Evaluación de la pérdida osea y del éxito / fracaso de implantes de titanio de posicionamiento inmediato y tardío con carga inmediata, usados para restauraciones de arco completo a 12 meses de su implantación / Evaluation of bone loss and success / failure of titanium implant positioning with immediate and late charge, used in full arch restorations at 12 months of implant

El propósito de esteestudio fue evaluar elnivel óseo y el éxito y fracaso de implantes con carga inmediata posicionados inmediatamentedespués de la extracciónpara rehabilitaciones de arco completo ycompararlos con los resultados obtenidos con implantes situados en alvéolos cicatrizados, en un periodo de 12 meses, para determinar la mejor alternativa de uso. Se efectúo una revisión sistemática en base aensayos clínicos aleatorios prospectivos y los ensayos clínicos aleatorizado o no aleatorizados, controlados o no controlados que evaluaron el fracaso yreabsorción ósea de implantes con carga inmediata posicionados en alveolos post-extracción y en alvéolos cicatrizados en pacientes adultos para rehabilitaciones de arco completo. Los datos de los ensayos clínicos fueron ingresados al software Review Manager®. Se realizaron dos metaanálisis para las distintas variables a analizar y posteriormente un análisis de sensibilidad para eliminar los estudios que causaban sesgo. De un total de 431 implantes analizados, 16 de ellos fracasaron, 11 de los cuales habían sido posicionados inmediatamente luego de la exodoncia. Tres de losautores considerados en la revisión, concuerdan en que hay un mayor éxito y menor pérdida ósea en aquellos implantes posicionados de manera tardía. Para rehabilitaciones implanto-soportadasde arco completo fijas o removibles, el protocolo de posicionamiento tardío, demostró ser una mejor alternativa puesto que manifestó una menor tasa de fracaso y una menor pérdida ósea.

The purpose of this study was to evaluate the bone level and the success and failure of loaded implants positioned immediately after extraction for full-arch restorations and compare the results obtained with implants placed in healed alveoli, in a period of 12 months, to determine the best alternative. A systematic review based on prospective randomized clinical trials, and randomized or nonrandomized controlled and uncontrolled trials evaluating failure and bone resorption of immediate loaded implants, positioned in post extraction and healed sockets in adult patients for full arch rehabilitations. Data from clinical trials were entered into Review Manager® software. Two meta-analyzes for different variables to analyze and subsequently a sensitivity analysis to eliminate bias caused studies were performed. From a total of 431 implants studied, 16 of them failed, 11 of which had been positioned immediately after the extraction. Three of the authors of the review considered agree that there are more successful and less bone loss in implants positioned so late. To implant-supported full-arch restorations fixed or removable, late positioning protocol proved to be a better alternative since it showed a lower failure rate and less bone loss.

Growth factors for treating diabetic foot ulcers.

