formulario ad-hoc basado en los criterios de Ryge modificados. Se construyeron cinco categorías: pre-sencia y tipo (R), extensión (E), y condición (C), de cada restauración; situación respecto de tratamientos endodónticos (EN) y presencia y tipo de anclaje intra-rradicular (A). Después de diferentes reuniones vir-tuales de calibración con ajustes correspondientes en el formulario, se seleccionaron al azar veinticinco radiografías panorámicas de la base de datos de la Cátedra de Diagnóstico por Imágenes. Tres observa-dores aplicaron en forma simultánea e independien-te las categorías a tres piezas (1.1, 1.3 y 1.6) en cada radiografía. La concordancia se evaluó con Kappa de Fleiss por categoría y por diente/categoría. Resulta-dos: categoría/diente(IC95%): R:1.1: 0,96 (0,90-1,2), 1.3: 0,77 (0,56-0,99), 1.6: 0,92 (0,80-1,03); E: 1.1: 0,92 (0,85-1), 1.3: 0,89 (0,73-1,04), 1.6: 0,92 (0,80-1,03); C: 1.1: 0,88 (0,78-0,98), 1.3: 0,74 (0,38-1,10), 1.6: 1 (1-1); EN: 1.1 y 1.3: 1 (1-1), 1.6: 0.90 (0.77-1.04); A: 1.1 y 1.6: 1 (1-1), 1,3: 0,88 (0,71-1,04). En las condiciones de este trabajo el grado de concordancia según Landis & Koch fue de casi perfecto a sustancial en todas las situaciones analizadas (AU))

The aim of this study was to assess agreement among different observers in the evaluation of dental resto-rations in panoramic x-rays at the Dental Hospital of the School of Dentistry, University of Buenos Aires. Materials and methods: an ad-hoc form based on the modified Ryge criteria was designed. Five categories were built: presence and type (R), extension (E), and condition (C), of each restoration, if present, pre-sence and condition of endodontic treatment (EN) and presence and type of intra-root anchorage devices (A). After several virtual calibration meetings among the observers with subsequent adjustments in the form, twenty-five panoramic x-rays were randomly selected and all categories were assessed in three teeth (1.1, 1.3 and 1.6) in each image. The assessment was carried out simultaneously and independently by three evaluators, who registered the data in the de-signed form. Agreement was assessed by category and by category/tooth with Fleiss Kappa. Results: category/tooth (95% CI): R/1.1: 0.96(0.90-1.2),1.3: 0.77(0.56-0.99), 1.6:0.92 (0.80-1.03); E/1.1: 0.92 (0.85-1), 1.3: 0.89 (0.73-1.04), 1.6: 0.92 (0.80-1.03); C: 1.1: 0.88 (0.78-0.98), 1.3: 0.74 (0.38-1.10), 1.6: 1 (1-1); EN: 1.1 and 1.3: 1 (1-1), 1.6: 0.90 (0.77-1.04); A: 1.1 and 1.6: 1 (1- 1), 1.3: 0.88 (0.71-1.04). Within the conditions of this study the degree of agreement ac-cording to Landis & Koch was from almost perfect to substantial in all the situations analyzed (AU)

Fotobiomodulación con láser de baja intensidad en el tratamiento integral ortodóntico: reporte de un caso / Photobiomodulation with low intensity laser in comprehensive orthodontic treatment: report of a case

El apiñamiento dental es una maloclusión frecuen-te y junto con los requerimientos de estética dental son una causa habitual de la solicitud de tratamien-to ortodóncico. El tiempo que demanda y las moles-tias que pudiera ocasionar el tratamiento produce inquietud en los pacientes y un esfuerzo de los or-todoncistas para optimizar el tiempo y prevenir los efectos adversos. Los tratamientos odontológicos multidisciplinarios permiten una mejor respuesta estética, funcional y de estabilidad post tratamiento. El tiempo de alineación dentaria y finalización, en los pacientes tratados con láser de baja intensidad po-dría mejorar tanto los índices gingivales como la res-puesta al dolor. Adicionalmente, las corticales óseas de los pacientes con ortodoncia tratados con láser, podrían verse menos afectadas en comparación con las de los pacientes no tratados. Se presenta un caso de fotobioestimulación con láser de baja intensidad aplicado en un paciente en fase de alineación, que forma parte de un estudio prospectivo aleatorizado que se desarrolla en la FOUBA y fue aprobado por el comité de Ética de la institución. El paciente aceptó y firmó el consentimiento informado. Finalizada la etapa de alineación, se evaluó la efectividad de la te-rapia con láser de baja intensidad actualmente de-nominada fotobiomodulación en incisivos superiores en la fase de alineación para acelerar el movimiento dentario, la respuesta gingival, el dolor, el estado de la cortical alveolar vestibular y la estética del perfil (AU)

