Short-Term Effect of Self-Selected Training Intensity on Ambulatory Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial.

PURPOSE: To investigate the short-term effect of self-selected training intensity (SSTI) on ambulatory blood pressure (BP) in hypertensive older women. PARTICIPANTS AND METHODS: This is a randomized, single-blind, two-arm, parallel-group controlled trial that included 40 medicated hypertensive older women (64.4±3.6 years; resting systolic 118±19 and diastolic BP 68±9 mmHg). SSTI intervention was performed three times per week, 30-50 minutes per session (n=20). The control group participated in health education meetings once per week (n=20). Ambulatory BP (primary outcome) and six-minute walking test performance (secondary outcome) were assessed at baseline and following 8 weeks of intervention. Heart rate (HR), rating of perceived exertion (RPE, 6-20), and affective valence (ie, feeling scale, -5/+5) were recorded during all SSTI sessions. Intention-to-treat and per-protocol analyses were used for data analyses. RESULTS: Fifteen participants from the SSTI group and 17 from the control group completed the study. No differences in ambulatory BP (24-h, awake, and asleep) were observed between SSTI and control groups (intention-to-treat and per-protocol analyses; p>0.05). The SSTI group showed a greater six-minute walking test performance than the control group in the intention-to-treat and per-protocol analyses (p<0.05). The participants exercised at 52±10% of HR reserve reported an RPE of 11±1 and an affective valence of 3.4±1.1 over the 8-week period. CONCLUSION: SSTI is a feasible approach to induce a more active lifestyle and increase health-related fitness in hypertensive older women, although it does not improve BP control over a short-term period.

Dislipemias en la edad pediátrica. Importancia del diagnóstico y tratamiento precoces / Dyslipidemia in pediatric population. Relevance of early diagnosis and treatment / Dislipidemia em idade pediátrica. Importância do diagnóstico e tratamento precoces

Resumen: Las alteraciones de los lípidos o dislipemias son factores de riesgo principales para el desarrollo de aterosclerosis y enfermedad cardiovascular (ECV). La ateroesclerosis puede iniciarse precozmente en la edad pediátrica, pero se manifestará clínicamente al llegar a la adultez. La prevención mediante la promoción de salud y el control de los factores de riesgo debe iniciarse precozmente y el pediatra debe liderar este proceso. La epidemia de obesidad es una de las causas del aumento de las alteraciones de los lípidos en sangre en la edad pediátrica. Las dislipemias severas obligan a la búsqueda de enfermedades genéticas, siendo la hipercolesterolemia familiar la más frecuente. El diagnóstico temprano de esta enfermedad tiene gran relevancia en la prevención de la ECV, así como en el diagnóstico familiar en cascada. Es fundamental el trabajo en conjunto con los médicos de adultos, ya sea en la referencia de los padres de niños diagnosticados con dislipemia, y de los hijos de adultos con esta enfermedad. Desde la pediatría debemos acompañar el desarrollo de programas de control de dislipemias creados por diferentes instituciones. Se han planteado nuevos aspectos en las recomendaciones de las principales sociedades científicas internacionales y en nuestro país es necesario una discusión de dichas recomendaciones para adaptarlas a nuestra realidad y necesidades. Este artículo tiene como objetivos principales exponer la importancia del conocimiento de esta patología en niños, sus características y manejo, con el objetivo de mantener la salud del niño, iniciar precozmente la prevención de la ECV del adulto, y promover la discusión de un tema en el que se plantean nuevas normativas de estudio y tratamiento.

