Checklist: Neck computed tomography in non-traumatic emergencies.

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.

Lista de verificación: tomografía computarizada de cuello en urgencias no traumáticas / Checklist: Neck computed tomography in non-traumatic emergencies

A los pacientes que acuden a urgencias con síntomas inflamatorio/infecciosos a nivel cervical o con masas que pueden comprometer el tracto aerodigestivo o las estructuras vasculares, es necesario hacerles una tomografía computarizada (TC) de cuello con contraste. Su interpretación radiológica se ve dificultada por la complejidad anatómica y la interrelación fisiopatológica entre los diferentes sistemas que lo componen, en un área de estudio relativamente pequeña. Estudios recientes proponen realizar una evaluación sistemática de las estructuras cervicales, utilizando para ello un listado de verificación de 7 elementos, para identificar correctamente la patología, y detectar los hallazgos incidentales que pueden interferir en el manejo del paciente. El objetivo de este trabajo es revisar los hallazgos de la TC en la patología no traumática del cuello en urgencias siguiendo una lectura sistemática, tras la cual se pueda realizar un informe radiológico estructurado, completo y conciso.(AU)

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.(AU)

Clínica, epidemiología e imagenología del fibroma osificante y la displasia fibrosa del territorio cráneo-maxilofacial: revisión narrativa / Clinical, epidemiology and imaging of ossifiying fibroma and fibrous dysplasia of the cranio-maxillofacial territory: narrative review

Introducción: El fibroma osificante (FO) y la displasia fibrosa (DF) tienen características imagenológicas e histopatológicas similares que dificultan el diagnóstico diferencial. El propósito de la presente revisión narrativa es analizar las características clínicas, epidemiológicas e imagenológicas del FO y la DF, y evaluar la relación entre las características imagenológicas y las variantes histopatológicas del FO, en reportes y series de casos publicados.Materiales y métodos:Se realizó una búsqueda de reportes y series de casos de FO y DF entre 2017-2021 en PubMed, Scopus y Web of Science. Los casos debían tener suficiente información clínica, epidemiológica, histopatológica e imagenológica.Resultados:Se incluyeron 23 artículos con 25 lesiones: 17 FO y 8 DF. El tiempo de evolución de DF es más prolongado que FO. FO se ubica con mayor tendencia en complejo osteomeatal en comparación con DF. Sólo FO presentó alteraciones en piel, radiolucidez/hipodensidad periférica, perforación ósea y rizalisis externa, además, tuvo mayor tendencia al avance a espacios anatómicos adyacentes y a generar asimetría facial y/o craneal. FO psammomatoide y FO trabecular comparten patrones imagenológicos y tienen límites definidos corticalizados. FO convencional tuvo mayor tendencia a perforar corticales. DF puede tener límites mal definidos y definidos corticalizados. El FO mostró características imagenológicas de mayor agresividad que la DF.Conclusiones:La histología e imagenología por sí solas no son decisivas en el diagnóstico de FO y DF. Es imprescindible considerar conjuntamente clínica, imagenología e histopatología, enfatizando en las características que orienten el diagnóstico diferencial.(AU)

Introduction: Ossifying fibroma (OF) and fibrous dysplasia (FD) have similar imaging and histopathological characteristics, which make differential diagnosis difficult. The aim of this narrative review was to analyze the clinical, epidemiological and imaging characteristics of OF and FD, as well as to evaluate the relationship between imaging characteristics and histopathologic variants of OF, in reports and case series published.Materials and methods:A search of reports and case series of OF and FD between 2017-2021 in PubMed, Scopus and Web of Science was performed. The cases had to have enough clinical, epidemiological, histopathological and imaging information.Results:23 articles with 25 lesions were included: 17 OF and 8 FD. FD had a longer time of evolution than OF. OF is more likely to be in osteomeatal complex compared to FD. Only OF had skin alterations, peripheral radiolucency/hypodensity, bone perforation and external root resorption, in addition, it had a greater tendency to advance to adjacent anatomical spaces and generate facial and/or cranial asymmetry. Psammomatoid OF and trabecular OF share imaging patterns and have defined and corticated margins. Conventional OF had a greater tendency to cortical perforation. DF can have ill-defined and defined and corticated margins. OF has imaging characteristics of greater aggressiveness than FD.Conclusion:Histology and imaging alone are not decisive in OF and FD diagnosis. It is essential to consider clinical, imaging and histopathological evaluations as a whole, emphasizing in the characteristics that guide the differential diagnosis.(AU)

Epidemiología, clínica e imagenología del quiste odontogénico glandular: revisión narrativa / Epidemiology, clinical and imaging of glandular odontogenic cyst: narrative review