Dental crowding, which is a frequent malocclusion, and dental aesthetic requirements are a common cause for requesting orthodontic treatment. The time that the treatment requires and the inconvenience that it could cause worries the patient and makes orthodontists strive to optimize time and prevent adverse effects. Multidisciplinary treatments would allow a better aesthetic, functional and post-treatment stability response. The dental alignment and completion time in patients treated with low-intensity laser could improve both gingival indices and response to pain. Additionally, the bone cortical of orthodontic patients treated with laser could be less affected compared to those of untreated patients. A case of low-intensity laser photobiostimulation applied to a patient in the alignment phase is presented, which is part of a prospective randomized study carried out at FOUBA and was approved by the institution's Ethics Committee. The patient accepted and signed the informed consent. After the alignment phase, the effectiveness of low-level laser therapy actually called photobiomodulation in upper incisors in the alignment phase is evaluated to accelerate tooth movement; the gingival response; the pain; the vestibular alveolar cortical and the aesthetics of the profile (AU)

Estrategias para la reproducción del color en restauraciones del sector anterior informadas por estudiantes de la Facultad de Odontología de la Universidad de Buenos Aires / Strategies for color reproduction in anterior restorations informed by students of the Faculty of Dentistry, University of Buenos Aires

El objetivo de este estudio fue valorar las estrategias empleadas, por estudiantes de la Facultad de Odon-tología de la Universidad de Buenos Aires para la re-producción del color en restauraciones del sector anterior según autorreporte. Materiales y Métodos: Se confeccionó un formulario en Google Forms (F) que los alumnos completaron en sus celulares con la información correspondiente a cada restaura-ción terminada. Resultados (IC95%): Se registraron 97 restauraciones en el sector anterior. El 57,73 % (47,79 - 67,09) proximales no involucraban el ángu-lo incisal y el 21,65 % (14,62 - 30,84) sí. Un 11,34 % (6,45 - 19,17) localizada en el tercio cervical. En el 93,81 % (87,15 - 97,13) se utilizó al menos una capa de composite de opacidad esmalte (E) mientras que en el 77,32 % (68,04 - 84,52) al menos una de dentina (D). En el 73,19 % (63,63 - 81,01) se utilizaron al me-nos dos opacidades E y D. Los colores de E más utili-zados fueron A2 y A3, 31,87 % (23,19 - 42,01) y 37,36 % (28,12 - 47,62) respectivamente, y el A3 de D 54,67 % (43,45 - 65,43). Tres fueron las estrategias princi-pales para la combinación de colores y opacidades: el empleo de colores iguales en ambas opacidades, y el uso de opacos de mayor o de menor intensidad; entre las que no se encontró ninguna predominante. Conclusiones: A partir de los resultados del presente estudio se puede concluir que en la mayoría de las restauraciones del sector anterior se emplean com-posites de al menos dos opacidades y que no hay una estrategia de asociación de opacidad y color predominante (AU)

The aim of this study was to assess the strategies that students from the Facultad de Odontología, Universidad de Buenos Aires claim to use for color reproduction in anterior restorations. Materials and Methods: A form was created in Google Forms (F) and students were instructed to complete on 40REV FAC ODONTOL, UNIV BUENOS AIRES 2023 VOL 38 N° 90RepRoducción del coloR en RestauRaciones del sectoR anteRioRFosas y fisurasProximales sin compromiso de ánguloProximales con compromiso de ánguloTercio cervicalcaras libres706050403020100% (IC95%)57,73%21,65%11,34%9,28%their cell phones with the corresponding information about each completed restoration. Results(95CI%):97 restorations were recorded in the anterior sector of which 57.73 % (47.79 - 67.09) were proximal and 21.65 % (14.62 - 30.84) that involved the incisal edge.11.34 %(6.45 - 19.17) were located in the cervical third of the vestibular surfaces. In 97.94 % of the restorations Brilliant New Generation (Coltene) the chosen composite, in 93.81 % (87.15 - 97.13) enamel opacity composite (E) was used at least for one layer, while in 77.32 % (68. 04 - 84.52) at least one layer of dentin (D) was applied. In 73.19 % (63.63 - 81.01) at least two opacities E and D were required. The most used E shades were A2 and A3, 31.87 % (23.19 - 42, 01) and 37.36 % (28.12 - 47.62) respectively, and A3 of D shades 54.67 % (43.45 - 65.43). Three core strategies were identified: the use of the same colors in both opacities, and the use of opaque of greater or lesser intensity; among which no predominance was found. Conclusions: Within the conditions of this study, it can be concluded that composites of at least two opacities are used in most anterior sector restorations and that there is no predominant opacity and color association strategy (AU)