Summary: Dyslipidemia is a major risk factor for aterosclerosis and cardiovascular disease. Atherosclerosis onset can occur early during pediatric age and be present with clinical manifestations in the adulthood. Prevention through health promotion and risk factors control should start early in a process lead by the pediatrician. The obesity epidemic is one of the causes of blood lipids alterations in this population. Severe dyslipidemias lead to genetic disorders screening and family hypercholesterolemia is the most common. Early diagnosis of this disorder is specially relevant for cardiovascular disease prevention and family diagnosis. Joint work with adult physicians is essential for the referral of parents of diagnosed children and offsprings of diagnosed adults. From pediatrics we must accompany the development of dyslipidemia control programs created by different institutions.New recommendations have been made by international scientific societies and our country needs to discuss and adapt them to our situation and needs. This article has as main objectives to expose the importance of the knowledge of this pathology in children, its characteristics and management in order to preserve children`s health and establish early prevention of cardiovascular disease in adults. It also aims to open up the discussion of a subject in which new guidelines are being set.

Resumo: As alterações de lipídios ou dislipidemias são fatores de risco principais para o desenvolvimento de aterosclerose e doenças cardiovasculares. Aterosclerose pode começar cedo na faixa etária pediátrica, mas ser clinicamente manifestada ao atingir a idade adulta. Prevenção através da promoção da saúde e controle de fatores de risco deve ser iniciada o mais cedo e o pediatra deve liderar esse processo de prevenção. A epidemia da obesidade é uma das causas do aumento de alterações dos lipídios no sangue na faixa etária pediátrica. As dislipidemias severas obrigam a procurar doenças genéticas, sendo a mais comum hipercolesterolemia familiar. O diagnóstico precoce desta doença tem grande relevância tanto na prevenção de doenças cardiovasculares como no diagnóstico familiar cascata. É fundamental o trabalho em conjunto com os médicos de adultos, seja também na referência de pais de crianças com dislipidemia diagnosticados, bem como a referência dos filhos de adultos com esta doença. Desde a pediatria devemos acompanhar o desenvolvimento de programas de controle de dislipidemias desenvolvido por diferentes instituições. Foram levantados novos aspectos nas recomendações das principais sociedades científicas internacionais e em nosso país é preciso discutir para adaptá-los à nossa realidade e necessidades. Este trabalho tem como principais objetivos expor a importância do conhecimento desta patologia em crianças, suas características e manejo com o objetivo de manter a saúde de crianças, início precoce de prevenção da doenças cardiovasculares do adulto e desencadear uma discussão de um tópico em que se propõe novas normativas de estudo e tratamento.

A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy.

INTRODUCTION: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. METHODS: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. RESULTS: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using -1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. CONCLUSIONS: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

Preliminary spectrum of genetic variants in familial hypercholesterolemia in Argentina.

BACKGROUND: Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein cholesterol and early cardiovascular disease. As cardiovascular disease is a leading cause of mortality in Argentina, early identification of patients with FH is of great public health importance. OBJECTIVE: The aim of our study was to identify families with FH and to approximate to the characterization of the genetic spectrum mutations of FH in Argentina. METHODS: Thirty-three not related index cases were selected with clinical diagnosis of FH. Genetic analysis was performed by sequencing, multiplex ligation-dependent probe amplification, and bioinformatics tools. RESULTS: Twenty genetic variants were identified among 24 cases (73%), 95% on the low-density lipoprotein receptor gene. The only variant on APOB was the R3527Q. Four were novel variants: c.-135C>A, c.170A>C p.(Asp57Ala), c.684G>C p.(Glu228Asp), and c.1895A>T p.(Asn632Ile); the bioinformatics' analysis revealed clear destabilizing effects for 2 of them. The exon 14 presented the highest number of variants (32%). Four variants were observed in more than 1 case and the c.2043C>A p.(Cys681*) was carried by 18% of index cases. Two true homozygotes, 3 compound heterozygotes, and 1 double heterozygote were identified. CONCLUSION: This study characterizes for the first time in Argentina genetic variants associated with FH and suggest that the allelic heterogeneity of the FH in the country could have 1 relative common low-density lipoprotein receptor mutation. This knowledge is important for the genotype-phenotype correlation and for optimizing both cholesterol-lowering therapies and mutational analysis protocols. In addition, these data contribute to the understanding of the molecular basis of FH in Argentina.

A 10-year experience using combined lipid-lowering pharmacotherapy in children and adolescents.