Introducción: El quiste odontogénico glandular (QOG) tiene una diversidad de características epidemiológicas, clínicas e imagenológicas. El propósito de la presente revisión fue analizarla epidemiología, clínica, imagenología junto con la agresividad, tratamiento, seguimiento y recidiva de QOG en la literatura actual. Materiales y métodos: Se realizó una búsqueda sistemática de casos clínicos de QOG publicados entre 2012-2022 en PubMed, Web of Science y Science Direct que tuvieran información epidemiológica, clínica e imagenológica junto a su confirmación histopatológica a través de descripción e imágenes. Resultados: Se incluyeron 27 artículos con 30QOG. Los QOG se presentaron entre los 7 y 78 años. Su tiempo de evolución promedio fue de un año. Se observaron mayoritariamente en región posterior de mandíbula y sin sintomatología. Mayoritariamente fueron radiolúcidos, uniloculares, con bordes definidos y corticalizados y presentaron expansión ósea. Presentaron características agresivas como gran tamaño, perforación ósea y los dientes involucrados tendieron a tenerespacio periodontal infiltrado, desplazamiento y rizálisis. La mayoría de los QOG se trataron con enucleación y no recidivaron. Conclusiones: Se observaron QOG con características que difieren de la literatura clásica en edad, tiempo de evolución, sintomatología, patrón imagenológico, presentación bilateral y ubicación. La imagenología del QOG tiene un comportamiento por lo general, agresivo. En tanto, su agresividad estuvo asociada con su mayor tamaño, borramiento y/o infiltración cortical, perforación ósea, espacio periodontal infiltrado, rizalisis externa y al compromiso de estructuras anatómicas adyacentes. Teniendo en cuenta estas características, los tratamientos de descompresión y exéresis, junto a seguimientos menores a 5 años podrían recidivar. (AU)

Introduction: Glandular odontogenic cyst (GOC) has a diversity of epidemiological, clinical and imaging characteristics. The purpose of this review was to analyze the epidemiology, clinic, and imaging, along with aggressiveness, treatment, follow-up, and recurrence of GOC in the current literature. Materials and methods: A systematic search for clinical cases of GOC published between 2012-2022 was conducted in PubMed, Web of Science and Science Direct. Epidemiological, clinical and imaging information, along with their histopathological confirmation through description and images had to be present in the articles. Results: 27 articles with 30 GOC were included. GOC was found to be present between 7 and 78 years. Its average evolution time was one year. They were observed mostly in the posterior mandible and were asymptomatic. They were mostly radiolucent, unilocular, with defined and corticated borders and presented bone expansion. They presented aggressive characteristics such as larger size, bone perforation and the teeth involved tended to have infiltrated periodontal space, displacement and root resorption. GOC were mostly treated with enucleation and did not present recurrence. Conclusions: GOC was observed with atypical characteristics, which differ from classical literature in terms of age, time of evolution, symptomatology, imaging pattern, bilateral presentation and location. Imaging of QOG generally has an aggressive behavior. Its aggressiveness was associated with its larger size, cortical effacement and/or infiltration, bone perforation, infiltrated periodontal space, root resorption, and involvement of adjacent anatomical structures. Considering the characteristics mentioned above, decompression and excision treatments, together with follow-up of less than 5 years, could lead to recurrence. (AU)

Culture-negative TB: clinical characteristics, risk factors and treatment outcomes.

BACKGROUND: Although culture remains the standard for TB diagnosis, 15-20% of patients diagnosed and treated for TB are culture-negative. We explored clinical characteristics, risk factors and treatment outcomes for culture-negative TB in a Peruvian cohort.METHODS: We recruited 4,500 index TB patients and 10,160 household contacts in Lima, Peru, and enrolled 692 secondary patients diagnosed with TB during follow-up of household contacts. We analyzed smear and culture status, sociodemographic factors, clinical characteristics and TB treatment outcomes to compare culture-negative and positive patients.RESULTS: Of the 4,880 adult patients, 915 (18.8%) were culture-negative. Culture-negative patients were less likely to report symptoms of TB disease and disease of longer duration. A multivariate analysis showed no statistically significant difference in loss to follow-up, treatment failure or recurrence between the culture-negative and -positive groups but a higher rate of death among culture-negative patients with an adjusted OR of 1.65 (95% CI 1.05-2.60). In a multivariate analysis of determinants of culture negativity, older age, substance use and being a secondary case were associated with culture status.CONCLUSIONS: More recognition and awareness of culture-negative TB is key for early and correct diagnosis to reduce transmission and improve treatment outcomes.