BACKGROUND: Foot ulcers are a major complication of diabetes mellitus, often leading to amputation. Growth factors derived from blood platelets, endothelium, or macrophages could potentially be an important treatment for these wounds but they may also confer risks. OBJECTIVES: To assess the benefits and harms of growth factors for foot ulcers in patients with type 1 or type 2 diabetes mellitus. SEARCH METHODS: In March 2015 we searched the Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: Randomised clinical trials in any setting, recruiting people with type 1 or type 2 diabetes mellitus diagnosed with a foot ulcer. Trials were eligible for inclusion if they compared a growth factor plus standard care (e.g., antibiotic therapy, debridement, wound dressings) versus placebo or no growth factor plus standard care, or compared different growth factors against each other. We considered lower limb amputation (minimum of one toe), complete healing of the foot ulcer, and time to complete healing of the diabetic foot ulcer as the primary outcomes. DATA COLLECTION AND ANALYSIS: Independently, we selected randomised clinical trials, assessed risk of bias, and extracted data in duplicate. We estimated risk ratios (RR) for dichotomous outcomes. We measured statistical heterogeneity using the I(2) statistic. We subjected our analyses to both fixed-effect and random-effects model analyses. MAIN RESULTS: We identified 28 randomised clinical trials involving 2365 participants. The cause of foot ulcer (neurologic, vascular, or combined) was poorly defined in all trials. The trials were conducted in ten countries. The trials assessed 11 growth factors in 30 comparisons: platelet-derived wound healing formula, autologous growth factor, allogeneic platelet-derived growth factor, transforming growth factor ß2, arginine-glycine-aspartic acid peptide matrix, recombinant human platelet-derived growth factor (becaplermin), recombinant human epidermal growth factor, recombinant human basic fibroblast growth factor, recombinant human vascular endothelial growth factor, recombinant human lactoferrin, and recombinant human acidic fibroblast growth factor. Topical intervention was the most frequent route of administration. All the trials were underpowered and had a high risk of bias. Pharmaceutical industry sponsored 50% of the trials.Any growth factor compared with placebo or no growth factor increased the number of participants with complete wound healing (345/657 (52.51%) versus 167/482 (34.64%); RR 1.51, 95% CI 1.31 to 1.73; I(2) = 51%, 12 trials; low quality evidence). The result is mainly based on platelet-derived wound healing formula (36/56 (64.28%) versus 7/27 (25.92%); RR 2.45, 95% 1.27 to 4.74; I(2) = 0%, two trials), and recombinant human platelet-derived growth factor (becaplermin) (205/428 (47.89%) versus 109/335 (32.53%); RR 1.47, 95% CI 1.23 to 1.76, I(2)= 74%, five trials).In terms of lower limb amputation (minimum of one toe), there was no clear evidence of a difference between any growth factor and placebo or no growth factor (19/150 (12.66%) versus 12/69 (17.39%); RR 0.74, 95% CI 0.39 to 1.39; I(2) = 0%, two trials; very low quality evidence). One trial involving 55 participants showed no clear evidence of a difference between recombinant human vascular endothelial growth factor and placebo in terms of ulcer-free days following treatment for diabetic foot ulcers (RR 0.64, 95% CI 0.14 to 2.94; P value 0.56, low quality of evidence)Although 11 trials reported time to complete healing of the foot ulcers in people with diabetes , meta-analysis was not possible for this outcome due to the unique comparisons within each trial, failure to report data, and high number of withdrawals. Data on quality of life were not reported. Growth factors showed an increasing risk of overall adverse event rate compared with compared with placebo or no growth factor (255/498 (51.20%) versus 169/332 (50.90%); RR 0.83; 95% CI 0.72 to 0.96; I(2) = 48%; eight trials; low quality evidence). Overall, safety data were poorly reported and adverse events may have been underestimated. AUTHORS' CONCLUSIONS: This Cochrane systematic review analysed a heterogeneous group of trials that assessed 11 different growth factors for diabetic foot ulcers. We found evidence suggesting that growth factors may increase the likelihood that people will have complete healing of foot ulcers in people with diabetes. However, this conclusion is based on randomised clinical trials with high risk of systematic errors (bias). Assessment of the quality of the available evidence (GRADE) showed that further trials investigating the effect of growth factors are needed before firm conclusions can be drawn. The safety profiles of the growth factors are unclear. Future trials should be conducted according to SPIRIT statement and reported according to the CONSORT statement by independent investigators and using the Foundation of Patient-Centered Outcomes Research recommendations.

