Modeling the impact of measured and projected climate and management systems on agricultural fields: Surface runoff, soil moisture, and soil erosion.

As global climate change poses a challenge to crop production, it is imperative to prioritize effective adaptation of agricultural systems based on a scientific understanding of likely impacts. In this study, we applied an integrated watershed modeling framework to examine the impacts of projected climate on runoff, soil moisture, and soil erosion under different management systems in Central Oklahoma. The proposed model uses measured climate data and three downscaled ensembles from the Coupled Model Intercomparison Project Phase 6 (CMIP6) at the water resources and erosion watershed to understand the impact of climate change and various climate conditions under three management systems: (1) continuous winter wheat (Triticum aestivum) under conventional tillage (WW-CT; baseline system), (2) continuous winter wheat under no-till (WW-NT), and (3) cool and warm season forage cover crop mixes under no-till (CC-NT). The study indicates that the occurrence of agricultural drought is projected to increase while erosion rates will remain unchanged under the WW-CT. In contrast, climate simulations imposed on the WW-NT and CC-NT systems significantly reduce runoff and sediment while preserving soil moisture levels. Especially, implementing the CC-NT system can bolster food security and foster sustainable farming practices in Central Oklahoma in the face of a changing climate.

Integrative BNN-LHS Surrogate Modeling and Thermo-Mechanical-EM Analysis for Enhanced Characterization of High-Frequency Low-Pass Filters in COMSOL.

This paper pioneers a novel approach in electromagnetic (EM) system analysis by synergistically combining Bayesian Neural Networks (BNNs) informed by Latin Hypercube Sampling (LHS) with advanced thermal-mechanical surrogate modeling within COMSOL simulations for high-frequency low-pass filter modeling. Our methodology transcends traditional EM characterization by integrating physical dimension variability, thermal effects, mechanical deformation, and real-world operational conditions, thereby achieving a significant leap in predictive modeling fidelity. Through rigorous evaluation using Mean Squared Error (MSE), Maximum Learning Error (MLE), and Maximum Test Error (MTE) metrics, as well as comprehensive validation on unseen data, the model's robustness and generalization capability is demonstrated. This research challenges conventional methods, offering a nuanced understanding of multiphysical phenomena to enhance reliability and resilience in electronic component design and optimization. The integration of thermal variables alongside dimensional parameters marks a novel paradigm in filter performance analysis, significantly improving simulation accuracy. Our findings not only contribute to the body of knowledge in EM diagnostics and complex-environment analysis but also pave the way for future investigations into the fusion of machine learning with computational physics, promising transformative impacts across various applications, from telecommunications to medical devices.

Oral lesions of systemic lupus erythematosus: A collaborative Latin American study.

BACKGROUND: Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America. METHODS: This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions. RESULTS: Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11-77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases. CONCLUSION: Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment.

Arthrodesis vs arthroplasty for moderate and severe Hallux rigidus: Systematic review.

Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced stages of the disease, when conservative treatment has failed. Although arthrodesis may be considered the technique recommended by multiple authors, for patients in whom joint mobility is to be preserved, arthroplasty could represent a reliable alternative. The purpose of this systematic review is to investigate and compare the clinical outcomes and complications of arthrodesis and interposition arthroplasty for moderate and severe stages of hallux rigidus. METHODS: For this systematic review we searched COCHRANE, EMBASE, PUBMED databases. Twenty-six research papers were obtained, with a total of 1348 feet, which were included for qualitative analysis. The following groups were included: Cartiva hemiarthroplasty (286), double stem silicone arthroplasty (276), total metallic arthroplasty (394) and arthrodesis (392). RESULTS: In the arthrodesis group, the AOFAS-HMI score was the most used, ranging from 36 to 45 in the preoperative period and from 79 to 89 in the postoperative period. The greatest improvement in the VAS PAIN score was from 86 to 4. The fusion rate was 98.6% of the total number of cases, the most frequent complication was pain due to material discomfort. In the total metallic arthroplasty group, the ROTO-GLIDE system reported an AOFAS score of 95 points, with low complication rates; but, with the TOEFIT-PLUS and BIOMED-MERCK systems, despite the good postoperative value, they report 37% and 15% revision due to aseptic loosening in the series with the longest follow-up, respectively. The Cartiva group showed a significative increase in FAAM ADL and FAAM SPORT from 59.4 to 90.4 and from 60.9 to 89.7, respectively; similarly, 20.5% implant removal and conversion to arthrodesis were reported. Finally, the double stem silicone arthroplasty group, in the series with the longest follow-up, it manages to improve the MOXFQ score from 78.1 to 11.0, with an average range of mobility of 22.3 degrees. Lysis was reported in 10% of cases. CONCLUSIONS: Arthrodesis has proven to be the best option for the treatment of advanced hallux rigidus. Arthroplasty can be a valid option for patients who demand to maintain the range of mobility of the joint; however, it is important to inform about the complications that may arise in the short and medium term. LEVEL OF CLINICAL EVIDENCE: II.