Hallazgo incidental atípico en radiografía panorámica de extensa masa calcificada en rodete tubárico. Seguimiento a 11 años / Atypical incidental finding in panoramic radiography of an extensive calcified mass in torus tubarius: a 11-year follow-up

Introducción: La mayoría de las calcificaciones en la región de cabeza y cuello son asintomáticas, generalmente detectadas como hallazgos incidentales en estudios imagenológicos. Se han reportado calcificaciones previamente en el rodete tubárico, sin embargo, no hay reportes del hallazgo incidental de una gran calcificación asintomática en el rodete tubárico con seguimiento de 11 años. Objetivo: El propósito del presente artículo es reportar el hallazgo incidental en una radiografía panorámica, de una gran calcificación en el rodete tubárico y discutir sus posibles diagnósticos. Presentación del caso: Mujer de 43 años, sin historia clínica personal ni antecedentes familiares relevantes asiste a una clínica dental privada, para su evaluación antes de un tratamiento dental integral. Se encontró una gran calcificación asintomática en la trompa auditiva, específicamente en el rodete tubárico, como hallazgo incidental en una radiografía panorámica. El presente reporte muestra el enfoque de toma de decisiones para su diagnóstico diferencial. Basado en las imágenes y su comportamiento clínico, es posible que esta lesión corresponda a un tonsilolito o la unión de varios tonsilolitos en el rodete tubárico. No se realizó ningún tratamiento quirúrgico. En su lugar, se ha realizado un seguimiento imagenológico de 11 años. Teniendo en cuenta la evolución del caso, se espera que la lesión se mantenga estable, sin embargo, debe continuar su seguimiento para evaluar sus características clínicas y radiográficas en el tiempo. Conclusiones: La radiografía panorámica permite observar la superposición de estructuras anatómicas externas al territorio maxilofacial. Por lo tanto, es esencial que los radiólogos maxilofaciales tengan conocimiento adecuado del territorio evaluado, para detectar alteraciones como la reportada. (AU)

Introduction: Most of calcifications in head and neck region are asymptomatic and are usually detected as incidental findings in imaging studies. Calcifications have previously been reported in the torus tubarius, however, there are no reports of the incidental finding of a large, asymptomatic calcification located in the torus tubarius that include an 11-years follow-up. Objective: The purpose of the present article is to report the incidental finding in a panoramic radiography, of a large calcification at the previously described location and discuss its presumptive diagnoses. Case presentation: A 43-year-old female patient, with neither personal medical history nor relevant family history attended a private dental clinic, for evaluation prior to the start of a comprehensive dental treatment. A large, asymptomatic calcification in the auditory tube, specifically in thetorus tubarius, was found as incidental finding in a panoramic radiography. The approach for its differential diagnosis decision making is shown. Based on imaging and clinical behavior, it is possible that this lesion corresponds to a tonsilolith, or the coalescence of several tonsiloliths formed in the torus tubarius. No surgical treatment was carried out. A 11-yearsclinical an imaging follow-up has been performed instead. Considering the evolution of this case, it is expected that this lesion will remain stable, however, the status of the patient must be followed-up to assess its clinical and radiographic characteristics. Conclusions: Panoramic radiograph allows clinicians to observe the superimposition of anatomical structures which are external to the maxillofacial territory. Therefore, it is essential that dental radiologists have an appropriate knowledge of the territory being evaluated. (AU)

Clínica, epidemiología e imagenología del quiste óseo aneurismático en el territorio craneofacial, análisis de sus patrones histopatólogicos: revisión narrativa / Clinical, epidemiology and imaging of the aneurysmal bone cyst in the craniofacial territory, analysis of its histopathological patterns: a narrative review

Introducción: El quiste óseo aneurismático (QOA) tiene una diversidad de características clínicase imagenológicas. Existe poca información respecto a la posible relación entre algunas de estas características y los patrones histopatológicos del QOA. El propósito de la presente revisión fue analizar la clínica, epidemiología e imagenología de casos de QOA, y determinar qué características podrían tener relación con algún tipo de patrón histopatológico del QOA en el territorio craneofacial. Materiales y métodos:Se realizó una búsqueda de casos de QOA en el territorio craneofacial publicados desde el año 2000, en PubMed, Scopus y Web of Science, mediante la búsqueda ("Aneurysmal bone cyst") AND ("Skull" OR "Jaw" OR "Mandible" OR "Maxilla"). Los casos debían tener información histopatológica, clínica, epidemiológica e imagenológica. Revisión: Se incluyó 40 artículos con 41 lesiones, siendo 34 de patrón clásico y 7 de patrón mixto-sólido (M-S). El patrón M-S se presentó mayoritariamente sin dolor y en el sexo masculino, mientras que el patrón clásico con dolor asociado y en el sexo femenino. Respecto a la imagenología, el patrón M-S se presentó sin límites definidos-corticalizados y generó perforación ósea con mayor frecuencia que el patrón clásico. Conclusiones: Los patrones histopatológicos del QOA tienen características clínicas, epidemiológicas e imagenológicas similares. Sin embargo, difieren en sexo, dolor asociado, límites definidos corticalizados y perforación ósea, lo que permitiría orientar al diagnóstico hacia un patrón histopatológico. (AU)

