Factores de riesgo que inciden en la reabsorción condilar posterior a cirugía ortognática. Revisión bibliográfica / Risk factors that affect condylar resorption after orthognathic surgery. Literature reviewRisk factors that affect condylar resorption after orthognathic surgery. Literature review

La reabsorción condilar (RC) después de una cirugía ortognática (CO) es una consecuencia no deseada y en ocasiones con complicaciones irreversibles. El propósito de la investigación fue determinar los factores de riesgo que inciden en la RC posterior a una CO, mediante una revisión bibliográfica. Para lo cual se planteó un estudio exploratorio y documental, se realizó una revisión de literatura de los artículos desde el periodo de 2000 hasta el 2020, sin restricción de idioma, se excluyeron las investigaciones en animales e in vitro, resúmenes de congresos, publicaciones de RC relacionadas por enfermedad sistémica y estudios sobre remodelación condilar sin especificar RC posquirúrgica. La búsqueda de información se efectuó entre julio-agosto del 2021, en las bases de datos de Pubmed, Embase y SciELO, inicialmente fue con los términos de RC, CO, reabsorción condilar progresiva, "RC y CO", reportando 1346 artículos iniciales, después se hizo una selección de los estudios en función de los factores de riesgo, identificando 53 artículos, siguiendo los lineamientos de PRISMA. Se incluyeron 23 artículos, el análisis de los mismos demostró que los principales factores de riesgo implicados en la RC posquirúrgica son el sexo femenino de los pacientes, entre 14 y 58 años, con maloclusión clase Angle II, con ángulos del plano mandibular alto (24º- 50º), expuestos a una cirugía bimaxilar, avance mandibular (AM) mayor a 5 mm en sentido antihorario, utilizar una fijación intermaxilar rígida y que la recaída posquirúrgica se puede relacionar con la RC.

Condylar resorption (CR) after orthognathic surgery (OS) is an undesirable consequence and sometimes with irreversible complications. The purpose of the research was to determine the risk factors that affect CR after OS by means of a literature review. For which an exploratory and documentary study was proposed, a literature review of the articles from 2000 to 2020 was carried out, without language restriction, excluding animal and in vitro research, conference abstracts, CR publications related to systemic disease and studies on condylar remodeling without specifying postoperative CR. The search for information was performed between July-August 2021, in Pubmed, Embase and SciELO databases, initially it was with the terms of CR, OS, progressive condylar resorption, "CR and OS", reporting 1346 initial articles, then a selection of studies was made according to risk factors, identifying 53 articles, following the PRISMA guidelines. Twenty-three articles were included, the analysis of which showed that the main risk factors involved in postoperative CR are the female sex of the patients, between 14 and 58 years old, with Angle II class malocclusion, with high mandibular plane angles (24º - 50º), exposed to bimaxillar surgery, mandibular advancement (MA) greater than 5 mm counterclockwise, use of rigid intermaxillary fixation and that postoperative relapse can be related to CR.

Creation and validation of a scale of sexuality for adolescents: Scale of Myths about Sexuality / Creación y validación de una escala de sexualidad para adolescentes: Escala de Mitos sobre la Sexualidad

INTRODUCTION: In recent decades western countries have become more open about sexuality and sexual relations, and adolescents get information about these issues mainly through the internet, TV and social networks. Often such information is incomplete, wrong or even contradicts itself. What favors them to develop myths, false beliefs and/or negative attitudes about sexuality, love, equality in relationships, or Sexually Transmitted Infections. At the same time, the presence of myths favors double standards, sexism, and a negative attitude toward toward personal, partner and/or social sexuality. OBJECTIVES: To create a scale for evaluating the permanence of myths about sexuality in adolescents, and to analyze the structural reliability and validity of this scale. METHOD: The sample was formed by a pilot group (n=216) and a final group (n=661), both with adolescents from high schools in the province of Malaga, obtained by non-probability cluster sampling. The first 69 initial items were given to the pilot sample to determine the final questions making up the "Escala de Mitos sobre la Sexualidad". RESULT: All final items have an item-total correlation over 0.29. A final questionnaire was obtained of 27 items, grouped into 6 components. The Cronbach's alpha coefficient indicated a high internal consistency of the test (0.881). Moreover, it confirms a significant difference between the sexes and between grades (cohorts). CONCLUSION: The Scale has appropriate parameters for use in sex education and research. The use of this scale would help to discover adherence to the myths of adolescents, in order to eliminate them and build a solid, free and personal concept of sexuality