El viaje del paciente con fibromialgia en Latinoamérica / The patient journey of fibromyalgia in Latin America

Objetivos: Explorar la experiencia de las personas con fibromialgia (FM) en países latinoamericanos con objeto de identificar problemas en la atención sanitaria y otros ámbitos potencialmente solucionables. Métodos: Estudio cualitativo con enfoque fenomenológico y de análisis de contenido a través de grupos focales y metodología de viaje del paciente (Ux del inglés User Experience). Se llevaron a cabo 9 grupos focales virtuales con pacientes con FM y profesionales sanitarios en Argentina, México y Colombia reclutados a partir de informantes clave y redes sociales. Resultados: Participaron 43 personas (33 clínicos y 10 pacientes). Los agentes que interaccionan con el paciente en la enfermedad se encuentran en 3 esferas: la de la atención sanitaria, la del apoyo y vida laboral y la del contexto socioeconómico. La línea del viaje presenta 2 grandes tramos, 2 bucles y una línea discontinua delgada. Los 2 grandes tramos representan los tiempos que van desde los primeros síntomas hasta la visita médica y desde el diagnóstico hasta el seguimiento. Los bucles incluyen: 1.°) sucesión de diagnósticos, tratamientos erróneos y derivaciones a especialistas y 2.°) nuevos síntomas cada cierto tiempo, visitas a especialistas y dudas diagnósticas. Pocos pacientes logran la fase final de autonomía. Conclusión: El viaje de una persona con FM en Latinoamérica está lleno de obstáculos. La meta deseada es que todos los agentes entiendan que el automanejo por parte del paciente con FM es una parte indispensable del éxito, y solo se puede lograr accediendo a recursos de forma precoz y guiado por profesionales.(AU)

Objectives: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. Methods: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. Results: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. Conclusion: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.(AU)

The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

El conocimiento y cumplimiento de las normas de protección sobre la radiación ionizante en una clínica dental docente / Knowledge and compliance with ionizing radiation protection standards in a teaching dental clinic

Introducción: El uso de radiografías como elemento complementario para el diagnóstico es fundamental para la práctica profesional de todo cirujano dentista. Por tanto, es importante conocer no solo los beneficios de la radiología oral y los fundamentos de protección radiológica, sino también determinar su nivel de aplicación o la adherencia frente al cumplimiento de los aspectos normativos que regulan el uso de la radiación ionizante en odontología. Objetivo: Relacionar el conocimiento sobre los cuidados en radiología bucal, las ventajas y los peligros en la toma de radiografías con el cumplimiento de las normas de protección radiológica y radiación ionizante en estudiantes de odontología de una clínica dental docente. Métodos: La población de estudio estuvo constituida por 180 estudiantes del cuarto año de la carrera de odontología, que emplearon los equipos radiológicos en la clínica docente asistencial durante los años 2019 (segundo semestre) y 2020 (primer trimestre). Se tomó como muestra representativa a 104 estudiantes, incorporados al estudio mediante muestreo aleatorio simple. Se aplicaron dos instrumentos de recolección de datos, uno para evaluar el conocimiento (cuestionario) y otro para verificar el cumplimiento de normas (lista de chequeo) sobre la protección radiológica y el diagnóstico por imágenes en la práctica odontológica. Para el análisis estadístico se aplicó la prueba estadística chi cuadrado con un nivel de significancia del 95 %. Resultados: No se encontró relación estadísticamente significativa (p = 0,30) entre el conocimiento teórico sobre la protección radiológica y el diagnóstico por imágenes, respecto el cumplimiento de las normas que regulan su aplicación (p > 0,05). El 90 % de participantes tienen conocimientos entre regulares y excelentes. Sin embargo, solo el 32 % cumple las normas técnicas de protección sobre radiación ionizante en su práctica clínica. Conclusión: Los estudiantes de odontología tienen suficiente conocimiento sobre protección radiológica y diagnóstico por imágenes. Sin embargo, este conocimiento no se refleja en prácticas adheridas a las normas.

Introduction: The use of radiographs as a complementary element for diagnosis is fundamental to the professional practice of every dental surgeon. Therefore, it is important to know not only the benefits of oral radiology and the fundamentals of radiological protection, but also to determine their level of application or adherence to compliance with the regulatory aspects that regulate the use of ionizing radiation in dentistry. Objective: To relate the knowledge of oral radiology care, the advantages and dangers in taking radiographs with compliance with the norms of radiological protection and ionizing radiation in dental students of a dental teaching clinic. Methods: The study population consisted of 180 fourth year dental students who used the radiological equipment in the teaching dental clinic during 2019 (second semester) and 2020 (first quarter). A representative sample of 104 students was taken, incorporated into the study by simple random sampling. Two data collection instruments were applied, one to evaluate knowledge (questionnaire) and the other to verify compliance with standards (checklist) on radiological protection and diagnostic imaging in dental practice. For the statistical analysis the chi-square statistical test was applied with a significance level of 95 %. Results: No statistically significant relationship was found (p = 0.30) between theoretical knowledge of radiological protection and diagnostic imaging with respect to compliance with the norms that regulate its application (p > 0.05). Ninety percent of participants have fair to excellent knowledge. However, only 32 % comply with the technical norms of ionizing radiation protection in their clinical practice. Conclusion: Dental students have sufficient knowledge of radiation protection and diagnostic imaging. However, this knowledge is not reflected in practices that adhere to the standards.