Investigación cualitativa en odontología, análisis narrativo de la evidencia existente: narrative analysis of the existing evidence / Qualitative research in odontology: narrative analysis of the existing evidence

Introducción: la investigación cualitativa es un tipo de aproximación a la realidad de forma comprensiva para fenómenos locales, bastante incipiente en el área de salud y aún más en odontología donde su utilización se restringe a investigaciones académicas particulares. Objetivo: evaluar la cantidad y contenidos de los resultados de las investigaciones odontológicas cualitativas publicadas en revistas entre los años 2008 hasta el año 2013. Metodología: se utiliza una búsqueda sistemática en buscadores como Pubmed, Scielo, Blackwell sinergy, Lilacs. Las palabras de búsqueda son dentistry, oral health, oral diseasse, qualitative, method qualitative, investigative qualitative. El análisis de datos es narrativo en el cual se sistematizan los resultados de los artículos seleccionados. Resultados: se encuentran 36 artículos cualitativos en los últimos cinco años, existe una limitada utilización de la investigación cualitativa en odontología, centrándose en la clínica e investigaciones observacionales descriptivas, lo que implica la existencia de un nicho investigativo no abordado y por ende no comprendido científicamente. Conclusiones: la evidencia cualitativa en odontología se agrupa en áreas definidas incorporando variables socioculturales con técnicas de recolección centrado en entrevistas y análisis comparativos tradicionales(AU)

Introduction: qualitative research is a method to approach reality, particularly local phenomena, in a comprehensive manner. It is quite incipient in the health sector, let alone in odontology, where its use is limited to specific academic research. Objective: evaluate the number and content of results obtained by qualitative odontological research published in journals in the period 2008-2013. Method: A systematic search was conducted in search engines like Pubmed, Scielo, Blackwell Synergy and Lilacs. The search terms were dentistry, oral health, oral disease, qualitative method, qualitative research. A narrative data analysis was performed in which the results of the papers selected were systematized. Results: the study found 36 qualitative papers published in the last five years. There is limited use of qualitative research in odontology, and it is mainly focused on clinical practice and observational descriptive research. This points to the existence of a research niche still untouched and therefore not well understood by science. Conclusions: qualitative odontological evidence is centered around specific areas, incorporating sociocultural variables and data collection techniques based on interviews and traditional comparative analysis(AU)

Cumplimiento de tratamientos farmacológicos: una aproximación cualitativa a la realidad pehuenche / Pharmacological treatment compliance: a qualitative approach to the Pehuenche reality

Antecedentes: las enfermedades crónicas no transmisibles son un problema creciente en distintos grupos socioeconómicos y etarios. Dentro de las enfermedades crónicas la hipertensión arterial, la diabetes y las dislipidemias son las que presentan mayor dificultad para el control por parte del personal médico. Los principales problemas se concentran en el cumplimiento farmacológico por parte de la población mapuche y pehuenche. Metodología: se aplicó una investigación cualitativa, etnometodológica que estableció las bases teórico-metodológicas sobre las problemáticas relacionadas al concepto de enfermedad y cumplimiento farmacológico. La información se recolectó mediante entrevistas en población pehuenche. Se concluyó el proceso de reclutamiento mediante el punto de saturación de la información. Se efectuó análisis de contenido de tipo semántico estructural. Resultados: la hipertensión arterial, la diabetes y las dislipidemias, así como las enfermedades crónicas, no poseen un precedente cultural e histórico. Éstas se oponen al sistema religioso y compiten con sus instituciones. Por esta razón el tratamiento farmacológico no resulta efectivo, debido al escenario sociocultural particular. Conclusión: las diferencias conceptuales entre la medicina alopática y la cultural pehuenche redundan en problemas de cumplimiento, en especial debido a sus conceptualizaciones de las enfermedades crónicas.

Background: Chronic noncommunicable diseases are a growing problem in different socioeconomic groups and age ranges. Among chronic diseases, high blood pressure, diabetes and dyslipidemia, pose a greater monitoring challenge for medical staff, mainly treatment compliance in the Mapuche and Pehuenche people. Methodology: Qualitative, ethnomethodological investigation that provides the theoretical and methodological framework on issues related to the concept of disease and treatment compliance. Information was collected through interviews. The recruitment process was stopped when the saturation point of information was reached. At that point, structural semantic content analysis was performed. Results: Conditions such as high blood pressure, diabetes, dyslipidemia and other chronic diseases are not culturally and historically defined, contradict religious the system and compete with longstanding institutions. Consequently, drug treatment is not effective in this particular socio-cultural setting. Conclusion: The conceptual differences between allopathic and Pehuenche medicine result in compliance issues, particularly because of their conceptualizations of chronic diseases.