Prevalence of Human Intestinal Entamoeba spp. in the Americas: A Systematic Review and Meta-Analysis, 1990-2022.

Among the seven species of Entamoeba known to infect humans, E. histolytica is widely recognized as a pathogen. It is reported that Entamoeba infections are common in the developing world, but rare in developed countries. The best way to diagnose these protozoan parasites is to detect antigens or DNA in the stool. This study aimed to review the prevalence, distribution, and diagnosis methods of Entamoeba spp. infecting humans in the Americas between 1990 and 2022. A systematic review and meta-analysis were performed, including 227 studies on Entamoeba infections from 30 out of 35 American countries. The pooled prevalence of each species of Entamoeba was calculated using the random-effects model. The assignment of Entamoeba species was mainly performed by microscopy. The most widely distributed and prevalent species was E. coli (21.0%). Of the studies, 49% could not differentiate the species of the Entamoeba complex. The pathogenic species E. histolytica was distributed among 22 out of 30 American countries studied, with a pooled prevalence of 9%. Molecular data on Entamoeba species are still scarce. This is the first study that reviewed and summarized data on the prevalence of this protozoan genera among American countries.

Tooth color in dental students from Buenos Aires University, Dental School, Argentina.

The aim of this study was to evaluate tooth color in dental students at the University of Buenos Aires, Argentina. The participants were 184 students (157 women and 27 men) aged 21 to 33 years, mean age 24.45 (SD 2.79) years, who were in the fourth year of their dental degree. They agreed to participate through an informed consent. Exclusion criteria were: having undergone a bleaching treatment within the previous six months, presence of total or partial peripheral restoration, pigmentations, fracture, carious and non-carious lesions or absence of the right upper central incisor (1.1). A dental prophylaxis procedure was performed on the buccal surface of each 1.1 tooth with a prophylaxis brush (TDV) mounted on a low-speed rotary instrument Kavo 2068 CHC (Germany) micromotor and a Kavo LUX K201(Germany) contra-angle. Shade was measured in the middle third of each 1.1 tooth, by the same observer, using a VITA Easyshade V spectrophotometer (Zahnfabrikn Bad Säckingen, Germany), which was calibrated before each determination according to manufacturer's instructions, in the same dental unit (Sino S2316), with natural illumination, in the same time slot, without using the dental unit lamp. The results were recorded in an ad-hoc form and rates and confidence interval were obtained. Shade prevalence percentages (95% CI) were: A1: 46.2 (38.83 - 53.68); followed by A2 and B2, both with 17.39 (12.21 - 23.66); A3: 6.52 (3.41-11.11); B1: 4.35 (1.9-8.39); D2: 2.72 (0.89 - 6.23); B3: 2.17 (0.60-5.47) and C2: 1.09 (0.13-3.87); D3, C3, A3.5 and A4: 0.54 (0.01-2.99). Shades D1 and C1 were not determined in any subject. Within the conditions of this study, A1 was the most prevalent shade in central incisors, followed by A2 and B2.