Lesiones en tejidos dentarios y trastornos de la salud bucal en el examen médico ocupacional de trabajadores del sector construcción de Lima, Perú / Lesions in dental tissues and oral health disorders in the occupational medical examination of workers in the construction sector in Lima, Peru / Lesões nos tecidos dentários e perturbações da saúde oral no exame médico ocupacional dos trabalhadores do sector da construção em Lima, Peru

RESUMEN Objetivo: Describir las lesiones en tejidos dentarios y trastornos de la salud bucal encontradas durante el examen médico ocupacional en trabajadores del sector construcción de Lima, Perú. Material y métodos: Estudio epidemiológico transversal realizado en 150 trabajadores del sector construcción, seleccionados mediante muestreo aleatorio simple. Se realizó una evaluación estomatológica mediante observación directa y se empleó un instrumento de evaluación odontológico-ocupacional con índices para caries dental, severidad de caries y traumatismos dentales e indicadores de consecuencias clínicas de caries no tratada (patología pulpar) y lesiones no cariosas. Resultados: La experiencia de caries de los operadores sin estudio superior (CPOD = 14,99) y con estudio superior (CPOD = 13,06) fue superior frente a los supervisores (CPOD = 8,23) y administrativos (CPOD = 5,08). Los trabajadores operadores sin estudio superior (SiC = 18,04) y con estudio superior (SiC = 17,17) presentaron peores indicadores de significancia de caries frente a los supervisores (SiC = 13,67) y administrativos (SiC = 8,25). Además, los operadores sin estudio superior presentaron mayor carga de consecuencias clínicas de caries no tratada (PUFA = 2,35; severidad = 9,2%) en comparación con los operativos con estudio superior (PUFA = 1,91; severidad = 8,4%), los supervisores (PUFA = 0,53; severidad = 2,1%) y los administrativos (PUFA = 0,46; severidad = 1,8%), así como mayor frecuencia de lesiones no cariosas (47,3 %) y traumatismos dentales (21,3 %). Conclusiones: La salud dental, sus consecuencias clínicas y la estructura de los tejidos dentarios de los trabajadores operativos de una empresa constructora se encuentran más afectadas en comparación con los otros grupos laborales de la misma empresa.

ABSTRACT Objective: To describe the lesions in dental tissues and oral health disorders found during the occupational medical examination of workers in the construction sector in Lima, Peru. Material and methods: A cross-sectional epidemiological study was carried out on 150 workers in the construction sector, selected by simple random sampling. A stomatological evaluation was carried out by direct observation, and a dental-occupational evaluation instrument was used with indexes for dental caries, caries severity and dental trauma, and indicators of clinical consequences of untreated caries (pulp pathology) and non-carious lesions. Results: The caries experience of operators without higher education (CPOD = 14.99) and with higher education (CPOD = 13.06) was higher than that of supervisors (CPOD = 8.23) and administrative workers (CPOD = 5.08). The operators without higher education (SiC = 18.04) and with higher education (SiC = 17.17) presented worse caries significance indicators compared to supervisors (SiC = 13.67) and administrative workers (SiC = 8.25). In addition, operators without higher education had a higher burden of clinical consequences of untreated caries (PUFA = 2.35; severity = 9.2%) compared to operators with higher education (PUFA = 1.91; severity = 8.4%), supervisors (PUFA = 0.53; severity = 2.1%) and administrators (PUFA = 0.46; severity = 1.8%), as well as a higher frequency of non-carious lesions (47.3%) and dental trauma (21.3%). Conclusions: Dental health, its clinical consequences, and the structure of the dental tissues of the operative workers of a construction company are more affected compared to the other labor groups of the same company.

RESUMO Objetivo: Descrever as lesões nos tecidos dentários e os distúrbios de saúde oral encontrados durante o exame médico ocupacional em trabalhadores do sector da construção em Lima, Peru. Material e métodos: Foi realizado um estudo epidemiológico transversal em 150 trabalhadores do sector da construção, selecionados por amostragem aleatória simples. Foi realizada uma avaliação de estomatologia por observação direta e foi utilizado um instrumento de avaliação dentária ocupacional com índices de cárie dentária, gravidade da cárie e traumatismo dentário e indicadores das consequências clínicas da cárie não tratada (patologia pulpar) e lesões não cariosas. Resultados: A experiência de cárie dos operadores sem ensino superior (CPOD = 14,99) e com ensino superior (CPOD = 13,06) foi maior em comparação com os supervisores (CPOD = 8,23) e trabalhadores administrativos (CPOD = 5,08). Os operadores sem ensino superior (SiC = 18,04) e com ensino superior (SiC = 17,17) apresentaram piores indicadores de significância da cárie quando comparados aos supervisores (SiC = 13,67) e aos funcionários administrativos (SiC = 8,25). Além disso, os operadores sem ensino superior apresentaram maior carga de consequências clínicas da cárie não tratada (PUFA = 2,35; severidade = 9,2%) em relação aos operadores com ensino superior (PUFA = 1,91; severidade = 8,4%), supervisores (PUFA = 0,53; severidade = 2,1%) e administradores (PUFA = 0,46; severidade = 1,8%), bem como maior frequência de lesões não cariosas (47,3%) e traumatismos dentários (21,3%). Conclusões: A saúde dentária, as suas consequências clínicas e a estrutura dos tecidos dentários dos operários de uma empresa de construção civil são mais afetadas em comparação com os outros grupos de trabalho da mesma empresa.

