Relación entre la compresión maxilar y potencial impactación del canino superior: Scoping review

El canino maxilar permanente corresponde al segundo diente más frecuentemente impactado en el arco dental. La etiología de esta patología aún no está totalmente definida, sin embargo, investigadores plantean la deficiencia del ancho del hueso maxilar como una posible causa. Objetivo: Investigar la evidencia que asocia menores dimensiones transversales del maxilar a la ocurrencia de la impactación de caninos superiores y esclarecer la posible relación. Materiales y métodos: Se realizó una revisión sistemática exploratoria a partir de una búsqueda amplia de la literatura en bases de datos PubMed, Cochrane, EBSCO y Multibuscador UNAB. Los artículos fueron recopilados, identificados y filtrados según el diagrama de flujo de declaración PRISMA. Resultados: La búsqueda identificó 755 estudios, de los cuales 14 fueron incluidos. Los estudios varían en diseño, edad de estudio y métodos de diagnóstico. La mitad de los estudios reporta una asociación positiva entre compresión maxilar e impactación canina superior, mientras que la otra mitad una asociación negativa. Conclusiones: No hay evidencia suficiente para poder asociar compresión maxilar con impactación de caninos superiores. Estudios con métodos de diagnóstico rigurosos son necesarios para una mejor comprensión. No obstante, se enfatiza la importancia de un diagnóstico precoz, para garantizar mejores resultados y pronóstico más favorable.

The permanent maxillary canine is the second most frequently impacted tooth in the dental arch. The etiology of this disease is not completely defined, yet some researchers propose the deficiency of the width from the maxilla as a possible cause. Objective: To investigate available evidence correlating smaller transverse maxilla dimensions with the occurrence of potential impaction of upper canines and clarify the possible relation. Materials and methods: A systematic exploratory review was carried out based on comprehensive search of the literature in databases such as PubMed, Cochrane, EBSCO and UNAB multi search engine. The articles were compiled, identified and filtered systematically according to the PRISMA flow diagram. Results: Our search identified 755 studies, 14 of which were included. These studies vary in design, patients age, and methods for detection. Half of the studies show a positive correlation between maxillary compression and potential upper canine impaction, whereas the other half show a negative correlation. Conclusions: There is not enough evidence to link maxillary compression to upper canine impaction. Studies with rigorous diagnostic methods for detection are necessary for a better understanding of this relation. Nonetheless, the importance of early diagnosis must be emphasized to guarantee better results and a more favorable prognosis.

Seeing is believing: Smart use of musculoskeletal ultrasound in rheumatology practice.

Musculoskeletal ultrasonography has become an increasingly valuable tool as a complement to the physical exam in rheumatology practice. Its point-of-care access, low cost, safety, portability, and reliability in trained hands, make this technique especially useful in patients with inflammatory arthritis. Growing evidence has demonstrated the value of musculoskeletal ultrasound in the detection of inflammatory and structural changes in patients with joint pain without obvious joint swelling, in differentiating various inflammatory diagnoses, in the monitoring of inflammatory arthritis, and interventional procedures. The potential role of ultrasound guiding treat-to-target strategies or tapering treatment in inflammatory arthritis requires further research. However, musculoskeletal ultrasound can also have pitfalls and limitations that a clinician should be aware of.

Facial biotype classification for orthodontic treatment planning using an alternative learning algorithm for tree augmented Naive Bayes.