Oral health care for patients with epidermolysis bullosa--best clinical practice guidelines.

OBJECTIVE: To provide the users with information on the current best practices for managing the oral health care of people living with EB. METHODS: A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE, EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. RESULTS: The guideline is composed of 93 recommendations divided into 3 main areas: 1) Oral Care--access issues, early referral, preventative strategies, management of microstomia, prescriptions and review appointments 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics, and 3) Anaesthetic management of dental treatment. CONCLUSIONS: A preventive protocol is today's dental management approach of choice.

Representaciones sociales de salud y adherencia farmacológica antihipertensiva en población pehuenche / Pehuenches social representations of arterial hypertension: the problem of adherence to medication

La hipertensión arterial es uno de los principales factores de riesgo de enfermedades cardiovasculares en los distintos grupos culturales del país1. Objetivo: Describir las representaciones sociales pehuenches sobre el tema de la adherencia antihipertensiva farmacológica dentro de la lógica sanitaria cultural pehuenche de la comuna de Alto Bío Bío, Material y método: Es una investigación cualitativa, de carácter fenomenológico, donde se emplea un muestreo no probabilístico, de caso consecutivo en la población pehuenche, recolectando la información mediante entrevistas semiestructuradas. El análisis de los resultados es semántico estructural, lo cual permite describir pertinentemente las estructuras culturales sanitarias. Resultados: Éstos indican que el problema de la adherencia en pacientes indígenas radica en que los fármacos son vistos como calmantes que no curan las causas de las enfermedades, debido a que éstas, en un contexto étnico, se encuentran en un plano físico, espiritual y religioso, desde un punto de vista cultural, mágico y religioso, y no en contextos clínicos e individuales. Conclusión: los pehuenches poseen problemas de adherencia farmacológica antihipertensiva, siendo definida como el grado en que la conducta de un paciente, en relación con la toma de medicamentos coincide con las instrucciones proporcionadas por el médico2. Sus tradiciones no definen a la hipertensión como una enfermedad válida e histórica, en consecuencia la farmacoterapia resulta suntuaria y disociativa de ritos y tradiciones que mantienen viva su cultura. La farmacoterapia antihipertensiva es evaluada como un factor perjudicial a las instituciones tradicionales pehuenches.

Arterial hypertension is one of the principal risk factors of cardiovascular diseases among many different cultural groups in the country1. Objective: Describe Pehuenche social representations relating to adherence to antihypertensive medications, within the health belief system of the Pehuenche community in the municipality of Alto Bío Bío. Material and method: This is a qualitative investigation, based on phenomenology, with a non-probabilistic sample of consecutive cases taken from the Pehuenche population. Information was collected through semi-structured interviews. Structural semantics was used to analyze the results, which allowed pertinent description of the health belief structure. Results: Results indicate that the problem of adherence to medications in indigenous patients lies in the belief that these medications are only "soothing" ("calmantes") and don't cure the causes of disease. This is due to the fact that, from a cultural, magical and religious viewpoint, the causes of disease are believed to be found on a physical, spiritual and religious level, and not in the clinical or individual context. Conclusion: The problem of adherence to antihypertensive medications, defined as the grade in which the patient's behavior towards taking medications coincides with the instructions provided by the doctor2, is found in the Pehuenche population. Because their traditions don't include hypertension as a valid and historically recognized disease, the treatment is seen as a luxury and is disengaged from the rites and traditions the keep their culture alive. Antihypertensive treatment is considered harmful to traditional Pehuenche institutions.

Neurochemical changes of the extracellular concentrations of glutamate and aspartate in the nucleus accumbens of rats after chronic administration of morphine.

