Enamel Wear of Antagonist Tooth Caused by Dental Ceramics: Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis aimed to evaluate the wear of the antagonist tooth in ceramic restorations. MATERIAL AND METHODS: This study was carried out based on Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) recommendations; it was also registered in PROSPERO (register number: CRD42022316252). Three databases were consulted in the literature search, Embase, Scopus, and Web of Science. The citation searching was conducted by two researchers independently. The clinical studies that evaluated wear in antagonist teeth concerning ceramic restoration were included. Twelve articles were selected after eliminating duplicates ones and applying the inclusion criteria, and two were chosen through citation. Fourteen articles were considered for the qualitative and quantitative analysis (meta-regression and meta-analysis). RESULTS: The mean linear wear of the antagonist tooth in relation to feldspathic was 8.914 µm, for lithium disilicate it was 0.018 µm, and for zirconia it was 0.257 µm. The mean volumetric wear of the antagonist tooth in relation to feldspathic was 0.273 mm3, for hybrid ceramic it was 0.030 mm3, for lithium disilicate it was 0.018 mm3, and for zirconia it was 0.014 mm3. The mean natural tooth wear was 0.7974 µm per month. Tooth wear caused by zirconia at six months was 31.755 µm, at 12 months it was 24.648 µm, and at 24 months it was 20.662 µm. CONCLUSIONS: Feldspathic produces greater wear of the antagonist tooth from ceramic restorations linearly and volumetrically. In addition, zirconia generates the least wear that will decrease over time, and it will be equal to or less than the natural wear in the tooth.

Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism.

BACKGROUND: The estimation of left ventricular ejection fraction (LVEF) by 2D echocardiography (2D-ECHO) is the most used tool to assess LV systolic function (LVSF). Global longitudinal strain (GLS) has recently been suggested as a superior method for several evaluations. This study explored the association and prevalence of LV systolic dysfunction (LVSD) by using these methods in patients with end-stage renal disease (ESRD) and severe hyperparathyroidism (SHPTH); both associated with cardiovascular events (CEs). AIM: To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO. METHODS: In 62 patients with ESRD and SHPTH, asymptomatic, and without a history of CEs, LVSF was evaluated by 2D-ECHO, obtaining the EF, by the Simpson biplane method, and GLS by speckle tracking. RESULTS: The total patients with ESRD had a preserved LVEF (> 50%) but abnormal GLS (< 13.55%). Additionally, multivariate analysis showed an independent association of GLS and serum parathyroid hormone (PTH), LV mass index, and hemoglobin. Also, PTH was independently associated with lateral e' wave and tricuspid regurgitation velocity. CONCLUSION: In patients with SHPTH linked to ESRD, the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.

Molecular biomarkers and integrated pathological diagnosis in the reclassification of gliomas.

The present study aimed to evaluate the impact caused by the 2016 World Health Organization (WHO) diagnostic classification of gliomas in 139 patients studied in Argentina. Formalin-fixed paraffin-embedded tissues were used for histological and immunohistochemical analysis [glial fibrillary acidic protein, KI67, synaptophysin and isocitrate dehydrogenase (IDH)1-R132H]. DNA from formalin-fixed paraffin-embedded tissues was used for molecular analysis: 1p/19q co-deletion and mutation status of the IDH gene. These experiments were performed by direct Sanger sequencing and multiplex ligation-dependent probe amplification. According to the new classification, diagnoses included oligodendroglioma IDH-mutant and 1p/19q co-deletion (4.20%), anaplastic oligodendroglioma IDH-mutant and 1p/19q co-deletion (2.52%), diffuse astrocytoma IDH-mutant (6.72%), diffuse astrocytoma IDH-wild type (1.68%), anaplastic astrocytoma IDH-mutant (5.04%), anaplastic astrocytoma IDH-wild type (8.40%), glioblastoma IDH-mutant (5.88%) and glioblastoma IDH-wild type (65.56%). Regarding tumor histology, 60% of oligodendrogliomas, 35% of astrocytoma and 100% of unclassified gliomas were re-classified, while glioblastomas maintained their initial classification. Additionally, the present study evaluated the prognostic value of the histological grade for the 2007 and 2016 WHO classifications of gliomas. The histological subgroup associated with longer overall survival (OS) was grade II glioma (OS-2007WHO, 35.6 months; and OS-2016WHO, 47.7 months). Glioblastoma was the subgroup associated with a poor outcome (OS-2007WHO, 10.4 months; and OS-2016WHO, 11.1 months). The present study evaluated the OS of tumor grade subgroups with respect to their IDH status. For all subgroups, IDH-mutant tumors were associated with an improved prognosis compared with IDH-wild type tumors. The results suggested that the incorporation of molecular biomarkers in the new WHO classification improves tumor characterization and prognostic value of the subgroups.