El objetivo de este estudio fue evaluar la prevalencia de color dental en estudiantes de odontología de la Universidad de Buenos Aires (UBA). Los participantes fueron 184 estudiantes de cuarto año de la carrera de Odontología (157 mujeres y 27 hombres) de entre veintiuno y treinta tres años, con un promedio de edad de 24,45 (DE 2,79) años que aceptaron participar mediante consentimiento informado. Criterios de exclusión: quienes hayan recibido blanqueamiento en los últimos seis meses, tenían una restauración periférica total o parcial, pigmentaciones, fractura, lesiones cariosas y/o no cariosas en el incisivo central superior derecho (1.1) o éste estaba ausente. Se realizó profilaxis dental en la superficie bucal de cada 1.1 con un cepillo ad-hoc (TDV) montado en un micromotor de baja velocidad Kavo 2068 CHC (Alemania) y un contra-ángulo Kavo LUX K201 (Alemania). La medición del color se llevó a cabo en el tercio medio de cada 1.1, por el mismo observador, en la misma clínica dental, con iluminación natural en la misma franja horaria y sin utilizar la lámpara del equipo dental. Se utilizó un espectrofotómetro VITA Easyshade V (Zahnfabrikn Bad Säckingen, Alemania) que se calibró antes de cada determinación de acuerdo con las instrucciones del fabricante. Los resultados se registraron en una planilla ad-hoc y se obtuvieron tasas e intervalos de confianza. Prevalencia de colores % (IC 95%): A1: 46,2 (38,83 - 53,68), seguido de A2 y B2 ambos con 17,39 (12,21 - 23,66), A3: 6,52 (3,41-11,11), B1: 4,35 ( 1,9- 8,39), D2: 2,72 (0,89 - 6,23), B3: 2,17 (0,60-5,47) y C2: 1,09 (0,13- 3,87); D3, C3, A3.5 y A4: 0.54 (0.01-2.99) D1 y C1 no se determinaron en ningún sujeto. Dentro de las condiciones de este estudio A1 fue el color más prevalente en los incisivos centrales de estudiantes de odontología, seguido de A2 y B2.

Tooth color in dental students from Buenos Aires University, Dental School, Argentina / Color dentario en estudiantes de la Facultad de Odontología de la Universidad de Buenos Aires, Argentina

ABSTRACT The aim of this study was to evaluate tooth color in dental students at the University of Buenos Aires, Argentina. The participants were 184 students (157 women and 27 men) aged 21 to 33 years, mean age 24.45 (SD 2.79) years, who were in the fourth year of their dental degree. They agreed to participate through an informed consent. Exclusion criteria were: having undergone a bleaching treatment within the previous six months, presence of total or partial peripheral restoration, pigmentations, fracture, carious and non-carious lesions or absence of the right upper central incisor (1.1). A dental prophylaxis procedure was performed on the buccal surface of each 1.1 tooth with a prophylaxis brush (TDV) mounted on a low-speed rotary instrument Kavo 2068 CHC (Germany) micromotor and a Kavo LUX K201(Germany) contra-angle. Shade was measured in the middle third of each 1.1 tooth, by the same observer, using a VITA Easyshade V spectrophotometer (Zahnfabrikn Bad Säckingen, Germany), which was calibrated before each determination according to manufacturer's instructions, in the same dental unit (Sino S2316), with natural illumination, in the same time slot, without using the dental unit lamp. The results were recorded in an ad-hoc form and rates and confidence interval were obtained. Shade prevalence percentages (95% CI) were: A1: 46.2 (38.83 - 53.68); followed by A2 and B2, both with 17.39 (12.21 - 23.66); A3: 6.52 (3.41-11.11); B1: 4.35 (1.9-8.39); D2: 2.72 (0.89 - 6.23); B3: 2.17 (0.60-5.47) and C2: 1.09 (0.13-3.87); D3, C3, A3.5 and A4: 0.54 (0.01-2.99). Shades D1 and C1 were not determined in any subject. Within the conditions of this study, A1 was the most prevalent shade in central incisors, followed by A2 and B2.