Concentraciones de vitamina D en ginecoobstetras, internistas y médicos generales en tres países latinoamericanos / Vitamin D concentrations in obstetricians, gynecologists, internists, and general practitioners in three Latin American countries

Resumen OBJETIVO: Determinar las concentraciones de 25(OH)D en ginecoobstetras y otros especialistas latinoamericanos y conocer la prevalencia de su deficiencia. MATERIALES Y MÉTODOS: Estudio transversal y observacional efectuado para determinar las concentraciones de 25(OH)D en médicos voluntarios, sobre todo ginecoobstetras, que acudieron a diferentes congresos en distintos países latinoamericanos. RESULTADOS: Se analizaron 643 determinaciones. El 19.4% tenían déficit (media 16.58 ng/mL), 72% insuficiencia (media 24.6 ng/mL) y 36.9% concentraciones normales (media 40.34 ng/mL). Los hombres tuvieron mayor déficit-insuficiencia (62.8%) que las mujeres (59.5%), pero sin diferencias significativas (p < 0.058). Las personas de piel clara tuvieron concentraciones deficitarias e insuficientes, menores que las de piel oscura (p < 0.001). Quienes tomaban suplementos de vitamina D tuvieron menor riesgo de déficit. CONCLUSIONES: El 60% de los ginecoobstetras, médicos internistas y generales de Latinoamérica tienen bajas concentraciones de 25(OH)D. La piel clara puede ser un factor de riesgo de mayor déficit-insuficiencia. En los grupos de médicos estudiados la suplementación con vitamina D parece incrementar las concentraciones de 25(OH)D.

OBJECTIVE: To determine 25(OH)D concentrations in obstetrician-gynecologists and other Latin American specialists and to know the prevalence of its deficiency. MATERIALS AND METHODS: Cross-sectional and observational study to determine 25(OH)D concentrations in volunteer physicians, mainly gynecologists, attending different congresses in different Latin American countries. RESULTS: A total of 643 determinations were analysed. 19.4% had deficiency (mean 16.58 ng/mL), 72% insufficiency (mean 24.6 ng/mL), and 36.9% normal concentrations (mean 40.34 ng/mL). Men had higher deficiency-insufficiency (62.8%) than women (59.5%), but no significant differences (p < 0.058). Light-skinned people had lower insufficiency levels than darker-skinned people (p < 0.001). Those taking vitamin D supplements had a lower risk of deficiency. CONCLUSIONS: Sixty percent of obstetrician-gynecologists, internists, and general practitioners in Latin America have low 25(OH)D concentrations. Caucasian skin may be a risk factor for increased deficiency. Vitamin D supplementation appears to improve 25(OH)D concentrations in the physician groups studied.

Seguridad del paciente y eventos adversos en la práctica odontológica en una clínica dental docente / Patient safety and adverse events in dental practice in a Teaching Dental Clinic

RESUMEN Objetivo: Evaluar la frecuencia y distribución de eventos adversos que se presentan en el desarrollo de los tratamientos odontológicos ejecutados por operadores clínicos de una Clínica Dental Docente durante el 2015. Material y Métodos: Se realizó un estudio observacional y descriptivo de corte longitudinal y prospectivo para evaluar la frecuencia de eventos adversos en la práctica odontológica de estudiantes de Odontología, para lo cual se implementó un Sistema de Registro y Notificación de Eventos Adversos en Odontología dirigido a 110 operadores clínicos en las áreas de Odontología Restauradora, Cirugía Bucal, Endodoncia y Rehabilitación Oral durante el 2015. Resultados: Se reportaron 167 eventos adversos que representan un 10.18% del total de tratamientos realizados durante el periodo de seguimiento y evaluación Los eventos más frecuentes, según campo clínico, fueron la "Hipersensibilidad post tratamiento restaurador" (operatoria dental), "Sobreobturación o subobturación con sintomatología" (endodoncia), "Alveolitis dental post-extracción" (cirugía bucal) y "Sensibilidad post-tallado para prótesis fija (pilares)" (rehabilitación oral). Conclusiones: La implementación de un sistema de registro y notificación es el punto de partida para la identificación de eventos adversos más frecuentes en la práctica odontológico, el cual es útil para definir procedimientos a seguir, elaborar protocolos y formular lineamientos para la atención segura y de calidad.