INTRODUCCIÓN: En las últimas décadas se ha producido una apertura respecto a la sexualidad y las relaciones sexuales en los países occidentales. Esto ha propiciado que los adolescentes obtengan información sobre estos temas principalmente en Internet, la televisión y las redes sociales. A menudo, esta información es incompleta, no es verídica o incluso puede llegar a ser contradictoria, lo que favorece que desarrollen mitos, creencias falsas o actitudes negativas sobre la sexualidad, el amor, la igualdad en las relaciones o las infecciones de transmisión sexual. Al mismo tiempo, la existencia de mitos favorece el doble rasero, el sexismo y una actitud negativa hacia la sexualidad personal, la de la pareja o la social. OBJETIVOS: Crear una escala para evaluar la existencia de mitos sobre sexualidad en adolescentes y analizar la fiabilidad y la validez estructural de esta escala. MÉTODO: La muestra estuvo formada por un grupo piloto (n=216) y otro final (n=661), ambos con adolescentes de institutos de la provincia de Málaga, obtenidos mediante muestreo por conglomerados no probabilísticos. Se pasaron los 69 ítems iniciales a la muestra piloto para establecer aquellos enunciados finales que compondrían la Escala de Mitos sobre la Sexualidad. RESULTADO: Todos los ítems finales tienen una correlación ítem-total superior a 0,29. Se obtuvo un cuestionario final de 27 ítems, agrupados en 6 componentes. El coeficiente alfa de Cronbach indicó una elevada coherencia interna de la prueba (0,881). Además, se confirmó una diferencia importante entre sexos y entre los cursos académicos (cohortes). CONCLUSIÓN: La Escala de Mitos sobre la Sexualidad presenta parámetros adecuados para ser utilizada en educación sexual y en investigación. El uso de esta escala ayudaría a descubrir la adhesión a los mitos de los adolescentes, para eliminarlos y construir un concepto de sexualidad sólido, libre y personal

Creation and validation of a scale of sexuality for adolescents: Scale of Myths about Sexuality.

INTRODUCTION: In recent decades western countries have become more open about sexuality and sexual relations, and adolescents get information about these issues mainly through the internet, TV and social networks. Often such information is incomplete, wrong or even contradicts itself. What favors them to develop myths, false beliefs and/or negative attitudes about sexuality, love, equality in relationships, or Sexually Transmitted Infections. At the same time, the presence of myths favors double standards, sexism, and a negative attitude toward toward personal, partner and/or social sexuality. OBJECTIVES: To create a scale for evaluating the permanence of myths about sexuality in adolescents, and to analyze the structural reliability and validity of this scale. METHOD: The sample was formed by a pilot group (n=216) and a final group (n=661), both with adolescents from high schools in the province of Malaga, obtained by non-probability cluster sampling. The first 69 initial items were given to the pilot sample to determine the final questions making up the "Escala de Mitos sobre la Sexualidad". RESULT: All final items have an item-total correlation over 0.29. A final questionnaire was obtained of 27 items, grouped into 6 components. The Cronbach's alpha coefficient indicated a high internal consistency of the test (0.881). Moreover, it confirms a significant difference between the sexes and between grades (cohorts). CONCLUSION: The Scale has appropriate parameters for use in sex education and research. The use of this scale would help to discover adherence to the myths of adolescents, in order to eliminate them and build a solid, free and personal concept of sexuality.

Validación de la versión reducida para adolescentes de la Encuesta revisada de opinión sexual / Validation of the reduced version for adolescents of the Revised sexual opinion survey

Introducción. La Encuesta revisada de opinión sexual (EROS) mide las actitudes sexuales, pero puede resultar extensa para población adolescente. Las actitudes sexuales son importantes de conocer debido a que son uno de los factores que determinan las conductas sexuales. Objetivo. Crear una versión reducida, válida y fiable de dicha escala. También se estudia la influencia del sexo, el tener pareja y el curso escolar. Material y método. El muestreo se realizó por conglomerado no probabilístico, de lo que resultó una muestra de 879 adolescentes, con edades comprendidas entre 12 y 18 años. Se utilizó el cuestionario EROS. Se realizó el cálculo de la ecuación Spearman-Brown para calcular el número definitivo de ítems. Resultados. La ecuación de Spearman-Brown aconseja reducir a 8 ítems la versión definitiva, eligiéndose aquellos que presentaban una mejor correlación ítem-total corregida. Igualmente, el coeficiente alfa de Cronbach indicó una alta consistencia interna de la prueba (0,839). Tras realizar el análisis factorial exploratorio utilizando el análisis de componentes principales y la rotación varimax, se obtuvieron 2 factores, que explican el 60,49% de la varianza. Además, se comprueba que existen diferencias significativas en función de las variables sexo, pareja y curso escolar. Conclusiones. La versión reducida de EROS presenta parámetros adecuados para ser utilizada en investigación. Tiene como ventaja ser más accesible para la población adolescente. Por otro lado, se confirma que el sexo, el curso escolar y el tener pareja influyen en la respuesta ante los estímulos sexuales en dicha población (AU)