RESUMEN El objetivo de este estudio fue evaluar la prevalencia de color dental en estudiantes de odontología de la Universidad de Buenos Aires (UBA). Los participantes fueron 184 estudiantes de cuarto año de la carrera de Odontología (157 mujeres y 27 hombres) de entre veintiuno y treinta tres años, con un promedio de edad de 24,45 (DE 2,79) años que aceptaron participar mediante consentimiento informado. Criterios de exclusión: quienes hayan recibido blanqueamiento en los últimos seis meses, tenían una restauración periférica total o parcial, pigmentaciones, fractura, lesiones cariosas y/o no cariosas en el incisivo central superior derecho (1.1) o éste estaba ausente. Se realizó profilaxis dental en la superficie bucal de cada 1.1 con un cepillo ad-hoc (TDV) montado en un micromotor de baja velocidad Kavo 2068 CHC (Alemania) y un contra-ángulo Kavo LUX K201 (Alemania). La medición del color se llevó a cabo en el tercio medio de cada 1.1, por el mismo observador, en la misma clínica dental, con iluminación natural en la misma franja horaria y sin utilizar la lámpara del equipo dental. Se utilizó un espectrofotómetro VITA Easyshade V (Zahnfabrikn Bad Säckingen, Alemania) que se calibró antes de cada determinación de acuerdo con las instrucciones del fabricante. Los resultados se registraron en una planilla ad-hoc y se obtuvieron tasas e intervalos de confianza. Prevalencia de colores % (IC 95%): A1: 46,2 (38,83 - 53,68), seguido de A2 y B2 ambos con 17,39 (12,21 - 23,66), A3: 6,52 (3,41-11,11), B1: 4,35 ( 1,9- 8,39), D2: 2,72 (0,89 - 6,23), B3: 2,17 (0,60-5,47) y C2: 1,09 (0,13- 3,87); D3, C3, A3.5 y A4: 0.54 (0.01-2.99) D1 y C1 no se determinaron en ningún sujeto. Dentro de las condiciones de este estudio A1 fue el color más prevalente en los incisivos centrales de estudiantes de odontología, seguido de A2 y B2.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños.

BACKGROUND: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. METHODS: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. RESULTS: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. CONCLUSIONS: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

INTRODUCCIÓN: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. MÉTODOS: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. RESULTADOS: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. CONCLUSIONES: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

High-dose vitamin D versus placebo to prevent complications in COVID-19 patients: Multicentre randomized controlled clinical trial.

BACKGROUND: The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19. METHODS AND FINDINGS: We designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failure Assessment score between baseline and the highest value recorded up to day 7. Secondary outcomes included the length of hospital stay; intensive care unit admission; and in-hospital mortality. Overall, 115 participants were assigned to vitamin D3 and 105 to placebo (mean [SD] age, 59.1 [10.7] years; 103 [47.2%] women). There were no significant differences in the primary outcome between groups (median [IQR] 0.0 [0.0-1.0] vs 0.0 [0.0-1.0], for vitamin D3 and placebo, respectively; p = 0.925). Median [IQR] length of hospital stay was not significantly different between vitamin D3 group (6.0 [4.0-9.0] days) and placebo group (6.0 [4.0-10.0] days; p = 0.632). There were no significant differences for intensive care unit admissions (7.8% vs 10.7%; RR 0.73; 95% CI 0.32 to 1.70; p = 0.622), or in-hospital mortality (4.3% vs 1.9%; RR 2.24; 95% CI 0.44 to 11.29; p = 0.451). There were no significant differences in serious adverse events (vitamin D3 = 14.8%, placebo = 11.7%). CONCLUSIONS: Among hospitalized patients with mild-to-moderate COVID-19 and risk factors, a single high oral dose of vitamin D3 as compared with placebo, did not prevent the respiratory worsening. TRIAL REGISTRATION: ClincicalTrials.gov Identifier: NCT04411446.

Application of cinematographic vignettes to teaching in Mental Health / Aplicación de viñetas cinematográficas a la docencia en Salud Mental.

In this work some ideas about the possible relationships between cinema and psychopathology are presented. To carry out this task, the results of an experience carried out at the IUSAM-APdeBA are described, where a particular way of telling patient stories is explored, which is the cinematographic story. One of the many possible varieties of communicating clinical cases, in addition to the classic written and oral forms, is the audiovisual format. It is known that it is not easy to find good patient stories; even more so in these times where the possibilities of communicating real cases have been restricted by ethical-legal regulations. It has been observed that the audiovisual clinical vignettes extracted from the cinematographic stories can be a very useful tool for the purposes of discussion, exchange and teaching in psychopathology.

En este trabajo se presentan algunas ideas en torno a las relaciones posibles entre cine y psicopatología. Para llevar adelante esta tarea se describen los resultados de una experiencia realizada en el IUSAM-ApdeBA donde se explora un modo particular de contar historias de pacientes que es el relato cinematográfico. Una de las tantas variedades posibles de comunicar casos clínicos, además de las clásicas forma escrita y la oral, es el formato audiovisual. Es sabido que no resulta fácil encontrar buenas historias de pacientes, más aun en estos tiempos donde las posibilidades de comunicar casos reales se ha visto restringido por normativas ético-legales. Se ha podido observar que las viñetas clínicas audiovisuales extraídas de los relatos cinematográficos pueden resultar una herramienta de gran utilidad para fines de discusión, intercambio y docencia en psicopatología.

