International on-line questionnaire about severe lower gastrointestinal bleeding management: Do we have it clear? / Encuesta internacional on-line sobre el manejo de la hemorragia digestiva baja grave. ¿Lo tenemos claro?

BACKGROUND AND AIMS: The diagnostic and therapeutic strategy in severe lower gastrointestinal bleeding (LGIB) varies depending on the patient's clinical situation. Actual clinical practice guidelines propose different management strategies. We aim to know the attitude of the gastroenterologists from different hospitalary centers in the management of this entity. METHODS: Descriptive and observational study using an on-line questionnaire, addressed to gastroenterologists in Spain and Latin America, in December 2021. RESULTS: We included 281 anonymous questionnaires of gastroenterologists from Spain and Latin America. Diagnostic and therapeutic management of severe LGIB was heterogeneous among the participants. Regarding to the first diagnostic modalities they showed variability between performing computed tomography angiography (CTA) (44.5%), gastroscopy (33.1%), colonoscopy (20.6%) and arteriography (1.1%). The therapeutic attitude after a positive CTA mostly varied between performing arteriography (38.1%) and colonoscopy (44.1%). If negative CTA, in the majority of cases a gastroscopy was performed. If the patient needed intensive critical unit (ICU) care and to undergo colonoscopy, most participants performed an urgent colonoscopy (<24h) (31% always, 43.4% in most cases); while if the patient did not require ICU admission this percentage was lower (10% always, 33.8% in most cases). The 40.9% of the participants admitted having doubts about the management of this patients and the 98.2% considered the need for a creation of an action protocol. CONCLUSIONS: There is a high interhospitalary variability on the management of severe lower gastrointestinal bleeding among gastroenterologists. It is necessary to unify the diagnostic and therapeutic management of this pathology.

Apical debris extrusion during instrumentation with continuous and reciprocating systems

Objective: to evaluate the amount of apical debris extrusion during root canal preparation using continuous and reciprocating systems. Material and Methods: Forty lower incisors were selected and randomly divided into four groups (n=10) for root canal preparation. Two multifile systems with continuous rotation (iRace® and Mtwo®) and two reciprocating single-file systems (Reciproc® and WaveOne®) were used. In the iRace® group, the R1 (15/.06), R2 (25/.04) and R3 (30/.04) instruments were used. In the Mtwo® group, the 10/.04, 15/.05, 20/.06, and 25/.06 instruments were used. In the Reciproc® and WaveOne® groups, the R25 and 25/.04 instruments were used, respectively. Apical debris extrusion was determined by calculating the difference between the pre- and post-instrumentation weight of the Eppendorf tubes. Statistical analysis was performed using the analysis of variance (ANOVA) test with the Bonferroni correction (p<0.05). Results: The iRace® group demonstrated significantly more apical extrusion than the Reciproc® group (p<0.05). There was no statistically significant difference between the Mtwo®, Reciproc®, and WaveOne® groups (p>0.05). Conclusion: All of the evaluated systems produced apical debris extrusion. The iRace® system produced more apical debris extrusion than the Reciproc® system, and there was no difference observed in this regard between the Mtwo®, Reciproc®, and WaveOne® systems.