BACKGROUND: When designing a treatment in orthodontics, especially for children and teenagers, it is crucial to be aware of the changes that occur throughout facial growth because the rate and direction of growth can greatly affect the necessity of using different treatment mechanics. This paper presents a Bayesian network approach for facial biotype classification to classify patients' biotypes into Dolichofacial (long and narrow face), Brachyfacial (short and wide face), and an intermediate kind called Mesofacial, we develop a novel learning technique for tree augmented Naive Bayes (TAN) for this purpose. RESULTS: The proposed method, on average, outperformed all the other models based on accuracy, precision, recall, [Formula: see text], and kappa, for the particular dataset analyzed. Moreover, the proposed method presented the lowest dispersion, making this model more stable and robust against different runs. CONCLUSIONS: The proposed method obtained high accuracy values compared to other competitive classifiers. When analyzing a resulting Bayesian network, many of the interactions shown in the network had an orthodontic interpretation. For orthodontists, the Bayesian network classifier can be a helpful decision-making tool.

2021 GRAPPA Trainee Symposium: A Summary of Oral and Poster Presentations.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held a trainee symposium at its 2021 virtual meeting. Dermatology and rheumatology trainees presented their work on psoriasis and psoriatic arthritis (PsA). This report briefly reviews 5 oral presentations: prediction of cardiovascular events in psoriatic disease (PsD), correlation between spine abnormalities and clinical findings, biomechanical stress as a trigger for PsA, differences in DNA methylation among twins with PsD, and critical proteins associated with induction of PsD. In addition, we highlight 22 posters broadly discussing clinical and molecular implications of PsD.

Characterising axial psoriatic arthritis: correlation between whole spine MRI abnormalities and clinical, laboratory and radiographic findings.

OBJECTIVE: To describe the prevalence of inflammatory and structural lesions using whole spine MRI in patients with psoriatic disease, and to assess their correlation with clinical features and with axial spondyloarthritis (axSpA) classification criteria. METHODS: This retrospective analysis included patients with whole spine and sacroiliac joints (SIJ) MRI, selected from 2 populations: (1) active psoriatic arthritis (PsA), irrespective of axial symptoms; (2) psoriasis with confirmed or suspected PsA and axSpA symptoms. MRI spondylitis and/or sacroiliitis (MRI-SpA) was defined according to Assessment of Spondyloarthritis International Society (ASAS) consensus and by radiologist impression. Agreement between MRI-SpA and different inflammatory back pain (IBP) definitions (Berlin/ASAS/rheumatologist criteria) and the axSpA classification criteria were calculated considering MRI as gold standard. Logistic regression determined MRI-SpA-associated factors. RESULTS: 93 patients were analysed (69.9% PsA; 30.1% psoriasis). Back pain was present in 81.7%, defined as IBP in 36.6%-57%. MRI-SpA was found in 9.7% of patients by ASAS definition and in 12.9% by radiologist impression, of which 25% had isolated spondylitis.Low agreement was found between the three IBP definitions and MRI-SpA. Rheumatologist criteria was the most sensitive (50%-55.6%) while ASAS and Berlin criteria were the most specific (61.9%-63%). axSpA criteria had poor sensitivity for MRI-SpA (22.2%-25%). Late onset of back pain or asymptomatic patients accounted for most cases with MRI-SpA not meeting axSpA or IBP criteria. Male sex was associated with MRI-SpA (OR 6.91; 95% CI 1.42 to 33.59) in multivariable regression analysis. CONCLUSION: Prevalence of MRI-defined axSpA was low and showed poor agreement with IBP and axSpA criteria.

Prediction methods of maxillary canine impaction: a systematic review.

OBJECTIVE: To describe and assess the available evidence of prediction methods of maxillary canine impaction (MCI). MATERIAL AND METHODS: A systematic search was conducted through PubMed, Cochrane Library, Embase, EBSCOhost, Scopus, ScienceDirect, Bireme and Scielo until December 2020. This systematic review was conducted according to the PRISMA statement. The methodology of the selected studies was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). RESULTS: A total of 2391 articles were identified in the first approach and after a 2-phase selection, 11 studies were included in qualitative analysis. Prediction methods were constructed using equation-based models, geometric measurements and computational methods from clinical and imaging data to predict palatal/buccal MCI. The quality of evidence was low to moderate due to the presence of risk of bias in most of the studies included. Three cohort studies with the best methodological quality proposed prediction models based on geometric measurements, canine position and facial growth pattern that would allow predicting MCI from CBCT, lateral and panoramic radiographs. CONCLUSIONS: The evidence is limited and most of the studies present a low methodological quality. However, it is possible to suggest that some prediction methods based on the position of the canine and facial growth pattern could predict palatal/buccal MCI in mixed dentition. Cohort studies with better methodological quality and long-term follow-up are needed to better validate a prediction model.