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños / Clinical practice guidelines for diagnosis and management of acute otitis media in children

Resumen Introducción: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. Métodos: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Resultados: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. Conclusiones: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

Abstract Background: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. Methods: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. Results: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. Conclusions: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

Central incisors shape and proportions prevalence in Argentinian university students: by visual assessment and a new standardized method.

The aim of this study was to analyze the dimensions of the clinical crown of upper central incisors and the prevalence of tooth shapes by two different protocols. Assessment was performed on each of the 111 dental stone type V maxillae models of students of dentistry from Buenos Aires University [93 females and 18 males, mean age 23.70 (± 2.26) years] The mesial and distal-vestibular angles were defined on each right upper incisor, and the following segments were defined: AB (zenith - incisal edge), CD, EF, GH (apical, middle, and incisal thirds - vestibule - mesial and vestibule-distal angles) and their lengths were determined with a precision caliper. Then, the CD/AB, EF/AB and mean CD-EF/AB ratios were calculated. Shapes were assessed by four independent observers, three of whom evaluated digital images of the models, while the fourth had no access to the images, and determined the shapes using an algorithm developed from the dimensions of the studied segments. Rates and confidence intervals were determined, and Fleiss' Kappa was calculated to assess the agreement among the evaluators who worked with the images and among all of them. Average incisor length was 10 mm, and widths at CD and EF were 7.35 mm (0.65) and 8.27 mm (0.58), respectively. Regarding shapes, 51.58% (47.90-55.20) of the incisors were identified as square, 18.02% (14.50-21.90) as ovoid and 30.41% (30.00-30.90) as triangular. Fleiss' Kappa agreement was 0.71 (0.62-0.80). The application of the proposed algorithm provided a considerable level of agreement among the observers. Regarding tooth size, both the average segment length and the proportions were similar to those reported by various authors.

El objetivo de este trabajo fue analizar las dimensiones de las coronas clínicas de incisivos centrales superiores, y la prevalencia de cada una de las formas dentarias según diferentes formas de determinación. Se utilizaron modelos de yeso tipo V de 111 estudiantes (93 mujeres y 18 varones) con una media de edad de 23,70 (± 2,26) años. Se definieron los ángulos vestíbulo - mesial y distal para los incisivos centrales superiores derechos (1.1), se definieron los siguientes segmentos: AB (cenit - borde incisal), CD, EF, GH (tercios apical, medio e incisal - ángulos vestíbulo - mesial y vestíbulo- distal) y se determinaron sus longitudes con un calibre de precisión. Se calcularon las proporciones CD/AB, EF/AB y media CDEF/ AB. Las formas de las piezas dentarias fueron identificadas por cuatro observadores independientes, tres lo hicieron mediante la evaluación de imágenes digitales de los modelos confeccionados. El cuarto observador, sin acceso a las imágenes, asignó a cada pieza una de las formas determinadas mediante la aplicación de un algoritmo elaborado ad-hoc. Se obtuvieron tasas e intervalos de confianza y se calculó Kappa de Fleiss para valorar la concordancia entre evaluadores. La longitud promedio fue de 10 mm y el ancho en los segmentos CD y EF fueron de 7.35 mm (0.65) y 8.27 mm (0.58) respectivamente. En cuanto a formas el 51,58% (47.90-55.20) de los incisivos estudiados fueron identificados como cuadrados, el 18.02% (14.50-21.90) como ovoides y el 30,41% (30.00-30.90) triangulares. La concordancia de Kappa de Fleiss fue de 0.71 (0.62-0.80). La aplicación del algoritmo propuesto alcanzó un nivel de concordancia considerable entre los evaluadores. En cuanto al tamaño dentario, tanto la longitud promedio de los segmentos estudiados como las proporciones halladas son similares a las reportadas por diversos autores.

Transmittance of lithium disilicate ceramic of different thicknesses and opacities with different curing units.