Introduction: The aneurysmal bone cyst (ABC) has a variety of clinical and imaging characteristics. There is little information regarding the possible relationship between some of these characteristics and its histopathological patterns. The aim of this review was to analyze the clinical, epidemiology and imaging characteristics of ABC cases, and determine what characteristics might be related to some type of histopathological pattern of ABC in the craniofacial territory. Materials and methods: A search was conducted for ABC cases in the craniofacial territory published since 2000, on PubMed, Scopus and Web of Science, by searching ("Aneurysmal bone cyst") AND ("Skull" OR "Jaw" OR "Mandible" OR "Maxilla"). Cases had to have histopathological, clinical, epidemiological, and imaging information. Review: 40 articles with 41 ABC lesions were included, with 34 being classic pattern and 7 mixed-solid (M-S). The M-S pattern was mostly painless and in males, while the classic pattern, with associated pain was mostly in females. Regarding imaging, the M-S pattern was without defined-corticated limits and with bone perforation more frequently than the classic pattern. Conclusions: Histopathological patterns of ABC have similar clinical, epidemiological and imaging characteristics. However, they differ in sex, associated pain, defined-corticated limits and bone perforation, which would allow the diagnosis to be directed towards a specific histopathological pattern. (AU)

Using digital chatbots to close gaps in healthcare access during the COVID-19 pandemic.

INTRODUCTION: Chatbots have emerged as a first link to care in recent years. The COVID-19 pandemic, and consequent health system disruptions, expanded their use. Socios En Salud (SES) introduced chatbots in Peru, which experienced one of the highest excess COVID mortalities in the world. METHODS: SES and the government identified unmet population health needs, which could be amenable to virtual interventions. Chatbots were developed to screen individuals for these conditions; we describe the period of deployment, number of screenings, and number of people who received services. RESULTS: Between April 2020 and May 2021, SES deployed nine ChatBots: four for mental health, two for maternal and child health, and three for chronic diseases: breast cancer, hypertension, diabetes mellitus, and obesity. Mental health services were provided to 42,932 people, 99.99% of those offered services. The other ChatBots reached fewer people. Overall, more than 50% of eligible people accepted chatbot-based services. DISCUSSION: ChatBot use was highest for mental health. Chatbots may increase connections between a vulnerable population and health services; this is likely dependent on several factors, including condition, population, and penetration of smart phones. Future research will be critical to understand user experience and preferences and to ensure that chatbots link vulnerable populations to appropriate, high-quality care.

INTRODUCTION: Les chatbots se sont imposés comme un premier lien aux soins ces dernières années. La pandémie de COVID-19, et les perturbations du système de santé qui en ont résultées, ont élargi leur champ d'application. Socios En Salud (SES) a introduit les chatbots au Pérou, qui a connu l'une des surmortalités dues au COVID les plus élevées au monde. MÉTHODES: SES et le gouvernement ont identifié des besoins non satisfaits en matière de santé de la population, qui pourraient faire l'objet d'interventions virtuelles. Des chatbots ont été développés pour dépister des individus pour ces conditions ; nous décrivons la période de leur déploiement, le nombre de dépistages et le nombre de personnes qui ont reçu ces services. RÉSULTATS: Entre avril 2020 et mai 2021, SES a déployé neuf ChatBots : quatre pour la santé mentale, deux pour la santé maternelle et infantile et trois pour les maladies chroniques, comme le cancer du sein, l'hypertension, le diabète et l'obésité. Des services de santé mentale ont été fournis à 42 932 personnes, soit 99,99% des personnes proposées. Les autres ChatBots ont touché moins de personnes. Dans l'ensemble, plus de 50% des personnes éligibles ont accepté les services proposés par les chatbots. DISCUSSION: L'utilisation des ChatBots était la plus élevée pour la santé mentale. Les chatbots peuvent augmenter les connexions entre une population vulnérable et les services de santé, mais cela dépende de plusieurs facteurs, dont la condition, la type de population et la pénétration des smartphones. Les recherches futures seront essentielles pour comprendre l'expérience et les préférences des utilisateurs et pour s'assurer que les chatbots relient les populations vulnérables vulnérables aux soins appropriés et de qualité.

SNP discovery and association study for growth, fatness and meat quality traits in Iberian crossbred pigs.

Iberian pigs and its crosses are produced to obtain high-quality meat products. The objective of this work was to evaluate a wide panel of DNA markers, selected by biological and functional criteria, for association with traits related to muscle growth, fatness, meat quality and metabolism. We used 18 crossbred Iberian pigs with divergent postnatal growth patterns for whole genome sequencing and SNP discovery, with over 13 million variants being detected. We selected 1023 missense SNPs located on annotated genes and showing different allele frequencies between pigs with makerdly different growth patterns. We complemented this panel with 192 candidate SNPs obtained from literature mining and from muscle RNAseq data. The selected markers were genotyped in 480 Iberian × Duroc pigs from a commercial population, in which phenotypes were obtained, and an association study was performed for the 1005 successfully genotyped SNPs showing segregation. The results confirmed the effects of several known SNPs in candidate genes (such as LEPR, ACACA, FTO, LIPE or SCD on fatness, growth and fatty acid composition) and also disclosed interesting effects of new SNPs in less known genes such as LRIG3, DENND1B, SOWAHB, EPHX1 or NFE2L2 affecting body weight, average daily gain and adiposity at different ages, or KRT10, NLE1, KCNH2 or AHNAK affecting fatness and FA composition. The results provide a valuable basis for future implementation of marker-assisted selection strategies in swine and contribute to a better understanding of the genetic architecture of relevant traits.