ABSTRACT Objective: To evaluate the frequency and distribution of adverse events that occur in the development of dental treatments performed by clinical operators of a Teaching Dental Clinic during 2015. Material and Methods: An observational and descriptive longitudinal and prospective study was carried out to evaluate the frequency of adverse events in the dental practice of Dentistry students, for which a System for the Registration and Notification of Adverse Events in Dentistry was implemented aimed at 110 clinical operators in the areas of Restorative Dentistry, Oral Surgery, Endodontics and Oral Rehabilitation during 2015. Results: 167 adverse events were reported, representing 10.18% of the total treatments performed during the monitoring and evaluation period. Common, depending on the clinical field, were "Post-restorative treatment hypersensitivity" (restorative dentistry), "Over-filling or under-filling with symptoms" (endodontics), "Post-extraction dental alveolitis" (oral surgery) and "Post-carving sensitivity for fixed prostheses (pillars)" (oral rehabilitation). Conclusions: The implementation of a registration and notification system is the starting point for the identification of the most frequent adverse events in dental practice, which is useful for defining procedures to be followed, developing protocols, and formulating guidelines for healthcare quality and safety.

Uso intraluminal de stent de nitinol dual para colapso completo de tráquea en un canino de raza maltés / Intraluminal use of dual nitinol stent for complete collapse of trachea in a Canine Maltese breed

RESUMEN Paciente canino, de raza maltés, género femenino, castrado, de 4 años y 5 Kg de peso. El motivo principal de consulta fue tos y dificultad respiratoria grave. Durante la evaluación clínica, el paciente presentó cianosis, estridor inspiratorio y espiratorio severo, tos en graznido especialmente después de un estímulo emocional. Se realizó una broncoscopia que reveló una disminución dinámica en el diámetro de la luz traqueal, un colapso severo en las porciones cervicales y torácicas. Debido a la gravedad del colapso traqueal, se decidió la implantación de un stent de nitinol. La elección del stent es fundamental y por tanto fue necesario realizar una medición del diámetro y la longitud de la tráquea para minimizar los efectos secundarios y los rechazos. La tráquea presentó variabilidad del diámetro a nivel torácico, razón por la cual se decidió utilizar un stent dual, el cual se colocó mediante observación directa a través de un broncoscopio pediátrico. Se presenta un caso en el que se usó un stent dual, indicado en casos en que el diámetro de la tráquea varía en su trayecto. Se obtuvieron excelentes resultados ya que se ajustó a los diferentes diámetros que presentó la tráquea en los niveles cervical y torácico.

ABSTRACT Canine patient, Maltese breed, female gender, castrated, 4 years old and 5 Kg of weight. The main reason for consultation was cough and severe respiratory distress. During the clinical evaluation, the patient presented cyanosis, severe inspiratory and expiratory stridor, squawking cough, especially after emotional stimulation. A bronchoscopy was performed that revealed a dynamic decrease in the diameter of the tracheal lumen, a severe collapse in the cervical and thoracic portions. Due to the severity of the tracheal collapse, the implantation of a nitinol stent was decided. The choice of stent is essential and therefore it was necessary to perform a measurement of the diameter and length of the trachea to minimize side effects and rejections. The trachea presented diameter variability at the thoracic level, which is why it was decided to use a dual stent, which was placed by direct observation through a pediatric bronchoscope. We present a case in which a dual stent was used, indicated in cases in which the diameter of the trachea varies along its path. Excellent results were obtained since it was adjusted to the different diameters that the trachea presented at the cervical and thoracic levels.

Multimedia educativa para el aprendizaje de la asignatura Educación Física en ciencias médicas / Educational Multimedia for the learning of Physical Education subject in medical sciences

Se decidió elaborar una multimedia educativa y didáctica para el aprendizaje y la correcta autopreparación en la asignatura Educación Física, como vía de solución a las insuficiencias detectadas en los estudiantes de primer y segundo años de la carrera de medicina. Esta se diseñó con la herramienta Mediator 9.0 y se estructuró en módulos que vinculan textos e imágenes, lo cual incentiva el aprendizaje y agiliza el estudio de los contenidos de la asignatura. Finalmente se logró una multimedia educativa con la integración de los contenidos de la asignatura en un solo material didáctico, muy fácil de usar en el trabajo individual, que mejora el interés y la motivación de los estudiantes, al mismo tiempo que estandariza e interrelaciona materias establecidas en el programa con otras asignaturas propias de la medicina.

It was decided to elaborate an educational and didactics multimedia for the learning and correct self-preparation in the Physical Education subject, as solution to the inadequacies detected in the students of first and second years of the medicine career. It was designed with the Mediator 9.0 tool and it was structured in modules that link texts and images, which motivates the learning and speeds up the study of the subject contents. Finally they managed to get an educational multimedia that integrates the contents of the subject in a single didactic material, very easy to use in the individual work, which improves the interest and motivation of the students, at the same time that it standardizes and interrelates established matters in the schedule with other subjects characteristic of the medicine.