The effects of discontinuing a chronic morphine treatment on the concentrations of glutamate and aspartate were analyzed in the nucleus accumbens of unrestrained unanesthetized rats. The administration of naloxone or the cessation of morphine administration resulted in increased concentrations of glutamate and aspartate in this central nervous system area. These increased amino acid concentrations were observed a few minutes after naloxone administration and persisted in the controls 48 h after the last dose of the opiate. Morphine withdrawal was also studied in rats not injected with naloxone. In these latter animals, increased concentrations of glutamate and aspartate persisted in controls 96 h after the last dose of the opiate. Single doses of morphine, acamprosate or riluzole administered to rats previously withdrawn from chronic morphine treatment restored the amino acid concentrations to normal levels. These results suggest that the maintenance of increased levels of amino acids could be the expression of new adjustments in central nervous system neurotransmission after discontinuation of the chronic morphine treatment.

Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors?

OBJECTIVES: We assessed which factors contribute to the high level of nutritional risk detected by the Mini Nutritional Assessment (MNA) test in institutionalized older women. To this end, we undertook a complete nutritional assessment. METHODS: A cross-sectional study in 89 older women (age range, 72-98 y) living in two private nursing homes in Granada (Spain) was carried out. The MNA test was used as an assessment tool to detect nutritional risk. The nutritional assessment included anthropometric measurements (body mass index, triceps and subscapular skinfold thicknesses, and mid-arm and calf circumferences), quantification of dietary intake (7-d weighed-food records), clinical and functional evaluations (number of drugs, Katz index, and Red Cross cognitive scale), and biological markers (albumin, prealbumin, transferrin, and lymphocyte counts). RESULTS: We found that 7.9% (n = 5) of the older women were malnourished (MNA score, 14.5 +/- 1.4), 61.8% (n = 56) were at risk of malnutrition (MNA score, 20.6 +/- 2.1), and 30.3% (n = 28) were well nourished (MNA score, 25.0 +/- 1.1) according to the MNA test. CONCLUSIONS: This high prevalence of risk of malnutrition detected by the MNA test in healthy institutionalized older women was due mainly to risk situations and self-perception of health and did not depend on age. Inadequate micronutrients intake may contribute to the development of malnutrition in this population.

Participación de la mujer de extrema pobreza en la educación alimentaria basada en la experiencia de huertos caseros / Participation of women from extreme poverty groups in nutritional education based on kitchen garden experience

Se realizó una experiencia de educación nutricional utilizando la estrategia de huertos caseros, en un grupo de 15 familias PEX del sector rural. Se elaboró un test, para medir conocimientos antes y después del tratamiento experimental. Los tópicos tratados cubrieron área de horticultura, avicultura y alimentación. Los puntajes obtenidos entre el pretest (T1) y posttest (T2) se compararon por diferencias de promedios, encontrándose diferencias significativas entre los puntajes del T1 y T2. Al analizar por separado las áreas temáticas, los conocimientos de alimentación presentaron los menores incrementos (aunque significativos; 0,01), atribuyéndose, tal vez a las características especiales del grupo; mujeres adultas, rurales, pobres, semianalfabetas y analfabetas por desuso en quienes fue difícil obtener el grado de abstracción necesario para la comprensión de los contenidos de alimentación y nutrición, aún habiendo utilizado ayudas visuales, alimentos y demostraciones. Por otro lado, la motivación alcanzada en esta área fue menor que en las otras dos, debido a que los adultos se motivan más por aprendizajes prácticos que le sean de utilidad inmediata, lo que se refleja en los altos puntajes finales obtenidos en las áreas de horticultura y avicultura. Sin embargo, se recomienda la actividad de huertos por ser altamente motivadora para trabajo en comunidades deprimidas. Se reafirma el rol de la mujer rural en el trabajo familiar y del huerto, sugiriendose dicha estrategia para ser utilizada por nutricionistas del área rural o urbano marginal