Clínica, epidemiología e imagenología del fibroma osificante y fibroma cemento osificante: revisión de casos reportados en la literatura / Clinic, epidemiology and imagenology of the ossifying fibroma and cemento ossifying fibroma: a review of cases reported in the literature

Introducción: El fibroma osificante (FO) y el fibroma cemento osificante (FCO) son patologías distintas, que hasta el 2017 se consideraban como una. A la fecha no se han comparado las características del FO y el FCO. La presente revisión tuvo como objetivo analizar características clínicas, epidemiológicas e imagenológicas del FO y FCO en los casos publicados. Materiales y métodos: Se realizó una búsqueda de casos clínicos de FO y FCOpublicados desde el año 2015 en PubMed, Scopus y Web of Science, mediante la estrategia de búsqueda ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). Los casos debían presentar información clínica, imagenológica e histológica suficientes para confirmar su diagnóstico, patrón histológico y comparar sus características. Revisión: Se incluyeron 32 artículos, con 32 casos y 34 lesiones, siendo 6 FCO y 28 FO. Los FO y FCO se diferencian por su edad y ubicación: mientras los FCO se presentan en edades adultas, exclusivamente en los maxilares y en relación con tejidos dentarios, los FO lo hacen principalmente en niños y jóvenes, y en cualquier hueso. Los FO y FCO tienen las mismas características imagenológicas: son lesiones uniloculares o multiloculares, con distintos grados de radiodensidad, límites definidos y una radiolucidez periférica. Sin embargo, los casos de FO trabecular pueden no presentar esta radiolucidez periférica. Conclusión: Los FO y FCO son patologías, clínica y epidemiológicamente similares, y con las mismas características imagenológicas. Por lo que establecer diferencias histológicas es esencial para un correcto diagnóstico. (AU)

Introduction: Ossifying fibroma (OF) and cemento ossifying fibroma (COF) are different pathologies, which until 2017 where considered as one. To date, the features of OF y COF have not been compared. This aim of this review was to analyze clinical, epidemiological and imaging features of OF and COF in published case reports. Materials and methods: A search of clinical cases of OF and COF published since 2015 was performed on PubMed, Scopus and Web of Science, using the search strategy ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). The cases had to haveenough clinical, imaging and histological information to confirm their clinical diagnosis, histological pattern and compare their features. Review: 32 articles were included, with 32 cases and 34 lesions, being 28 OF and 6 COF. OF and COF differ by age and location: while COF occur in adult ages, exclusively in the jaws and in relation to dental tissues, OF occur mainly in children and young people, and in any bone. OF and COF have the same imaging characteristics: they are unilocular or multilocular lesions, with different degrees of radiodensity, defined limits and a peripheral radiolucent area. However, cases of trabecular OF may not present this peripheral radiolucent area. Conclusions: OF and COF are similar pathologies clinically and epidemiologically, with the same imaging characteristics. So, establishing histological differences is essential for an accurate diagnosis. (AU)

Fenotipo de la enfermedad de Parkinson basado en la edad de inicio en pacientes latinoamericanos: un análisis emparejado / Parkinson’s disease phenotype based on age at onset in Latin American patients: a paired-based analysis

Introducción: Diversos estudios han demostrado una mayor gravedad de sintomatología motora y no motora en pacientes con enfermedad de Parkinson (EP) con edad de inicio tardía comparados con los de inicio intermedio. Decidimos probar estos resultados en una población con EP en Latinoamérica. Pacientes y métodos: Reclutamos a 24 pacientes con EP con una edad de inicio > 65 años (inicio tardío), y cada paciente se emparejó con un control con inicio de la enfermedad entre los 48 y los 60 años (inicio intermedio), emparejados por sexo y duración de la enfermedad (±2 años). Se registraron baterías de pruebas clínicas que evaluaron los síntomas motores –escala unificada de la enfermedad de Parkinson modificada por la Sociedad de Trastornos del Movimiento (MDS-UPDRS)–, los no motores (escala de síntomas no motores), los cognitivos (escala de evaluación cognitiva de Montreal) y la calidad de vida (cuestionario de enfermedad de Parkinson 8). Los grupos se compararon con análisis de regresión logística condicional. Resultados: La edad media de inicio fue de 70,53 ± 3,28 y 53,79 ± 4,96 para los grupos de inicio tardío y de inicio intermedio, respectivamente. No se observaron diferencias significativas en la mayoría de las baterías clínicas cuando se compararon los pacientes con EP según la edad de inicio, con peores puntuaciones significativamente en la MDS-UPDRS, parte III, y en su subdominio de temblor en el grupo de inicio intermedio. Conclusiones: Éste es el primer estudio que informa sobre un fenotipo motor más benigno en pacientes con EP de inicio tardío. A pesar de utilizar una edad de corte más baja para definir el inicio tardío, las características vasculares, epidemiológicas, étnicas y de adhesión al tratamiento también deben considerarse como posibles factores explicativos.(AU)