BACKGROUND: Current pediatric guidelines for heterozygous familial hypercholesterolemia (HeFH) propose pharmacotherapy (PT) with statins from age 8 to 10 years; however, schemes with absorption inhibitors combined with statins, could be started earlier. The aim of the study was to show the 10-year results of a combined treatment protocol. METHODS: Prospective, descriptive and analytical study. Pediatric patients (n=70; mean age at PT initiation 9.3 years [range, 2-17.5]) with HeFH who required PT between 2005 and 2015 were included. All patients ≥10 years, with LDL >190 mg/dL or >160 mg/dL with one cardiovascular risk factor (CVRF) or >130 mg/dL with two or more CVRF; and those patients 5-10 years and with LDL-C >240 mg/dL or a family history of a cardiovascular event before 40 years, were medicated. After a period on a lipid-lowering diet (LLD), all patients were started on ezetimibe. Patients who did not achieve the treatment goal were given statins. The variables were: age, age at PT initiation, duration of PT, initial LDL-C, mean LDL-C during ezetimibe monodrug therapy, mean LDL-C during combined PT, and percentage of LDL decrease. RESULTS: LDL-C levels were: Baseline: 235 mg/dL±55; after 3 months on ezetimibe: 167 mg/dL±47 (decrease: -27.62%). In 18 patients who did not reach the treatment goal atorvastatin was added and their LDL-C decreased -41.5% (p: 0.02). Overall, mean final LDL-C was 155 mg/dL±30.4 (range, 98-257) and treatment goals were reached in 74% of the patients. No severe side effects were reported. CONCLUSIONS: Combined and sequential treatment starting at early ages was shown to be safe and effective over this follow-up period.

Lineamientos en soporte nutricional en posoperatorios de cirugía cardíaca neonatal / Introduction on postoperative nutritional support in neonatal cardiac surgery

La malnutrición es una complicación habitual de los neonatos con patología cardiovascular en el período posquirúrgico. Esto sucede por la escasa reserva metabólica, el aumento del gasto energético provocado por la lesión, el aporte de nutrientes insuficiente o tardío que reciben y por su incapacidad de metabolizarlos dada su condición crítica. Una intervención nutricional adecuada, que alcanza los objetivos, logra mejor respuesta metabólica del neonato operado y tiene consecuencias significativas en el tiempo de internación, cicatrización de heridas, susceptibilidad a las infecciones y evolución posquirúrgica. Estos lineamientos pretenden establecer fundamentos prácticos para el soporte nutricional tanto enteral como parenteral del paciente cardiovascular neonatal, teniendo en cuenta la restricción hídrica y la optimización de macro y micronutrientes requeridos en el posoperatorio.

Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time.

[Introduction on postoperative nutritional support in neonatal cardiac surgery]. / Lineamientos en soporte nutricional en posoperatorios de cirugía cardíaca neonatal.

Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time.

Lineamientos en soporte nutricional en posoperatorios de cirugía cardíaca neonatal. / [Introduction on postoperative nutritional support in neonatal cardiac surgery].

Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time.

Medición ecográfica del espesor medio-intimal carotídeo en pacientes pediátricos con obesidad, hipercolesterolemia familiar y diabetes tipo 1 / Ultrasonography measurement of carotid intima-media thickness in pediatric patients with obesity, familial hypercholesterolemia and type 1 diabetes