Objetivo: avaliar a quantidade de debris extruidos apicalmente durante o preparo do canal radicular usando sistemas de rotação contínua e reciprocante. Materiais e Métodos: Quarenta incisivos inferiores foram selecionados e randomicamente divididos em quatro grupos (n=10) para o preparo do canal radicular. Dois sistemas de limas múltiplas de rotação contínua (iRace® e Mtwo®) e dois sistemas de limas únicas reciprocantes (Reciproc® e WaveOne®) foram usados. No grupo iRace®, foram utilizados os instrumentos R1 (15/.06), R2 (25/.04) e R3 (30/.04). No grupo Mtwo®, foram utilizados os instrumentos 10/.04, 15/.05, 20/.06, 25/.06. Nos grupos Reciproc® e WaveOne®, foram utilizados os instrumentos R25 e 25.04, respectivamente. A extrusão apical de debris foi calculada pela diferença entre os pesos dos tubos Eppendorf antes e após a instrumentação. A análise estatística foi feita usando o teste de análise de variância (ANOVA) seguida do teste de Bonferroni (p<0,05). Resultados: O grupo iRace® demonstrou significativamente mais extrusão quando comparado ao Reciproc (p<0,05). Não houve diferença estatisticamente significativa entre os grupos Mtwo®, Reciproc®, e WaveOne® (p>0,05). Conclusão: Todos os sistemas avaliados produziram extrusão apical de debris. O Sistema iRace® produziu mais extrusão apical de debris do que o Sistema Reciproc® e não foi observada diferença entre os sistemas Mtwo®, Reciproc® e WaveOne®.

Influence of age, body mass index and comorbidity on major outcomes in acute pancreatitis, a prospective nation-wide multicentre study.

BACKGROUND: There are few large prospective cohort studies evaluating predictors of outcomes in acute pancreatitis. OBJECTIVES: The purpose of this study was to determine the role of age and co-morbid disease in predicting major outcomes in acute pancreatitis. METHODS: Data points were collected according to a predefined electronic data collection form. Acute pancreatitis and its complications were defined according to the revised Atlanta classification. Univariable and multivariable analyses were conducted using Cox proportional hazard regression and multiple logistic regression. RESULTS: From June 2013-February 2015, 1655 adult patients were recruited from 23 centres across Spain. Co-morbid disease, obesity, open surgical necrosectomy within 30 days, and pancreatic necrosis were independently associated with both 30-day mortality and persistent organ failure (p < 0.05 for all). Age was not associated with persistent organ failure, however the extreme of age (>85 years) was associated with mortality (p < 0.05). Co-morbid disease and obesity were not independently associated with a prolonged length of stay or other markers of morbidity on adjusted analysis (p > 0.05). CONCLUSION: Comorbidity and obesity are important determinates of mortality and persistent organ failure in acute pancreatitis, but in the absence of organ failure they do not appear to independently contribute to morbidity. This has important implications for severity classification and predictive models of severity in acute pancreatitis.

Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention.

Inflammatory bowel diseases (IBD) represent a growing public health concern due to increasing incidence worldwide. The current notion on the pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental triggers. Among the environmental factors associated with IBD, diet plays an important role in modulating the gut microbiome, influencing epigenetic changes, and, therefore, could be applied as a therapeutic tool to improve the disease course. Nevertheless, the current dietary recommendations for disease prevention and management are scarce and have weak evidence. This review summarises the current knowledge on the complex interactions between diet, microbiome and epigenetics in IBD. Whereas an overabundance of calories and some macronutrients increase gut inflammation, several micronutrients have the potential to modulate it. Immunonutrition has emerged as a new concept putting forward the importance of vitamins such as vitamins A, C, E, and D, folic acid, beta carotene and trace elements such as zinc, selenium, manganese and iron. However, when assessed in clinical trials, specific micronutrients exerted a limited benefit. Beyond nutrients, an anti-inflammatory dietary pattern as a complex intervention approach has become popular in recent years. Hence, exclusive enteral nutrition in paediatric Crohn's disease is the only nutritional intervention currently recommended as a first-line therapy. Other nutritional interventions or specific diets including the Specific Carbohydrate Diet (SCD), the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol (FODMAP) diet and, most recently, the Mediterranean diet have shown strong anti-inflammatory properties and show promise for improving disease symptoms. More work is required to evaluate the role of individual food compounds and complex nutritional interventions with the potential to decrease inflammation as a means of prevention and management of IBD.

Asociación de taurodontismo con hipodoncia: ¿puede incluirse el taurodontismo en los "patrones de anomalías dentarias asociadas"? / Association between hypodontia and taurodontism. Could taurodontism be included in DAP?