Registro de fibrilación auricular en servicios de urgencias del Institut Català de la Salut (URGFAICS): análisis en función del tipo de fibrilación auricular y de la reconsulta a urgencias relacionada a los 30 días / Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days

Objetivos: Estudiar las características de los pacientes que consultan por un episodio de fibrilación auricular (FA) en los servicios de urgencias hospitalarios (SUH), en función de si la FA es de novo o conocida previamente, y la reconsulta relacionada con la FA a los 30 días (R30d). Método: Estudio observacional de cohorte prospectivo y multicéntrico que incluyó a todos los pacientes ≥ 18 años que consultaron por síntomas relacionados con una FA o el hallazgo de una FA en 5 SUH catalanes. Se recogieron variables demográficas, del episodio agudo, de manejo en urgencias y la R30d. Resultados: De los 1.199 pacientes, 1.052 tuvieron seguimiento a 30 días. La edad media fue de 73 (DE 13) años y 646 (53,9%) eran mujeres. Seiscientos cincuenta y dos pacientes (54,4%) tenían una FA conocida, los cuales tenían mayor edad, presencia de comorbilidades y uso de antiarrítmicos y anticoagulantes orales. Hubo escasas diferencias en el manejo farmacológico en urgencias. La R30d fue de un 7,9%, y fue más frecuente cuando se usó digoxina en urgencias y bloqueadores de los canales del calcio al alta. Conclusiones: Existen diferencias basales entre los pacientes con FA de novo y conocida, pero estas son escasas en el manejo en urgencias. En pacientes atendidos por fibrilación auricular en urgencias, la R30d se relacionó con el uso de digoxina en urgencias y de bloqueadores de los canales del calcio al alta

Objectives: To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. Methods: Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. Results: We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. Conclusions: We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge

Calidad técnica y percibida del servicio de operatoria dental en una clínica dental docente / Technical and perceived quality of dental operative service in a teaching dental clinic

Objetivos: Evaluar la calidad técnica de los tratamientos realizados por los operadores y la calidad percibida por los pacientes del Servicio de Operatoria Dental en una Clínica Dental Docente durante el año 2014. Material y métodos: Participaron 216 pacientes de manera voluntaria y aleatoria a quienes se les aplicó una encuesta para medir la calidad percibida del servicio. Posteriormente, se evaluaron los tratamientos de operatoria que les fueron realizados para determinar la calidad técnica a través de la comparación con los protocolos de atención. Resultados: En relación con la calidad percibida, el 74,8% de los participantes percibe la calidad de atención como "Regular", seguido de un 15,3% de pacientes que la perciben como "Malo" y un solo un 5% como "Muy malo". Sólo un 4,3% la percibe como "Bueno" y un 0,6% la percibe como "Muy bueno". En relación con la calidad técnica, se cumple en el 99% de los tratamientos evaluados, ya que se encuentran adheridos a los protocolos de atención clínica. Conclusiones: La calidad percibida por el paciente es en su mayoría negativa o neutral, sin embargo, los resultados de la calidad técnica de los tratamientos describen que éstos se encuentran altamente adheridos a los protocolos de atención.

Objectives: To evaluate the technical quality of the treatments performed by the operators and the quality perceived by the patients of the Dental Operative Service in a Teaching Dental Clinic during the year 2014. Material and methods: 216 patients participated voluntarily and randomly in a survey to measure the perceived quality of the service as well as evaluate the operative treatments that were performed to determine the technical quality.Results: Regarding perceived quality, 74.8% of the participants perceived the quality of care as "Ordinary", followed by 15.3% of patients perceiving it as "Poor" and only 5% as "Very bad". Only 4.3% perceive it as "Good" and 0.6% perceive it as "Very good". Concerning technical quality, 99% of the evaluated treatments are fulfilled since they adhere to the clinical care protocols. Conclusions: The quality perceived by the patient is mostly negative or neutral, however, the results of the technical quality of the treatments describe that they are highly adhered to the care protocols.

Reproducibilidad de los tiempos de ejecución de la prueba de Timed Up and Go, medidos con acelerómetros de smartphonesen personas mayores residentes en la comunidad / Reproducibility of quantifying Timed Up and Go test, measured with smartphone accelerometers in older people living in the community

Introducción: Las unidades de medición inercial (UMI) incorporadas en los teléfonos inteligentes (smartphones) permiten registros que concuerdan con los obtenidos por instrumentos de laboratorio, por lo cual sería factible el uso de smartphones para el registro de parámetros cinemáticos como la velocidad y aceleración, permitiendo mayor robustez en los análisis de test que evalúan el riesgo de caídas en personas mayores (PM) residentes en la comunidad, tales como el Timed Up and Go (TUG). Método: 35 PM de sexo femenino residentes en la comunidad, usuarias de los Centros de Salud Familiar (CESFAM) Juan Pablo II y Corvallis de la ciudad de Antofagasta, Chile, fueron evaluadas con el TUG; simultáneamente se registró la aceleración y velocidades lineal y angular utilizando un smartphone equipado con una UMI tridimensional. Mediante un macro computacional se determinaron los tiempos de inicio y fin de cada subetapa del test por 2 observadores independientes. La reproducibilidad de los subtiempos de cada subetapa del TUG fue evaluada con el coeficiente de correlación intraclase (CCI). Resultados: El CCI para el tiempo de las subetapas tuvo valores de entre 0,78-0,99, con intervalo de confianza aceptable (0,45-1,00), constituyendo un registro reproducible y confiable para la valoración del riesgo de caídas en PM autovalentes de la comunidad. Conclusiones: La reproducibilidad de los tiempos de las subetapas del TUG registradas con UMI de un smartphone permiten su uso para la práctica clínica con grupos de PM, mejorando la evaluación y la prevención del riesgo de caída (AU)