[Hemophagocytic syndrome at a pediatric specialty hospital. Underdiagnosis and overdiagnosis]. / Síndrome hemofagocítico en un hospital de especialidades pediátrica. Subdiagnóstico y sobrediagnóstico.

BACKGROUND: The hemophagocytic syndrome is a serious complication of several systemic illnesses. OBJECTIVE: To define the characteristics of the hemophagocytic syndrome at a pediatric specialty hospital in Tuxtla Gutiérrez, Chiapas, Mexico; incidences, underdiagnosis and overdiagnosis, associated conditions, treatment, and prognosis were included. METHODS: 214 cases of probable hemophagocytic syndrome that were seen between January 2011 and May 2019 were analyzed. 26 patients diagnosed with hemophagocytic syndrome and 188 cases with suspicion of this entity and/or ferritin > 500 ug/L were included. The cases that met four or more criteria of the HFS (Histiocyte Society, 2004) were included in this study. RESULTS: Thirty-five cases were validated (fourteen were previously diagnosed, nine had suspicion, and twelve had ferritin > 500 µg/L). Neither twelve out of 26 of the cases that were previously diagnosed (46.2 % overdiagnosed). Of the 35 validated cases, 21 hadn't been diagnosed (60 % underdiagnosed) met the diagnostic criteria of the HFS. The annual occurrence was of 2.0/1000 egresses. The Epstein-Barr virus was involved in 42 % of the cases. The overall mortality was of 80 %. CONCLUSIONS: Hemophagocytic syndrome had been significantly underdiagnosed and overdiagnosed at the analyzed hospital. The clinical features allow early suspicion, diagnosis, and treatment. Specific and non-specific illnesses that were associated to hemophagocytic syndrome were identified.

Antecedentes: El síndrome hemofagocítico es una complicación grave que se observa en diversos padecimientos sistémicos. Objetivo: Conocer las características del síndrome hemofagocítico en el Hospital de Especialidades Pediátricas de Tuxtla Gutiérrez, Chiapas, México; se incluyó incidencia, subdiagnóstico y sobrediagnóstico, padecimientos asociados, tratamiento y pronóstico. Métodos: Se analizaron 214 casos probables de síndrome hemofagocítico atendidos entre enero de 2011 y mayo de 2019. Se incluyeron 26 pacientes con diagnóstico de síndrome hemofagocítico y 188 en los que se sospechaba esta entidad o con ferritina > 500 µg/L. Los casos en los que se cumplieron cuatro o más criterios de la Sociedad del Histiocito fueron incluidos en el estudio. Resultados: Se validaron 35 casos (14 con diagnóstico previo, nueve con sospecha y 12 con ferritina > 500 µg/L). No cumplieron con los criterios de la Sociedad del Histiocito, 12 casos diagnosticados previamente (sobrediagnóstico de 46.2 %). De los 35 validados, 21 no habían sido diagnosticados (subdiagnóstico de 60 %). La incidencia anual fue de 2.0/1000 egresos. El virus Epstein-Barr estuvo involucrado en 42 % de los casos. La mortalidad representó 80 %. Conclusiones: El síndrome hemofagocítico fue subdiagnosticado y sobrediagnosticado en el hospital estudiado. Las características clínicas permiten sospecharlo, diagnosticarlo y tratarlo oportunamente. Se identificaron padecimientos específicos y no específicos asociados a síndrome hemofagocítico.