INTRODUCCIÓN: "Los patrones de anomalías dentarias asociadas” (PAD) comprenden un conjunto de alteraciones dentarias que se presentan juntas con mucha más frecuencia que la explicada por simple azar. Existe controversia sobre si puede incluirse entre los PAD el taurodontismo. OBJETIVO: Demostrar la hipótesis de que existe una asociación entre hipodoncia y taurodontismo, a fin de dilucidar si puede incluirse este último en los PAD. MÉTODO: Se analizó la presencia de taurodontismo en el 36 en las ortopantomografías de una muestra de 100 pacientes con hipodoncia y un grupo control de otros 100 sin hipodoncia obtenidos de la base de datos de la Unidad de Ortodoncia de la Fundación Jiménez Díaz. El diagnóstico de taurodontismo se realizó visualmente. Para ello se comparó la morfología pulpar del paciente con un esquema de 4 imágenes representando una cámara pulpar normal, hipotaurodontismo, y taurodontismo moderado y severo. La posible asociación entre el taurodontismo y la agenesia se evaluó mediante la prueba exacta de Fisher. RESULTADOS: El diagnóstico visual de taurodontismo se hizo en el 9% de los pacientes con hipodoncia y el 3% de los controles. Esta diferencia no alcanzaba significación estadística. CONCLUSIÓN: Aunque la presencia de taurodontismo fue mayor en los pacientes con agenesia que en los controles, los resultados obtenidos no permiten la incuestionable inclusión de esta anomalía en los PAD. Será necesaria la realización de más estudios para aclarar esta posible asociación (AU)

Dental anomaly patterns (DAP) are associated dental abnormalities that are observed together much more frequently than can be explained by chance alone. The inclusion of taurodontism within the group of DAP has been met with controversy. OBJECTIVE: To investigate the association between hypodontia and taurodontism to support its possible inclusion in the DAP. METHODS: Presence of taurodontism of tooth 36 was analyzed in OPGs performed in 100 patients with hypodontia and 100 control subjects obtained from the data base of the Orthodontics Unit of Fundación Jiménez Díaz Hospital (Madrid). To define taurodontism a visual method was used, consisting of a chart comparison with 4 images depicting normal pulpchamber, hypotaurodontism, and moderate and severe taurodontism. Possible association between taurodontism and agenesia was assessed by means of Fisher’s exact test (..) (AU)

Valoración estética de 5 perfiles faciales modificados por ordenador: influencia de la edad del evaluador / Aesthetic assesment of 5 computer-modified facial profiles images: influence of evaluator age

Conseguir una estética facial armoniosa es uno de los principales objetivos del tratamiento de ortodoncia, pero la valoración de cualquier aspecto anatómico que comporte un cierto componente estético está impregnada de subjetividad. La finalidad de este estudio fue comparar la valoración estética dada por un grupo de niños/adolescentes y otro de adultos a cinco perfiles, obtenidos a partir del de un mismo individuo mediante modificaciones por ordenador. Se encontraron diferencias significativas en función de la edad del evaluador, pero no así en función del sexo. Si bien el prognatismo mandibular fue el perfil peor considerado por todos los evaluadores, los niños/adolescentes mostraron mayor aceptación de los perfiles con hipoplasia mandibular y maxilar que los adultos. Conclusión: La apreciación estética del perfil facial se modifica con la edad, de manera que los adolescentes y adultos tienen una percepción similar de las anomalías, mientras que los niños más pequeños tienden a infravalorarlas. (AU)

Attractive facial aesthetics is undoubtedly one of the primary treatment goals of orthodontics. However, perception of anatomical features having an aesthetic component is influenced by subjectivity. The aim of this study was to compare the aesthetic assessment of five different computer-modified facial profiles of the same individual based on evaluations provided by one group of children and teenagers and another comprised of adults. Statistically significant differences were found according to the age of the evaluators, though not their sex. Overall, the participants rated the image depicting mandibular prognathism as the least attractive, although the younger group displayed greater tolerance for profiles with mandibular and maxillary hypoplasia.Conclusion: Aesthetic perception evolves with age,with adolescents and adults sharing a similar view of facial anomalies, while children tend to be less influenced by such features (AU)