Análisis Comparativo de la Eficacia, Comodidad y Seguridad del Cepillo Eléctrico Oscilante-Rotatorio Oral-B en Pacientes Portadores de Ortodoncia Fija: Un Ensayo Clínico Aleatorizado

RESUMEN: La higiene oral es fundamental en pacientes en tratamiento de ortodoncia. Actualmente hay una oferta amplia de cepillos eléctricos con este fin. El objetivo del presente estudio, fue determinar la eficacia y la comodidad del cep illo eléctrico Oral-B® Professional Care 500 en pacientes portadores de ortodoncia. Se realizó un ensayo clínico, randomizado, doble ciego, unicéntrico, con una muestra de 90 pacientes, divididos en dos grupos: 45 pacientes utilizaron cepillo eléctrico y 45 sujetos utilizaron cepillos manuales durante 90 días. Se determinó la efectividad con los índices O'leary, índice de placa de bracket e índice de Eastman al inicio, a los 30 y a los 90 días de uso de los cepillos y se evaluó la comodidad del cepillo eléctrico mediante una encuesta de satisfacción al término del estudio. Al analizar los datos, se observó una disminución significativa en los índices de O'leary y de placa de bracket en ambos grupos,mientras que se observó una disminución significativa en el índice de Eastman sólo en el grupo que utilizó el cepillo eléctrico. El resultado de la encuesta, indica qu e, en opinión de los participantes del estudio, el cepillo eléctrico es cómodo, fácil de usar y recomendable para pacientes con aparatología fija. En conclusión, el cepillo eléctrico Oral-B® Professional Care 500 resultó ser efectivo y cómodo al ser usado por pacientes portadores de ortodoncia fija y puede ser recomendado para este tipo de pacientes.

ABSTRACT: Oral hygiene is essential in patients undergoing orthodontic treatment. Currently there is a wide offer of electric brushes for this purpose. The objective of this study is to determine the efficacy and comfort of the Oral-B® Professional Care 500 electric toothbrush in orthodontic wearers. A double-blind, single-center clinical trial was carried out, in which the sample was 90 patients, these were randomized into two groups: 45 patients with electric toothbrush treatment and 45 subjects with manual toothbrush treatment. The effectiveness was determined with the O'leary indexes, the bracket plate index and the Eastman index. For the evaluation of comfort, a survey was used. Statistical analysis was performed with the Shapiro-Wilks test and the Mann-Whitney U test, in which a significant decrease was found in the O'leary index and bracket plate index in the group that used the electro-oscillating brush rotary and a greater decrease in the Eastman index was observed in the same group. In conclusion, the electric toothbrush is comfortable and easy to use, recommended for patients with fixed appliances.

Hermansky-Pudlak Syndrome and Lung Disease: Pathogenesis and Therapeutics.

Hermansky-Pudlak Syndrome (HPS) is a rare, genetic, multisystem disorder characterized by oculocutaneous albinism (OCA), bleeding diathesis, immunodeficiency, granulomatous colitis, and pulmonary fibrosis. HPS pulmonary fibrosis (HPS-PF) occurs in 100% of patients with subtype HPS-1 and has a similar presentation to idiopathic pulmonary fibrosis. Upon onset, individuals with HPS-PF have approximately 3 years before experiencing signs of respiratory failure and eventual death. This review aims to summarize current research on HPS along with its associated pulmonary fibrosis and its implications for the development of novel treatments. We will discuss the genetic basis of the disease, its epidemiology, and current therapeutic and clinical management strategies. We continue to review the cellular processes leading to the development of HPS-PF in alveolar epithelial cells, lymphocytes, mast cells, and fibrocytes, along with the molecular mechanisms that contribute to its pathogenesis and may be targeted in the treatment of HPS-PF. Finally, we will discuss emerging new cellular and molecular approaches for studying HPS, including lentiviral-mediated gene transfer, induced pluripotent stem cells (iPSCs), organoid and 3D-modelling, and CRISPR/Cas9-based gene editing approaches.