The aim of this study was to evaluate the amount of radiating energy transmitted through lithium disilicate discs of different thicknesses and opacities with different curing units (CU). Discshaped specimens 8 mm in diameter and 1.5 mm or 0.7 mm thick were designed with Zbrush® and Cura 3D® software, milled from HT and MO IPS e-maxCAD blocks (Ivoclar Vivadent) with Ceramill Mikro 4 (Amann Girrbach, Austria) and processed according to manufacturer instructions. Thickness was checked with a Mitutoyo (México) caliper. Four groups (n=4) were formed: G1(HT/1.5 mm), G2(MO/1.5 mm), G3(HT/0.7 mm) y G4(MO/0.7 mm), and the effect of three CUs: Coltolux (Coltene- Whaledent), LED.C, (Woodpecker Medical Instrument Co.Ltd) and Deepcure L(3M-ESPE) was tested Measurements were taken with a halogen and LED radiometer (Woodpecker® LM-1-Guilin Woodpecker Medical Instrument Co.Ltd) after applying the guide of each CU directly on the reading window (d) and after interposing each of the specimens. The ratio of transmitted energy was determined in each case and data was analyzed with repeated measures ANOVA and Tukey test for multiple comparisons. LED.C: d:1600 mW/cm2, G1: 0.31(0.00), G2: 0.14(0.00) G3: 0.54(0.01), G4: 0.38(0.01); Deepcure L: d:1500 mW/cm2, G1: 0.34(0.01), G2: 0.20(0,00), G3: 0.56(0.01), G4: 0.41(0.02); Coltolux: d:1275 mW/cm2, G1: 0.44(0.01), G2: 0.24(0,00), G3: 0.65(0.01), G4: 0.47(0,00). Statistically significant differences were found among the curing units (P<0.001) and for the interaction CU-thickness (P<0.001) and CU-opacity (P=0.023). Within the conditions of this study, the ratio of light transmitted through lithium disilicate structures is related to their thickness and opacity, and to the curing unit employed.

Uno de los factores relacionados con éxito de las restauraciones y prótesis de cerámica de matriz vítrea es el logro de una fijación adhesiva para lo cual la correcta polimerización del medio de fijación es un requisito fundamental. El objetivo de este trabajo fue valorar la transmitancia de una cerámica a base de disilicato de litio de diferentes opacidades y espesores, con distintas unidades de curado. Probetas con forma de discos de 8mm de diámetro y dos diferentes espesores (1.5 mm y 0.7 mm) fueron diseñadas con Zbrush® y Cura 3D®, maquinadas a partir de bloques HT y MO de IPS e-maxCAD (Ivoclar Vivadent) con Ceramill Mikro 4 (Amann Girrbach, Austria) y procesadas según instrucciones del fabricante. Se obtuvieron cuatro grupos (n=4): G1(HT/1.5 mm), G2(MO/1.5 mm), G3(HT/0.7 mm) y G4(MO/0.7 mm),los espesores se controlaron con un calibre (Mitutoyo, México). A continuación, se registró la irradiancia con cada una de las unidades de curado (UC) Coltolux (Coltene- Whaledent) LED.C, (Woodpecker Medical Instrument Co.Ltd) y Deepcure L(3M-ESPE), aplicadas sobre la ventana de un radiómetro (Halogen and led radiometer Woodpecker® LM-1-Guilin Woodpecker Medical Instrument Co.Ltd) en forma directa (d), y luego de interponer los diferentes especímenes y se calculó la proporción de energía transmitida en cada caso. Los datos se analizaron con ANOVA de medidas repetidas y prueba de Tukey para las comparaciones múltiples. LED.C: d:1600 mw/ cm2, HT/0,7mm: 0,54(0,01), HT/1,5mm:0,31(0); MO/0,7mm: 0,38(0,01), MO/1,5mm: 0,14(0,00); Deepcure L: d:1500 mW/ cm2, HT/0,7 mm: 0,56(0,01), HT/1,5 mm: 0,34(0,01), MO/0,7 mm: 0,41(0,02), MO/1,5 mm: 0,20(0,00); Coltolux: d:1275 mw/ cm2, HT/0,7 mm:0,65 (0,01), HT/1,5 mm:0,44(0,01), MO/0,7 mm: 0,47(0,00), MO/1,5mm: 0,24(0,00). Se encontraron diferencias estadísticamente significativas entre las diferentes unidades de curado (P<0,001), y en la interacción unidades de curado-espesor (P<0,001) y unidades de curado-opacidad (P=0,023). La proporción de energía luminosa transmitida por una estructura de cerámica de disilicato de litio depende del espesor y opacidad de la restauración y de la unidad de curado utilizada.