Propósito. Evaluar con ultrasonografía (US) el Espesor Medio Intimal (EMI) como marcador de riesgo cardiovascular (RCV) temprano en pacientes con diagnóstico clínico y de laboratorio de Hipercolesterolemia Familiar (HCF), Diabetes Tipo 1 (DBT-1) y Obesidad(OB), comparando con grupo control. Materiales y Métodos. Estudio prospectivo, descriptivo y de corte transversal. Evaluamos el EMI de las arterias carótidas comunes (CC) e incluimos en una sola variable dicotómica otras alteraciones estructurales de la pared (placas ateromatosas e irregularidades de la íntima). La US fue realizada en forma cegada al resultado de los exámenes de sangre, según las recomendaciones del consenso de Mannheim 2007, en 121 pacientes (de 6 a 18 años): 24 HCF, 40 DBT-1 y 43 OB; y 14 controles. Se excluyeron pacientes con otras patologías que pudieran alterar la pared arterial. Analizamos las variables con el programa Statistix 8. Resultados. Comparados con los controles, los 3 grupos tuvieron un mayor EMI, siendo las diferencias estadísticamente significativas. Los EMI Medio (mm) fueron en HCF: 0,59 (0,31-2,15), p: 0,006; IC: 0,06-0,36. Obesos: 0,48 (0,3-0,85), p: 0,001; IC: 0,06-0,14. DBT-1: 0,46 (0,25-0,65), p: 0,0004; IC: 0,03-0,13. Grupo control: 0,37 (0,30-0,45). Los pacientes con HCF presentaron la mayor diferencia. No se encontró asociación entre el valor de LDL-C y el EMI. El 62,5% recibían tratamiento farmacológico en el momento de la evaluación. En DBT-1 no se encontró asociación entre el EMI y los niveles de HbA1c y lípidos; y en el grupo OB no se encontró asociación entre el EMI y el Z score IMC. El 31% de HCF, el 8% de DBT-1 y el 6% de OB presentaron placas ateromatosas e irregularidades de la íntima. Conclusión. La US del EMI permitió demostrar que los pacientes...

Medición ecográfica del espesor medio-intimal carotídeo en pacientes pediátricos con obesidad, hipercolesterolemia familiar y diabetes tipo 1 / Ultrasonography measurement of carotid intima-media thickness in pediatric patients with obesity, familial hypercholesterolemia and type 1 diabetes

Propósito. Evaluar con ultrasonografía (US) el Espesor Medio Intimal (EMI) como marcador de riesgo cardiovascular (RCV) temprano en pacientes con diagnóstico clínico y de laboratorio de Hipercolesterolemia Familiar (HCF), Diabetes Tipo 1 (DBT-1) y Obesidad (OB), comparando con grupo control. Materiales y Métodos. Estudio prospectivo, descriptivo y de corte transversal. Evaluamos el EMI de las arterias carótidas comunes (CC) e incluimos en una sola variable dicotómica otras alteraciones estructurales de la pared (placas ateromatosas e irregularidades de la íntima). La US fue realizada en forma cegada al resultado de los exámenes de sangre, según las recomendaciones del consenso de Mannheim 2007, en 121 pacientes (de 6 a 18 años): 24 HCF, 40 DBT-1 y 43 OB; y 14 controles. Se excluyeron pacientes con otras patologías que pudieran alterar la pared arterial. Analizamos las variables con el programa Statistix 8. Resultados. Comparados con los controles, los 3 grupos tuvieron un mayor EMI, siendo las diferencias estadísticamente significativas. Los EMI Medio (mm) fueron en HCF: 0,59 (0,31-2,15), p: 0,006; IC: 0,06-0,36. Obesos: 0,48 (0,3-0,85), p: 0,001; IC: 0,06-0,14. DBT-1: 0,46 (0,25-0,65), p: 0,0004; IC: 0,03-0,13. Grupo control: 0,37 (0,30-0,45). Los pacientes con HCF presentaron la mayor diferencia. No se encontró asociación entre el valor de LDL-C y el EMI. El 62,5% recibían tratamiento farmacológico en el momento de la evaluación. En DBT-1 no se encontró asociación entre el EMI y los niveles de HbA1c y lípidos; y en el grupo OB no se encontró asociación entre el EMI y el Z score IMC. El 31% de HCF, el 8% de DBT-1 y el 6% de OB presentaron placas ateromatosas e irregularidades de la íntima. Conclusión. La US del EMI permitió demostrar que los pacientes con enfermedades crónicas, con RCV aumentado en edad adulta, presentaron alteraciones precoces de la íntima media carotídea en la etapa pediátrica. Esto permite aplicaciones clínicas preventivas y de orientación terapéutica.(AU)