Actualización en odontología mínimamente invasiva: remineralización e infiltración de lesiones incipientes de caries / Minimal intervention dentistry update: remineralization and infiltration of incipient caries lesions

Son muchos los autores que coinciden en que el flúor tiene una capacidad de acción limitada y en que el tratamiento de la caries no queda solucionado con la realización, únicamente, de las técnicas de restauración dentarias. Buscando nuevos horizontes en este campo de la odontología, se ha desarrollado el concepto actual de odontología mínimamente invasiva, en el que se engloban los procesos de remineralización e infiltración dentaria. En el presente trabajo se definen cada una de estas terapias y se analizan los resultados científicos publicados sobre la aplicación de las mismas (AU)

Many authors agree with the fact that fluoride has a limited capacity to work and that the medical treatment of cavities is not solved just with the development of teeth restorative techniques. For this reason, the minimal intervention dentistry concept, that includes the remineralization and the dental infiltration, has been recently developed. In this essay each therapy was defined and scientific results published about the products used on them were analyzed (AU)

Comparación de los niveles de contaminación por humo de tabaco ambiental en lugares de trabajo en 4 ciudades de Venezuela / Comparison of environmental tobacco smoke, indoor pollution levels in workplaces in 4 cities in Venezuela

Es bien sabido que el Humo de Tabaco Ambiental (HTA) es un contaminante del aire sumamente peligroso. Este humo contiene alrededor de 4.800 componentes químicos, de los cuales 69 son carcinógenos y muchos otros son irritantes, tóxicos y mutagénicos. Por esta razón Venezuela se ha unido a la lucha mundial contra este enemigo de la salud y para sustentarla se realizó en nuestro país en el año 2006 un estudio de los niveles de contaminación causada por HTA. Con esto se logró comparar la calidad de aire en ambientes cerrados sin prohibición para fumar, o con prohibición parcial (división de área para fumadores y no fumadores), como por ejemplo bares, restaurantes, casinos y transporte; con ambientes con prohibi-ción total para fumar, como universidades y hospitales. Este estudio se realizó midiendo en tiempo real la concentración (µg/m3) de partículas respirables con un diámetro menos a 2,5 µm (PM2.5), estas partículas son liberadas en grandes cantidades por cigarrillos encendidos y están relacionadas con los efectos adversos a la salud que produce el cigarrillo. Se determinó que en los ambientes con prohibición total los niveles de contaminación son 92% más bajos que los ambientes sin prohibición o con una prohibición parcial. Este resultado da a nuestro país el soporte científico para la implementación de políticas Ambientes Libres de Humo de Tabaco, que garanticen a la población un ambiente inocuo.

It is well known that secondhand smoke (SHS) is the main source of pollution in enclosed places to the people, such as: workplaces, public places, public transportation facilities, communities and home. This pollutant contains 4800 chemicals, 69 of which are carcinogens. In addition, many of these substances are toxic, poisonous and mutagenic to the human body. For this reason Venezuela has united to the worldwide fighting against this health hazard. In 2006 our country carried out a study evaluating the pollution levels caused by SHS. In this study was possible to compare air quality in partial or smoking places such as bars, restaurants and in public transport against nonsmoking places such as hospitals and universities. The study was done measuring concentrations (µg/m³) of breathable particles with a diameter less than 2.5 µm (PM2.5) in realtime, which are release by a lighted cigarette. Based on the measures taken, it was possible to determine that in free smoke places the pollution levels are 92% lower compare to smoking places. This result gives to our country the scientific support to establish policies for environments smokefree that warranty the public from the adverse health effects of passive smoking in public places.

Acceptability and characteristics of 124 human bioequivalence studies with active substances classified according to the Biopharmaceutic Classification System.