Introduction: Studies have demonstrated a higher motor and non-motor burden in Parkinson’s disease (PD) patients with old age at onset compared to those with middle age at onset. We decided to test these findings in a Latin American PD population. Patients and methods: We recruited 24 PD patients with age at onset > 65 years, and each patient was matched to 1 control patient with disease onset at ages between 48 and 60 years, matched for gender and disease duration (±2 years). Clinical test batteries that assessed motor (MDS-UPDRS), non-motor (NMSS), cognitive (MoCA), and quality of life (PDQ-8) were recorded. Groups were compared with conditional logistic regression analysis. A comparative post-hoc analysis was also conducted, considering only patients with age at onset > 70 years (n = 11) and their matched controls. Results: Mean age at onset was 70.53 ± 3.28 and 53.79 ± 4.96 for the old-age and middle-age group, respectively. No significant differences were observed in most clinical batteries when comparing PD patients based on age at onset, with worse scores in MDS-UPDRS Part III and Tremor subscore in the middle-age onset group. The post-hoc analysis showed similar results, with non-significantly worse scores in the middle-age onset group. Conclusion: This is the first study reporting a more benign motor phenotype in old-age onset PD patients. Despite the lower cut-off value used for old age onset PD, vascular, epidemiological, ethnic and treatment adherence features must be also considered as potential explicative factors, with further multicenter studies in larger populations needed.(AU)

[Parkinson's disease phenotype based on age at onset in Latin American patients: a paired-based analysis]. / Fenotipo de la enfermedad de Parkinson basado en la edad de inicio en pacientes latinoamericanos: un análisis emparejado.

INTRODUCTION: Studies have demonstrated a higher motor and non-motor burden in Parkinson's disease (PD) patients with old age at onset compared to those with middle age at onset. We decided to test these findings in a Latin American PD population. PATIENTS AND METHODS: We recruited 24 PD patients with age at onset > 65 years, and each patient was matched to 1 control patient with disease onset at ages between 48 and 60 years, matched for gender and disease duration (±2 years). Clinical test batteries that assessed motor (MDS-UPDRS), non-motor (NMSS), cognitive (MoCA), and quality of life (PDQ-8) were recorded. Groups were compared with conditional logistic regression analysis. A comparative post-hoc analysis was also conducted, considering only patients with age at onset > 70 years (n = 11) and their matched controls. RESULTS: Mean age at onset was 70.53 ± 3.28 and 53.79 ± 4.96 for the old-age and middle-age group, respectively. No significant differences were observed in most clinical batteries when comparing PD patients based on age at onset, with worse scores in MDS-UPDRS Part III and Tremor subscore in the middle-age onset group. The post-hoc analysis showed similar results, with non-significantly worse scores in the middle-age onset group. CONCLUSION: This is the first study reporting a more benign motor phenotype in old-age onset PD patients. Despite the lower cut-off value used for old age onset PD, vascular, epidemiological, ethnic and treatment adherence features must be also considered as potential explicative factors, with further multicenter studies in larger populations needed.

TITLE: Fenotipo de la enfermedad de Parkinson basado en la edad de inicio en pacientes latinoamericanos: un análisis emparejado.Introducción. Diversos estudios han demostrado una mayor gravedad de sintomatología motora y no motora en pacientes con enfermedad de Parkinson (EP) con edad de inicio tardía comparados con los de inicio intermedio. Decidimos probar estos resultados en una población con EP en Latinoamérica. Pacientes y métodos. Reclutamos a 24 pacientes con EP con una edad de inicio > 65 años (inicio tardío), y cada paciente se emparejó con un control con inicio de la enfermedad entre los 48 y los 60 años (inicio intermedio), emparejados por sexo y duración de la enfermedad (±2 años). Se registraron baterías de pruebas clínicas que evaluaron los síntomas motores ­escala unificada de la enfermedad de Parkinson modificada por la Sociedad de Trastornos del Movimiento (MDS-UPDRS)­, los no motores (escala de síntomas no motores), los cognitivos (escala de evaluación cognitiva de Montreal) y la calidad de vida (cuestionario de enfermedad de Parkinson 8). Los grupos se compararon con análisis de regresión logística condicional. Resultados. La edad media de inicio fue de 70,53 ± 3,28 y 53,79 ± 4,96 para los grupos de inicio tardío y de inicio intermedio, respectivamente. No se observaron diferencias significativas en la mayoría de las baterías clínicas cuando se compararon los pacientes con EP según la edad de inicio, con peores puntuaciones significativamente en la MDS-UPDRS, parte III, y en su subdominio de temblor en el grupo de inicio intermedio. Conclusiones. Éste es el primer estudio que informa sobre un fenotipo motor más benigno en pacientes con EP de inicio tardío. A pesar de utilizar una edad de corte más baja para definir el inicio tardío, las características vasculares, epidemiológicas, étnicas y de adhesión al tratamiento también deben considerarse como posibles factores explicativos.

Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty. / Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzada.

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. MATERIALS AND METHOD: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. RESULTS: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. ICC between observers A and B for CCD measured in X rays was 0.96. Mean CCD measured in X rays for each group (I, II/III and IV) was 148.11°, 147.7° and 147°, and in CT was 131.21°, 127.9° and 122.14°, respectively. A significant difference was found in femoral version between groups I and IV (P=0.0002) and II/III and IV (P=0.042). Pearson correlation between femoral version and severity of DDH was positive (r=0.52; P=0.0002). A significant difference between CCD measured in CT was found between groups I and IV (P=0.003). CONCLUSIONS: A significant increase in femoral version related to severity of DDH and a positive correlation between these 2features were found. Furthermore, a significant decrease in CCD between groups I and IV measured in CT was revealed. These findings would be helpful for preoperative planning of total hip replacement in osteoarthritis secondary to DDH, because once the surgeon has assessed the severity of DDH on X rays or CT, an increased femoral version could be expected. Therefore, availability of specific implants such as conic, modular or cemented stems is critical, in order to modify the femoral anteversion to normal values in the most severe cases.

A serosurvey for spotted fever group Rickettsia and Coxiella burnetii antibodies in rural dogs and foxes, Chile.

Antibodies against Spotted Fever Group (SFG) Rickettsia and Coxiella burnetii, investigated through indirect antibody immunofluorescence tests, were detected in serum samples from 3.1% and 0% of 358 rural dogs, respectively, and in none of 32 wild foxes tested. SFG Rickettsia seropositive dogs were only detected in the Mountain Desert (8%) and the Steppe-Mediterranean (9%) regions. Exposure in the Mountain Desert, where no ticks and fleas were found on any dog, could correspond to a new SFG Rickettsia sp. recently described in soft ticks or to a related agent. Our survey confirms low endemicity in the country of C. burnetii, as observed in recent serosurveys in humans.

Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzada / Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty / Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzadaS

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Variaciones anatómicas en primer y segundo molar permanente mandibular con tratamiento endodóntico, evaluadas con tomografía computarizada de haz cónico. Revisión narrativa / Anatomical variations in the first and second permanent mandibular molar with endodontic treatment, evaluated with cone-beam computed tomography. Narrative review

Introducción: Una de las dificultades de los tratamientos endodónticos son las variaciones anatómicas de las raíces y sistema de canales radiculares. Existe poca información sobre prevalencia y distribución espacial de estas variaciones en casos reportados con CBCT (del inglés Cone-Beam Computed Tomography). El propósito de la presente revisión fue analizar las variaciones anatómicas en primer y segundo molar permanente mandibular con tratamiento endodóntico evaluadas con CBCT. Materiales y métodos: Se seleccionaron artículos con casos de tratamiento endodóntico en primer o segundo molar permanente mandibular. Se determinaron el número, distribución espacial de variaciones anatómicas radiculares y canales. Además, el número y tipo de alteraciones de forma. Resultados: La mayor prevalencia del número y distribución espacial de raíces en primer molar fue de tres raíces [1M (mesial), 2D (distal)] con un 76,5% y cuatro raíces (2M, 2D) con un 55,6% en segundo molar. La mayor prevalencia del número y distribución de canales radiculares para el primer y segundo molar fue de cuatro canales: 1mesiovestibular, 1mesiolingual, 1distovestibular y 1distolingual, con un 30% y 90,9% de los casos seleccionados respectivamente. La distribución de alteraciones de forma fue de 8,7% para geminación y de 2,1% para taurodontismo. Conclusiones: La variación anatómica de raíces del primer y segundo molar inferior permanente con más frecuencia fue de tres y cuatro respectivamente. La variación anatómica de canales con más frecuencia fue de cuatro: 2M y 2D. El número de alteraciones de forma fueron poco frecuentes, presentando geminaciones y taurodontismo, solo en segundos molares.