To evalúate by ultrasonographic images carotid intima-media thickness (IMT) as an early marker of cardiovascular risk (CVR) in patients with clinical and laboratory diagnosis of familial hypercholesterolemia (FHC), type 1 diabetes (DBT-1) and Obesity (OB), compared to a healthy control group. Materials and Methods. A prospective, descriptive, and cross-sectional study. We evaluated the IMT of common carotid (ce) arteries and included in a single dichotomic variable other structural modifications of the wall (atheromatous plaques and intima irregularities). US was blinded to the blood tests results (as recommended by the 2007 Mannheim consensus) from 121 patients (aged 6 to 18 years): 24 FHC, 40 DBT-1, 43 OB, and 14 controls. Patients with other diseases that could alter the arterial wall were excluded. Variables were analyzed using the Statistix 8 program. Results. The three groups had a higher IMT than the control group, with these differences being statistically significant. Mean IMT (mm) were 0.59 (0.31-2.15), p: 0.006, CI 0.06 to 0.36 in FHC; 0.48 (0.3-0.85), p: 0.001, CI 0.06-0.14 in obesity; and 0.46 (0.25-0.65), p: 0.0004, CI 0.03-0.13 in DBT-1. Control group: 0.37 (0.30-0.45). The major difference was observed in FHC patients. No association was found between LDL-C valué and IMT Upon the examination, 62.5% were receiving pharmacotherapy. In DBT-1 no association was found between IMT and the levéis of HbAlc and lipids. In the OB group there was no association between IMT and BMI Z-score. Atheromatous plaques and intima irregularities were found in 31% of FHC patients, 8% of DBT-1 patients, and 6% of OB patients. Conclusión. Ultrasonographic IMT measurements demonstrated that patients with chronic diseases and increased CVR at adulthood presented early changes in the carotid intima-media at childhood. This allows clinical prevention strategies and therapeutic guidance.(AU)

Medición ecográfica del espesor medio-intimal carotídeo en pacientes pediátricos con obesidad, hipercolesterolemia familiar y diabetes tipo 1 / Ultrasonography measurement of carotid intima-media thickness in pediatric patients with obesity, familial hypercholesterolemia and type 1 diabetes

Propósito. Evaluar con ultrasonografía (US) el Espesor Medio Intimal (EMI) como marcador de riesgo cardiovascular (RCV) temprano en pacientes con diagnóstico clínico y de laboratorio de Hipercolesterolemia Familiar (HCF), Diabetes Tipo 1 (DBT-1) y Obesidad (OB), comparando con grupo control. Materiales y Métodos. Estudio prospectivo, descriptivo y de corte transversal. Evaluamos el EMI de las arterias carótidas comunes (CC) e incluimos en una sola variable dicotómica otras alteraciones estructurales de la pared (placas ateromatosas e irregularidades de la íntima). La US fue realizada en forma cegada al resultado de los exámenes de sangre, según las recomendaciones del consenso de Mannheim 2007, en 121 pacientes (de 6 a 18 años): 24 HCF, 40 DBT-1 y 43 OB; y 14 controles. Se excluyeron pacientes con otras patologías que pudieran alterar la pared arterial. Analizamos las variables con el programa Statistix 8. Resultados. Comparados con los controles, los 3 grupos tuvieron un mayor EMI, siendo las diferencias estadísticamente significativas. Los EMI Medio (mm) fueron en HCF: 0,59 (0,31-2,15), p: 0,006; IC: 0,06-0,36. Obesos: 0,48 (0,3-0,85), p: 0,001; IC: 0,06-0,14. DBT-1: 0,46 (0,25-0,65), p: 0,0004; IC: 0,03-0,13. Grupo control: 0,37 (0,30-0,45). Los pacientes con HCF presentaron la mayor diferencia. No se encontró asociación entre el valor de LDL-C y el EMI. El 62,5% recibían tratamiento farmacológico en el momento de la evaluación. En DBT-1 no se encontró asociación entre el EMI y los niveles de HbA1c y lípidos; y en el grupo OB no se encontró asociación entre el EMI y el Z score IMC. El 31% de HCF, el 8% de DBT-1 y el 6% de OB presentaron placas ateromatosas e irregularidades de la íntima. Conclusión. La US del EMI permitió demostrar que los pacientes con enfermedades crónicas, con RCV aumentado en edad adulta, presentaron alteraciones precoces de la íntima media carotídea en la etapa pediátrica. Esto permite aplicaciones clínicas preventivas y de orientación terapéutica.(AU)