Microanálisis de la comunicación verbal y no verbal en hechos clínicos psicoanalíticos / Microanalysis of verbal and nonverbal communication in psychoanalitic clinical facts

Se analizan seis fragmentos de una psicoterapia psicodinámica de larga duración, los cuales han sido definidos como "hechos clínicos" (HC). Se pretende identificar y describir algunos elementos verbales y no verbales presentes en la interacción paciente­terapeuta dentro de los segmentos pre-seleccionados del proceso.

[A standard questionnaire to reduce the routine battery of preoperative tests for elective surgery]. / Utilidad de un cuestionario estandarizado para disminuir el uso rutinario de estudios preoperatorios en cirugía electiva.

BACKGROUND: Preoperative medical testing in the United States is estimated at $3,000,000 USD per year. In an attempt to reduce this cost, some key points have been described with the purpose of promoting appropriate preoperative measurements with an adequate costObjective: To evaluate the utility of a preoperative standardized questionnaire in adult patients prior to elective surgery to detect which patients could be operated without laboratory testing. METHOD: An observational, prospective and analytic study was carried out. The questionnaire has been applied to 176 patients, all adults scheduled for elective surgery from April 2011 to March 2012. RESULTS: There were 57.4% females and 42.6% males. Ages varied between 18 and 85 years old, with a median of 46 years; 40.3% of the patients were > 50 years old and 59.7% were < 50 years old. The negative predictive value of the questionnaire is 95.88% (CI 95.34-96.42%). CONCLUSION: This questionnaire is a useful instrument to determinate the necessity of preoperative laboratory testing in young, clinical healthy and elective surgery patients in a general hospital.

Antecedentes: el costo de los exámenes preoperatorios en Estados Unidos se calcula en 3,000 millones de dólares anuales. Con la intención de disminuir este costo se han descrito algunos puntos clave que pueden promover una preparación preoperatoria con un adecuado costo-beneficio. Objetivo: evaluar la utilidad de la aplicación de un cuestionario estandarizado a pacientes adultos llevados a cirugía electiva para identificar a los que pudieran ser operados sin necesidad de estudios preoperatorios. Material y métodos: estudio observacional, prospectivo, analítico, en el que se aplicó un instrumento evaluador estandarizado a pacientes adultos para determinar la necesidad de realizar estudios preoperatorios programados para procedimientos electivos de cirugía general de abril de 2011 a marzo de 2012. Resultados: el cuestionario se aplicó a 176 pacientes, 57.4% mujeres y 42.6% hombres. La edad varió entre 18 y 85 años, con una media de 46 años. El 40.3% de los pacientes eran mayores de 50 años, y 59.7% menores de 50 años de edad. El valor predictivo negativo del cuestionario fue 95.8% (IC 95.34-96.42%). Conclusión: este cuestionario es una herramienta útil, que permite identificar a los pacientes jóvenes, clínicamente sanos, que no requieren estudios de laboratorio prequirúrgicos para cirugía electiva de cirugía general.

[Laparoscopic choledochoduodenostomy as an optional treatment choledocholithiasis]. / Coledocoduodenoanastomosis laparoscópica como opción terapéutica en coledocolitiasis compleja.

INTRODUCTION: Choledochoduodenostomy is indicated for unsolved choledocholithiasis and biliary malignant or benign stenosis. This surgical procedure has been feared for its potential complications. This article shows our initial experience with this laparo-endoscopic approach. METHODS: We performed laparoscopic choledochoduodenoastomy in seven elderly patients with recurrent or unsolved choledocholithiasis. Additionally, laparo-endoscopic extraction of gallstones was performed in necessary cases. We gathered and analyzed the demographic data, diagnostic proofs and follow up of the patients. RESULTS: Average age of patients was 71 years, with 57.1% of women in our population. Main omorbidities of our patients included obesity in 71.4%, diabetes mellitus type 2 in 57.4%, and arterial hypertension in 42.85%. Patients had in average 2.7 previous episodes of choledocholithiasis and/or cholangitis and the average diameter of the removed stones was 22.6 mm. Average follow-up was 155 days (range 28 to 420). DISCUSSION: Laparoscopic chooledochoduodenostomy has proved to be safe, effective and be superior to open surgery, as long as an appropriate selection of patients is performed and surgeons with experience on laparoscopic techniques are available. All these factors reduce the long-term complications with which this surgical procedure has been related. CONCLUSIONS: Laparoscopic choledochoduodenostomy is an option for the definitive surgical treatment of "difficult choledocholithiasis" in elderly patients with multiple comorbidities; it also offers the advantages of the minimally invasive approaches.