Introduction: Inertial Measurement Units (IMU) incorporated in smartphones can provide records that match registers obtained by laboratory instruments. This means that the use of smartphones would be feasible for recording three-dimensional kinematics parameters like velocity and acceleration, enabling more robust analyses, such as the Timed Up and Go (TUG) test, that assess the risk of falls older people (OP) living in the community. Method: The study included 35 female OP, users of the Family Health Centres (CESFAM) Juan Pablo II and Corvallis from Antofagasta city, Chile. They were evaluated with the TUG, with linear and angular acceleration and velocity being recorded simultaneously using a smartphone equipped with a three-dimensional IMU. Using a computer macro application, the start and end time of each sub-stage of the test was determined by two independent observers. Reproducibility of the times of each sub-stage of TUG was assessed using the Intraclass Correlation Coefficient (ICC). Results: The ICC gave values of 0.78 to 0.99, with an acceptable confidence interval, (0.45-1.00), thus providing a reproducible and reliable recording. Conclusions: The reproducibility of the times of the sub-stages of TUG, recorded with inertial measurement units from a smartphone enables it to be used in clinical practices with OP groups, in order to improve the evaluation and prevention of the risk of falls (AU)

Estado nutricional de los adolescentes de la comunidad Minerva del barrio San Jacinto agosto a septiembre 2015 / Nutritional status of adolescents in the Minerva community of the San Jacinto neighborhood August to September 2015

El presente estudio ilustra la realidad nutricional en cuanto al peso, talla, IMC, Tensión Arterial, dietas y hábitos de estilos de vida, de la población adolescente de una comunidad urbana en San Salvador. En nuestro país son muchos los factores que influyen en la malnutrición de los adolescentes, dichos factores afectan la elección de dietas y las prácticas de hábitos saludables. La adolescencia supone un período de "crisis" donde la vulnerabilidad hace que aparezcan hábitos y situaciones de riesgo, y que además con la realidad en las que vivimos en nuestro país dichos riesgos especialmente los nutricionales aumentan. La aceleración del crecimiento y de la madurez, provoca un aumento del gasto energético. Los cambios en la composición corporal tienen una clara repercusión nutricional. Múltiples estudios demuestran la relación que hay entre la malnutrición y alteraciones en el comportamiento de los adolescentes, deficiencia en el rendimiento escolar, en la edad adulta (como consecuencia de la malnutrición en la adolescencia) desarrollo de obesidad y síndrome metabólico que en ocasiones se manifiestan en edades tempranas como parte de la conjunción de otros factores, como el genético, que da la génesis de dichas patologías. El estudio se realizó en sujetos de los 9 a los 18 años de edad, a los cuales se les interrogó a cerca de sus hábitos nutricionales, estilos de vida y se les midió la Tensión Arterial, obteniendo datos diversos que ilustran las condiciones nutricionales de dicha población. La población estudiada presenta resultados que orientan a dieta muy calórica y poco ejercicio. La principal debilidad del estudio está relacionada a la mudanza de la población adolescente a zonas menos peligrosas lo que reduce la población general sujeta al estudio

Odontogeriatría y gerodontología: el envejecimiento y las características bucales del paciente adulto mayor: Revisión de literatura / Geriatric dentistry and gerodontology: aging and oral characteristics of elderly patients. Review

Las tendencias demográficas a nivel mundial han demostrado un aumento de la población de adultos mayores, y en el Perú esa situación no es la excepción. Este fenómeno demográfico plantea muchos retos en el campo de la salud, uno de los cuales es la formación de profesionales especializados y comprometidos para atender a este grupo etario. En el campo odontológico, el adulto mayor puede presentar múltiples enfermedades bucales como caries dental, enfermedad periodontal, lesiones en la mucosa oral, candidiasis e inclusive cáncer oral, siendo las más destacadas la caries dental y la enfermedad periodontal. Otras manifestaciones clínicas que se producen en boca y que son muy frecuentes son la pérdida de hueso alveolar, movilidad dental y disminución del gusto que provocan disminución del apetito y, por consiguiente, la baja de peso e inclusive anemia. Por otro lado, es común que la población geriátrica presente una serie de complicaciones que han de ser abordadas conjuntamente por el odontólogo y el médico tratante. Este grupo poblacional padece enfermedades crónicas como consecuencia del proceso natural de envejecimiento en el cual ocurren cambios o modificaciones a nivel molecular, celular, tisular y orgánico que contribuyen a la progresiva disminución de la capacidad del organismo para mantener su viabilidad. La presente revisión bibliográfica aporta las bases conceptuales del envejecimiento y las características bucales del paciente adulto mayor, lo cual va a permitir un mayor conocimiento del campo de acción de la odontogeriatría y gerodontología...