Introduction: One of the difficulties of endodontic treatments is the anatomical variations of the roots and the root canal system. There is little information on the prevalence and spatial distribution of these variations in cases reported with CBCT (Cone-Beam Computed Tomography). The purpose of this review was to analyze the anatomical variations in the mandibular first and second permanent molars with endodontic treatment evaluated with CBCT. Materials and methods: Articles with cases of endodontic treatment in the first or second permanent mandibular molar were selected. The number, spatial distribution of anatomical variations of roots and canals were determined. The number and type of shape alterations were also determined. Results: The highest prevalence regarding number and spatial distribution of root in the first molar was three roots (1M (mesial), 2D (distal)) with 76.5% and four roots (2M, 2D) with 55.6% in second molar. The highest prevalence regarding number and distribution of root canals for the first and second molars was four channels: 1 mesiobuccal, 1 mesiolingual, 1 distobuccal and 1 distolingual, with 30% and 90.9% of the cases selected, respectively. The distribution of shape alterations was 8.7% for gemination and 2.1% for taurodontism. Conclusions: The anatomical variation of roots of the first and second permanent lower molars with the most frequency was three and four respectively. The most frequent anatomic variation of channels was four: 2M and 2D. The number of shape alterations were less frequent, presenting geminations and taurodontism, only in second molars.

Hipoplasia de cóndilo occipital: hallazgo en telerradiografía de perfil / Unilateral hypoplastic occipital condyle: anincidental finding on a cephalometric lateral radiograph

Introducción: Los cóndilos occipitales y procesos articulares superiores de atlas conforman la articulación atlanto-occipital, la que contribuye en la flexión y extensión de cabeza y cuello. La hipoplasia de cóndilo occipital (HCO) esuna anomalía del desarrollo poco frecuente, pudiendo presentarse aislada o como parte de un síndrome. Si bien el diagnóstico y manejo de una HCO corresponde al área médica, es posible que en ciertos casos esta anomalía pueda ser advertida por el odontólogo. Caso: Paciente sexo femenino, 23 años, asintomática, acude a realizarse una telerradiografía de perfil, previo a tratamiento de ortodoncia. En dicha radiografía se observóuna desproyecciónen sentido vertical del arco posterior de atlas. El informe radiográfico incluyó un diagnóstico presuntivo de HCO. Posteriormente se complementó con un examen de tomografía computarizada de haz cónico (TCHC), que confirmó el diagnóstico de HCO derecho. Conclusión: La HCO puede observarse en una telerradiografía de perfil, y su diagnóstico puede realizarlo un radiólogo maxilofacial. La confirmación del diagnóstico debe realizarse con imágenes de TCHC para analizar las estructuras óseas, y con resonancia magnética para analizar los tejidos blandos circundantes (AU)

Introduction: Occipital condyles and articular processes of atlas vertebrae form the atlanto-occipital joint. This joint contributes to flexion and extension of head and neck. Hypoplasia of the occipital condyle (HCO) is an unusual developmental anomaly, being shown isolated or as a part of a syndrome. While diagnosis and clinical management of HCO corresponds to the medical area, some cases of HCO may be adverted by a dentist. Case: Female patient, 23 years old, asymptomatic, come to be undergone to a lateral cephalometric radiograph prior to an orthodontic treatment. In this image the posterior arch of the atlas was observed as not superimposed. In the radiographic report the presumptive diagnosis included HCO. This radiographic examination was complemented with a cone-beam computed tomography examination (CBCT), which confirmed the diagnosis of HCO. Conclusion: HCO can be seen on a lateral cephalometric radiograph, and the diagnosis can be performed by a maxillofacial radiologist. Confirmation of diagnosis should be done with CBCT images to analyze bone structures, and with magnetic resonance imaging to analyze surrounding soft tissues. (AU)

Family and social environment associated with traits of antisocial personality disorder in the prison population of Peru.

INTRODUCTION: The prison environment in Peru is one of the worst in the continent. In situations such as these, where there is considerable stress, many inmates can develop antisocial disorders, especially if they come from a conflictive family setting. OBJECTIVES: To determine the association between family relationships, social environment and features of antisocial personality disorder (ASPD) in the Peruvian prison population in 2016. MATERIAL AND METHOD: Analytical cross-sectional study based on a sub-analysis of the First National Penitentiary Census of Peru in 2016. The sample is the prison population (≥18 years old) that participated in said census, which was carried out in 66 correctional facilities nationwide and reached a coverage of 98.8%. RESULTS: Of the 77,086 prisoners, 76,152 participated in the analysis. The prevalence of antisocial traits was 96% and half of the population met two criteria for the disorder. Independently associated factors were, being male (RPa: 1.35; 1.30-1.40), born outside the capital (RPa: 0.89; 0.88-0, 91), friends in the neighborhood who committed offences (RPa: 1.01; 1.00-1.02) and not living with a father (RPa: 1.00; 1.00-1.01). DISCUSSION: The prevalence of antisocial personality disorder traits in the Peruvian prison population was 96%. We found greater association with the male sex, in those born in Lima and in those who escaped from their home before the age of 15.