Mejoría en el score de riesgo cardiovascular por la cirugía bariátrica / Improvement in the cardiovascular risk score due to bariatric surgery

Introducción: La obesidad se ha considerado como un factor de riesgo para desarrollar eventos coronarios agudos. Los principales factores para desarrollar este tipo de enfermedades están presentes en la mayoría de los pacientes sometidos a cirugía bariátrica. Objetivo: Evaluar el riesgo cardiovascular de los pacientes sometidos a cirugía bariátrica en forma preoperatoria y postoperatoria tras un seguimiento a dos años. Sede: Hospital General ''Dr. Manuel Gea González''. Diseño: Estudio retrospectivo, longitudinal, observacional y comparativo. Material y métodos: Pacientes de la clínica de cirugía bariátrica, operados con la técnica de bypass gástrico, calculando el riesgo cardiovascular de forma preoperatoria y posteriormente a dos años de seguimiento. Resultados: Se incluyeron 64 pacientes (13 hombres y 51 mujeres). La edad promedio de los hombres fue 42 años su índice de masa corporal promedio fue 49.44 kg/m², la puntuación del riesgo cardiovascular preoperatoria fue: 5.15 (2-9). Al seguimiento a dos años su índice de masa corporal promedio disminuyó a 36.23 kg/m², la puntuación del riesgo cardiovascular fue: 2.38 (0-5). En las mujeres la edad promedio fue de 36 años, su índice de masa corporal promedio previo a la cirugía fue 45.32 kg/m², la puntuación del riesgo cardiovascular fue: 4.3 (-10 a 13). A un seguimiento de dos años su índice de masa corporal promedio fue 28.64 kg/m² (20.1-42.1), la puntuación del riesgo cardiovascular fue -4.1 (-11 a 8). Conclusión: La cirugía bariátrica no sólo ha demostrado ser un método eficaz y seguro para la disminución del peso corporal en pacientes con obesidad mórbida, también aquí se demuestra que disminuye el riesgo cardiovascular que poseen estos pacientes.

Introduction: Obesity has been considered a risk factor for acute coronary events. The main factors to develop this type of diseases are present in most of the patients subjected to bariatric surgery. Objective: To assess the cardiovascular risk of patients subjected to bariatric surgery preoperatively and at 2-years follow-up. Setting: General Hospital ''Dr. Manuel Gea González''. Design: Retrospective, longitudinal, observational, and comparative study. Patients and methods: Patients from the bariatric surgery clinic, operated with the gastric bypass technique, calculating the cardiovascular risk preoperatively and at 2-year follow-up. Results: The study included 64 patients (13 men and 51 women). Average age of men was 42 years, their average body mass index was 49.44 kg/m², preoperative cardiovascular risk score was 5.15 (2-9). At 2-year follow-up, their BMI diminished to 36.23 kg/m², the cardiovascular risk score was 2.38 (0-5). In women, average age was of 36 years, their body mass index before surgery was of 45.32 kg/m², the cardiovascular risk score was 4.3 (-10 a 13). At 2-year follow-up, their average body mass index reduced to 28.64 kg/m² (20.1-42.1), and the cardiovascular risk score was -4.1 (-11 to 8). Conclusion: Bariatric surgery has not only been demonstrated as an efficacious and safe method to reduce body weight in patients with morbid obesity but also to diminish the cardiovascular risk depicted by these patients.