Introduction. The Revised sexual opinion survey (R-SOS) measures sexual attitudes, but it can be extensive for adolescent population. It is important to know sexual attitudes, because they are one of the factors that determine sexual conducts. Objective. To create a limited, valid and reliable version of the abovementioned scale. The influence of sex, having a relationship and the academic year is also studied. Material and method. Sampling was carried out by non-probabilistic cluster. This resulted in a sample of 879 adolescents, between 12 and 18 years of age. The questionnaire R-SOS was used. The calculation of the equation Spearman-Brown was performed to obtain the definitive number of items. Results. The Spearman-Brown equation advises to reduce the definitive version to 8 items. Those items that presented a better total-item correlation were elected. Likewise, Cronbach's alpha rate indicated high internal consistency of the test (0.839). Besides, it is proved that significant differences exist according to the variables of sex, being in a relationship and the academic year. Two factors were obtained which explain 60.49% of the variance after conducting the exploratory factor analysis using the analysis of main components and the rotation varimax. Conclusions. The reduced version of R-SOS has adequate parameters to be used in the research. One of its advantages is that it is more accessible for the adolescent population. One the other hand, it has been confirmed how sex, the academic year and being in a relationship influence the answer to sexual stimulants of the abovementioned population (AU)

Síndrome de boca ardiente: claves diagnósticas y terapéuticas / Burning mouth syndrome: Diagnostic and therapeutic keys

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Elevated plasma levels of urotensin II do not correlate with systemic haemodynamics in patients with cirrhosis.

BACKGROUND: The hyperdynamic circulation of hepatic cirrhosis is related to decreased systemic vascular resistance due to arterial vasodilation. Urotensin II plasma levels are increased in cirrhotic patients, and have been suggested to play a role in the pathogenesis of systemic haemodynamic alterations. AIM: To evaluate the relationships between systemic haemodynamics and urotensin II plasma levels. METHODS: Thirty-six consecutive in-patients with cirrhosis and no alteration of plasma creatinine, and 20 age- and gender-matched healthy volunteers underwent noninvasive assessment of systemic haemodynamics and measurement of urotensin II plasma levels. RESULTS: In comparison to healthy controls, cirrhotic patients had signs of hyperdynamic circulation and higher plasma urotensin II levels. Plasma urotensin II was neither significantly different amongst patients with different severity of cirrhosis nor between patients with or without ascites. Both in controls and cirrhotic patients no significant correlations were found between parameters of systemic haemodynamics and plasma urotensin II levels. CONCLUSIONS: In patients with cirrhosis and hyperdynamic circulation, but with normal serum creatinine, urotensin II is higher than in healthy subjects. However, no correlation with cardiac index or other haemodynamic parameters was observed, indicating that other mechanisms prevail.

Effects of cardiac resynchronization therapy on systemic inflammation and neurohormonal pathways in heart failure.

BACKGROUND: The effect of cardiac resynchronization therapy (CRT) on systemic inflammation and neurohormonal alterations associated with heart failure is not well characterized. Accordingly, we aimed to assess the long term effects of CRT on systemic inflammation and neurohormonal factors in heart failure patients. METHODS AND RESULTS: In 47 HF patients (NYHA III-IV) we evaluated, at baseline and after one year of CRT: TNF-alpha, TNF soluble receptors (sTNFR1 and sTNFR2), insulin-like growth factor-1alpha (IGF-1alpha), adiponectin, norepinephrine, pro-atrial natriuretic peptide (pro-ANP), N-terminal-pro-brain natriuretic peptide (NT-proBNP) and angiotensin II, NYHA functional class, quality of life (the Minnesota Living with Heart Failure questionnaire), a 6-minute walk test and an echocardiogram. Long-term CRT decreased activation of renin-angiotensin system (RAS) only in patients with reverse remodelling. It failed to prevent a decline in adiponectin levels, regardless of reverse remodelling. NT-proBNP remained unchanged in patients with reverse remodelling, whereas its levels increased in those without reverse remodelling. IGF-1alpha increased with CRT, whereas CRT had no effect on pro-ANP and inflammatory markers. CONCLUSIONS: Long-term CRT is associated with decreased RAS activation and stabilization of NT-proBNP in heart failure patients with reverse remodelling. Long-term CRT, with or without reverse remodelling, does not affect systemic inflammation and fails to prevent a decline in adiponectin.

Adenosine monophosphate-activated protein kinase modulates the activated phenotype of hepatic stellate cells.