AIM: The aim of this study was to evaluate the acceptability of 124 bioequivalence (BE) studies with 80 active substances categorized according to the Biopharmaceutics Classification System (BCS) in order to establish if there were different probabilities of proving BE between the different BCS classes. METHODS: We evaluated the differences between pharmaceutical products with active substances from different BCS classes in terms of acceptability, number of subjects in the study (n), the point estimates, and intra- and inter-subject coefficients of variation data from BE studies with generic products. RESULTS: Out of 124 BE studies 89 (71.77%) were performed with pharmaceutical products containing active substances classified by the BCS. In all BCS classes there were non-bioequivalent pharmaceutical products: 4 out of 26 (15.38%) in class 1, 14 out of 28 (50%) in class 2, 3 out of 22 (13.63%) in class 3 and 1 out of 13 (7.69%) in class 4. When we removed those pharmaceutical products in which intra-subject variability was higher than predicted (2 in class 1 active substances, 9 in class 2 and 2 in class 3) there were still non-BE pharmaceutical products in classes 1, 2 and 3. CONCLUSIONS: Comparisons between pharmaceutical products with active substances from the four BCS classes have not allowed us to define differential characteristics of each class in terms of n, inter and intra-subject variability for C(max) or AUC. Despite the usually employed test dissolution methodology proposed as quality control, pharmaceutical products with active substances from the four classes of BCS showed non-BE studies.

Estudios de bioequivalencia: la necesidad de establecer la fiabilidad de los medicamentos genéricos / Bioequivalence studies: need for the reability of generic drugs

Un medicamento genérico es un medicamento que contiene un principio activo ya conocido y previamente desarrollado e inventado por otros. El coste de estos productos genéricos o multifuente debe ser menor que el de sus contrapartidasoriginales. Los efectos clínicos y el balance riesgo-beneficio de un medicamento no dependen exclusivamente de la actividadfarmacológica de la sustancia activa. La demostración de bioequivalencia de los medicamentos genéricos es de gran importancia. En Europa y en los Estados Unidos de Norteamérica la autorización de medicamentos genéricos descansa en la demostración de la bioequivalencia mediante estudios de biodisponibilidad comparada in vivo. Estos argumentos son imprescindibles para la autorización de la comercialización de los fármacos genéricos por parte de las autoridadessanitarias europeas y norteamericanas. Como medida de la cantidad de fármaco absorbido se utiliza el área bajo la curvaconcentración-tiempo (AUC), y como indicador de la velocidad de absorción se mide la concentración máxima (Cmax) alcanzada en la curva concentración-tiempo y el tiempo que tarda en alcanzarse (Tmax). Se entiende por bioequivalencia entre dos productos cuando presentan una biodisponibilidad comparable en condiciones experimentales apropiadas. El objetivo final de todo este proceso tiene como único sentido poner a disposición de la sociedad fármacos de calidad, que además puedan contribuir a una utilización más racional de los recursos económicos en el sistema sanitario.

A generic medicine is a pharmaceutical product containing an active ingredient already known and previously developed and invented by others. The cost of these generic or multisource products should be less than their counterparts original. Theclinical effects and the risk-benefit balance of a medicine do not depend exclusively on the activity of a pharmacologically active substance. Demonstration of bioequivalence of generic medicine is of great importance. In Europe and the UnitedStates generic medicine approval is based in the demonstration of bioequivalence through comparative bioavailability studies in vivo. These arguments are required for marketing approval of generic medicines by the European and North American health authorities. As a measure of the amount of drug absorbed it is used the area under the curve concentrationtime (AUC), and as an indicator of the rate of absorption it is measured the peak concentration (Cmax) reached in the concentration-time curve and the time for its occurrence (Tmax). It is known as bioequivalence between two products when they have a comparable bioavailability in the appropriate experimental conditions. The ultimate goal of this process is to make quality drugs available to society and contribute to a more rational use of economic resources in the health system.