To evalúate by ultrasonographic images carotid intima-media thickness (IMT) as an early marker of cardiovascular risk (CVR) in patients with clinical and laboratory diagnosis of familial hypercholesterolemia (FHC), type 1 diabetes (DBT-1) and Obesity (OB), compared to a healthy control group. Materials and Methods. A prospective, descriptive, and cross-sectional study. We evaluated the IMT of common carotid (ce) arteries and included in a single dichotomic variable other structural modifications of the wall (atheromatous plaques and intima irregularities). US was blinded to the blood tests results (as recommended by the 2007 Mannheim consensus) from 121 patients (aged 6 to 18 years): 24 FHC, 40 DBT-1, 43 OB, and 14 controls. Patients with other diseases that could alter the arterial wall were excluded. Variables were analyzed using the Statistix 8 program. Results. The three groups had a higher IMT than the control group, with these differences being statistically significant. Mean IMT (mm) were 0.59 (0.31-2.15), p: 0.006, CI 0.06 to 0.36 in FHC; 0.48 (0.3-0.85), p: 0.001, CI 0.06-0.14 in obesity; and 0.46 (0.25-0.65), p: 0.0004, CI 0.03-0.13 in DBT-1. Control group: 0.37 (0.30-0.45). The major difference was observed in FHC patients. No association was found between LDL-C valué and IMT Upon the examination, 62.5% were receiving pharmacotherapy. In DBT-1 no association was found between IMT and the levéis of HbAlc and lipids. In the OB group there was no association between IMT and BMI Z-score. Atheromatous plaques and intima irregularities were found in 31% of FHC patients, 8% of DBT-1 patients, and 6% of OB patients. Conclusión. Ultrasonographic IMT measurements demonstrated that patients with chronic diseases and increased CVR at adulthood presented early changes in the carotid intima-media at childhood. This allows clinical prevention strategies and therapeutic guidance.(AU)

Avaliação in vitro de diferentes métodos de remoção da resina residual do esmalte dentário / Evaluation in vitro different methods of dental enamel residual resinremoval

O objetivo desta pesquisa foi comparar in vitro diferentes métodos de remoção da resina residual do esmalte dentário, após o descolamento de bráquetes. Os corpos de prova foram separados em 5 grupos (n=10). Após a remoção dos bráquetes com pistola removedora (Orthosource), a resina remanescente foi removida por diferentes tipos de tratamento: grupo I – Jato de óxido de alumínio, grupo II – ponta de carboneto de tungstênio (30 lâminas) em alta rotação; grupo III – ponta de óxido de alumínio (Shofu) em alta rotação, grupo IV – sistema Profin, grupo V – alicate removedor de resina. Depois da remoção da resina foi realizado polimento com pasta de pedra pomes e água em todas as amostras. A avaliação foi realizada antes da colagem, depois da remoção e após o polimento, por meio da análise rugosimétrica de superfície e observação em microscopia eletrônica de varredurra. Os valores de rugosidade foram submetidos à análise de variância e ao teste de Tukey (5%). Os resultados demonstraram que em todas as fases, o alicate removedor de resina foi método que mostrou os melhores resultados. Depois da remoção da resina residual, os métodos com broca de carboneto de tungstênio (30 lâminas) e com ponta de óxido de alumínio mostraram os maiores valores de rugosidade com diferença estatística significante em relação aos demais. O polimento foi importante para o restabelecimento da lisura superficial do esmalte, em todos os métodos de remoção da resina residual.

Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in obese Argentinean children and adolescents.

The aim of this study was to evaluate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in obese children and adolescents and to examine insulin resistance and insulin secretion. We studied 427 asymptomatic obese patients. DM2 and IGT were diagnosed by an oral glucose tolerance test. Insulin resistance and P-cell function were assessed by using homeostasis model assessment (HOMA), insulin/glucose index (I/GI), fasting insulin and insulin sensitivity index (ISI-composite). Thirty patients showed IGT (7%) and seven had DM2 (1.6%). The mean age was 10.7 +/- 3.5 years, the diabetic group being significantly older than the normal group (p < 0.01). The mean body mass index was 30 +/- 5.3 kg/m2 without significant differences between groups. beta-Cell function declined significantly in the patients with IGT and DM2, and insulin resistance increased significantly. Given the rather high prevalence of glucose metabolism impairment, children with obesity should undergo glucose tolerance testing for appropriate therapeutic intervention.

Transición del Sistema de Atención Pediátrico al de Adultos en Diabetes Mellitus Tipo 1

Objetivos: Obtener información para un diagnóstico de la situación asistencial actual en lo referente a los sistemas en uso para la efectivización de los procesos que permiten la derivación de los adolescentes diabéticos a servicios de atención de adultos, en función del diseño de programas de intervención específicos y la posterior evaluación de los resultados. Identificar los factores que obstaculizan los procesos de transferencia y constituyen factores de riesgo para la evolución posterior del paciente en el sistema de adultos. Identificar los factores que favorecen una buena evolución posterior a la transferencia. Identificar los rasgos que se asocian a buen y mal pronóstico en un proceso de derivación y los requisitos para que un paciente esté en condiciones de hacer una buena transición. Diseño y refinamiento de herramientas de evaluación de sistemas de transición. Propuesta de una metodología de trabajo para implementar un sistema de transición. Generar conciencia a nivel médico-asistencial y de salud pública de la necesidad de una planificación para estos procesos.

Tração reversa da maxila: caso clínico / Reverse maxillary traction: case report

Nos diversos tipos de maloclusão, podemos ter desvios dentários, esqueléticos ou uma combinação entre eles. De todas as maloclusões, a de Classe III é a que tem maior potencial genético, em que o crescimento acaba sendo maior inimigo durante e após o tratamento. Tais indivíduos freqüentemente podem apresentar retrusão maxilar esquelética, protrusão mandibular esquelética, ou a combinação de ambas associada a uma atresia maxilar, o que é manifestado por uma mordida cruzada anterior e/ou posterior. O objetivo deste trabalho foi fazer uma revisão da literatura e descrever o caso clínico de um paciente portador da maloclusão de Classe III. Concluímos que a tração reversa da maxila e disjunção palatina é o tratamento de escolha, nos casos de maloclusão de Classe III esquelética na dentição mista.

Transición del Sistema de Atención Pediátrico al de Adultos en Diabetes Mellitus Tipo 1

Objetivos: Obtener información para un diagnóstico de la situación asistencial actual en lo referente a los sistemas en uso para la efectivización de los procesos que permiten la derivación de los adolescentes diabéticos a servicios de atención de adultos, en función del diseño de programas de intervención específicos y la posterior evaluación de los resultados. Identificar los factores que obstaculizan los procesos de transferencia y constituyen factores de riesgo para la evolución posterior del paciente en el sistema de adultos. Identificar los factores que favorecen una buena evolución posterior a la transferencia. Identificar los rasgos que se asocian a buen y mal pronóstico en un proceso de derivación y los requisitos para que un paciente esté en condiciones de hacer una buena transición. Diseño y refinamiento de herramientas de evaluación de sistemas de transición. Propuesta de una metodología de trabajo para implementar un sistema de transición. Generar conciencia a nivel médico-asistencial y de salud pública de la necesidad de una planificación para estos procesos.