UNLABELLED: Adiponectin limits the development of liver fibrosis and activates adenosine monophosphate-activated protein kinase (AMPK). AMPK is a sensor of the cellular energy status, but its possible modulation of the fibrogenic properties of hepatic stellate cells (HSCs) has not been established. In this study, we investigated the role of AMPK activation in the biology of activated human HSCs. A time-dependent activation of AMPK was observed in response to a number of stimuli, including globular adiponectin, 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside (AICAR), or metformin. All these compounds significantly inhibited platelet-derived growth factor (PDGF)-stimulated proliferation and migration of human HSCs and reduced the secretion of monocyte chemoattractant protein-1. In addition, AICAR limited the secretion of type I procollagen. Knockdown of AMPK by gene silencing increased the mitogenic effects of PDGF, confirming the negative modulation exerted by this pathway on HSCs. AMPK activation did not reduce PDGF-dependent activation of extracellular signal-regulated kinase (ERK) or Akt at early time points, whereas a marked inhibition was observed 24 hours after addition of PDGF, reflecting a block in cell cycle progression. In contrast, AICAR blocked short-term phosphorylation of ribosomal S6 kinase (p70(S6K)) and 4E binding protein-1 (4EBP1), 2 downstream effectors of the mammalian target of rapamycin (mTOR) pathway, by PDGF. The ability of interleukin-a (IL-1) to activate nuclear factor kappa B (NF-kappaB) was also reduced by AICAR. CONCLUSION: Activation of AMPK negatively modulates the activated phenotype of HSCs.

Effect of chronic hepatitis C virus infection on inflammatory lipid mediators.

BACKGROUND: Platelet-activating factor (PAF), a powerful phospholipid mediator of inflammation, is degraded by plasma PAF-acetyl-hydxolase (pPAF-AH), an enzyme which circulates in serum mainly in a complex with lipoproteins that confer its biological activity. Hepatitis C virus (HCV) is linked to lipoproteins in serum too. Reduced pPAF-AH activity was observed in several diseases, including systemic vasculitis. AIM: To evaluate if chronic HCV infection could alter pPAF-AH physiological functions. SUBJECTS: 145 subjects were studied: 56 HCV- and 52 HBV-infected patients (pathologic controls); 37 healthy subjects (healthy controls). METHODS: pPAF-AH activity, PAF and Apo B100 titers were determined in plasma; enzyme expression levels were evaluated in monocyte-derived macrophages. HCV-RNA was detected in plasma, peripheral blood mononuclear cells and liver samples. RESULTS: HCV-infected patients showed an increase of PAF levels following a significant decrease of pPAF-AH activity. A recovery of pPAF-AH activity occurs only in patients who clear HCV after the antiviral treatment. Expression levels of pPAF-AH mRNA and Apo B100 titers were not modified in HCV patients in comparison to controls. CONCLUSION: In light of these results, it is tempting to hypothesize that during chronic HCV infection, the PAF/pPAF-AH system may be altered and this condition may contribute to HCV-related vascular damage.

Impaired sympathetic regulation of cerebral blood flow in patients with cirrhosis of the liver.

Continuous recording of mean cerebral blood flow velocity (MCBFV) by Doppler ultrasound allows detection of low-frequency (LF) oscillations, which reflect sympathetic activity in the cerebral circulation. To establish whether the sympathetic drive to the cerebral circulation is altered in patients with compensated cirrhosis, and, if so, where alterations take place, LF oscillations of MCBFV, heart rate (RR interval) and systolic arterial pressure (SAP) were analysed in 10 patients with cirrhosis and 10 control subjects during supine rest and on stimulation of carotid baroreceptors using a neck chamber applying sinusoidal suction. Bivariate analysis was used to study the relationship between pairs of oscillations. In the case of a significant association, the delay in the appearance of the oscillation in MCBFV, SAP and RR was calculated. Baroreceptor stimulation induced significant increases in SAP LF and RR LF power in both groups, while MCBFV LF power increased only in controls. During baroreceptor stimulation, the lag phase between SAP LF and MCBFV LF power was significantly lower in cirrhotic patients than in control subjects (0.96 compared with 1.59 rad; P<0.01), indicating altered sympathetic regulation of the cerebral circulation. The baroreflex arc was intact, as indicated by the similar pattern of RR-SAP interval in patients and controls. Plasma noradrenaline levels increased significantly in both groups in response to head-up tilt. These results indicate that patients with cirrhosis have an altered sympathetic regulation of the cerebral circulation that is characterized by an inadequate response of resistance microvessels, despite adequate baroreceptor function.

Terceirizaçäo: "O caso Hospital e Maternidade Assunçäo" / Outsourcing: \"The Hospital e Maternidadade Assunçäo case\"

Relata o processo de terceirizaçäo no Hospital e Maternidade Assunçäo. Aborda a terceirizaçäo dentro de sua evoluçäo histórica, aspectos legais e outros temas correlatos. Avalia as vantagens e desvantagens do processo, apresentando os pontos mais importantes para o planejamento, a análise, a decisäo, a contrataçäo, a implantaçäo e a avaliaçäo.