Demographic trends worldwide have shown an increase in elderly population and the situation in Peru is no exception. This demographic phenomenon poses many challenges in the field of health, one of which is the formation of specialized professionals committed to serving this age group. In the dental field, the elderly may have multiple oral diseases such as dental caries, periodontal disease, oral mucosal lesions, oral candidiasis and even oral cancer, the most prominent dental caries and periodontal disease. Other clinical manifestations that occur in the mouth and are very common are alveolar bone loss, tooth mobility and decreased taste that cause decreased appetite and consequently, low weight and even anemia. Furthermore, it is common for the geriatric population presents a number of complications that have to be addressed jointly by the dentist and the treating physician. This population suffers from chronic illnesses as a result of the natural aging process in which changes or modifications at the molecular, cellular, tissue and organ contributing to the gradual decline in the bodyÆs ability to maintain viability occur. This literature review provides the conceptual basis of aging and oral characteristics of elderly patients, which will allow a better understanding of the scope of geriatric dentistry and gerodontology...

Evaluación de la calidad de los registros empleando la auditoría odontológica en una clínica dental docente / Quality evaluation of the records using dental audit in a teaching dental clinic

Objetivo: Evaluar la calidad de registro o llenado de historias clínicas de pacientes nuevos atendidos en una Clínica Dental Docente durante el período de enero a julio de 2012 empleando la auditoría odontológica como herramienta sistematizada. Material y métodos: Se tomaron como muestra 140 historias clínicas de pacientes nuevos de las cuales se evaluó la frecuencia y porcentaje de registro de los diferentes aspectos que componen la historia clínica. Resultados: Se encontró que el 78% de las historias no tenían completo el registro en los diferentes aspectos evaluados, encontrando que de los diecisiete aspectos evaluados, nueve registran entre 11% y 29%, quedando entre un 89% y un 71% de historias que no registran estos aspectos. Se identificaron tres aspectos que se registran entre 84% y 86% (número de historias, cuestionario de salud y examen estomatológico), cuatro aspectos resgistran entre 94% y 98% (fecha de ingreso, asignación de operador, odontograma y filiación) y sólo un aspecto se registra al 100% (evolución del tratamiento) del total de historias clínicas auditadas. conclusiones: más del 45% de las historias clínicas auditadas en la presente investigación tenían deficiencias en el registro o llenado de los datos que la historia clínica requiere como información de documento médico-legal.

Introduction: To assess the quality of registration or filling histories of new patients treated at a Teaching Dental Clinic during the period January to July 2012 using the Dental Audit as a tool systematized. Material and methods: Was sampled 140 medical records of new patients which assessed the frequency and percentage of recording various aspects that make up the medical record. Results: We found that 78% of the medical records do not have full registration in the different aspects evaluated, fi nding that of the seventeen aspects evaluated, nine recordedbetween 11% and 29 %, remaining between 89% and 71% of medical records that not record these aspects. Weidentifi ed three aspects that are recorded between 84% and 86% (medical record number, health questionnaire and dental examination), four points recorded between 94% and 98% (date of entry, operator assignment, odontogram and fi liation) and only one side is recorded 100% (treatment outcome) of the total audited medical records. Conclusions: Over 45% of medical records audited in this investigation are impaired in the registry or data fi lling medical history required as medico-legal document.

Síndrome metabólico en la mujer menopáusica / Metabolic syndrome in menopausal women

El síndrome metabólico (SM) comprende un conjunto de factores de riesgo derivados de desordenes metabólicos que interactúan entre sí incrementando la morbimortalidad cardiovascular. La transición a la menopausia y el que caracteriza la postmenopausia, en paralelo a los fenómenos de envejecimiento, incrementan en forma significativa el riesgo de SM en la mujer...

Mucositis oral en el paciente con terapia antineoplásica / Oral mucositis in patients with antineoplastic therapy

La mucositis oral es una de las complicaciones más frecuentes y sintomáticas de la terapia antineoplásica y se asocia conun aumento significativo en la morbilidad, dolor, limitación funcional, deterioro en la calidad de vida y costos globales de la atención médica. La incidencia de inflamación de la mucosa (mucositis) en pacientes con cáncer de cabeza y cuello sometidos a radioterapiapuede ser tan alta como un 100%; aquellos que reciben quimioterapia presentan mucositis hasta en un 40-70%, de acuerdo con el esquema asignado. Múltiples estrategias han sido estudiadas tanto para la prevención como para el manejo de la mucositis oral, pero los resultados no son consistentes y muchas de las intervenciones actuales son utilizadas de manera empírica, sin tener evidencia científica que soporte la continuidad o no de su uso.

Oral mucositis is one of the most common and symptomatic complications of antineoplasic therapy and is associated with a significant increase in morbidity, pain, functional limitation, deterioration in quality of life and overall costs of medical care. The incidence of mucosal inflammation (mucositis) in patients with head and neck cancer undergoing radiotherapy may be as high as 100%, those receiving chemotherapy present mucositis in up to 40-70% depending on the scheme allocated. Multiple strategies have been studied for both prevention and the management of oral mucositis, but the results are not consistent and many of the existing interventions are used in an empirical way, without scientific evidence that supports whether its use should be continued or not.