Reducing travel-related SARS-CoV-2 transmission with layered mitigation measures: symptom monitoring, quarantine, and testing.

BACKGROUND: Balancing the control of SARS-CoV-2 transmission with the resumption of travel is a global priority. Current recommendations include mitigation measures before, during, and after travel. Pre- and post-travel strategies including symptom monitoring, antigen or nucleic acid amplification testing, and quarantine can be combined in multiple ways considering different trade-offs in feasibility, adherence, effectiveness, cost, and adverse consequences. METHODS: We used a mathematical model to analyze the expected effectiveness of symptom monitoring, testing, and quarantine under different estimates of the infectious period, test-positivity relative to time of infection, and test sensitivity to reduce the risk of transmission from infected travelers during and after travel. RESULTS: If infection occurs 0-7 days prior to travel, immediate isolation following symptom onset prior to or during travel reduces risk of transmission while traveling by 30-35%. Pre-departure testing can further reduce risk, with testing closer to the time of travel being optimal even if test sensitivity is lower than an earlier test. For example, testing on the day of departure can reduce risk while traveling by 44-72%. For transmission risk after travel with infection time up to 7 days prior to arrival at the destination, isolation based on symptom monitoring reduced introduction risk at the destination by 42-56%. A 14-day quarantine after arrival, without symptom monitoring or testing, can reduce post-travel risk by 96-100% on its own. However, a shorter quarantine of 7 days combined with symptom monitoring and a test on day 5-6 after arrival is also effective (97--100%) at reducing introduction risk and is less burdensome, which may improve adherence. CONCLUSIONS: Quarantine is an effective measure to reduce SARS-CoV-2 transmission risk from travelers and can be enhanced by the addition of symptom monitoring and testing. Optimal test timing depends on the effectiveness of quarantine: with low adherence or no quarantine, optimal test timing is close to the time of arrival; with effective quarantine, testing a few days later optimizes sensitivity to detect those infected immediately before or while traveling. These measures can complement recommendations such as social distancing, using masks, and hand hygiene, to further reduce risk during and after travel.

Reacción acneiforme como efecto adverso del apremilast / Acneiform reaction as an adverse effect of apremilast

El apremilast es un fármaco inhibidor de la fosfodiesterasa-4 que modula, a nivel intracelular, la expresión de citoquinas involucradas en la patogenia inflamatoria de la psoriasis. Su uso está indicado en la psoriasis en placas moderada y severa, con buenos resultados clínicos. Los principales efectos adversos son gastrointestinales y, en menos del 2% de los pacientes, dermatológicos, con exantema y foliculitis. Se presenta el caso de un paciente de 42 años que, luego de tomar el apremilast, desarrolló lesiones faciales que correspondieron clínica e histopatológicamente a una reacción acneiforme, con evolución favorable y resolución total del cuadro posterior a la suspensión del medicamento.

Apremilast is a phosphodiesterase-4 inhibitor that modulates the intracellular expression of cytokines, which are involved in the pathogenesis of psoriasis. Apremilast is indicated in moderate to severe plaque psoriasis, and it has shown good clinical results. The main adverse effects occur at a gastrointestinal level, and in less than 2% at the dermatologic level with exanthema and folliculitis. We present a 42-year-old patient that developed facial lesions after taking apremilast. The facial lesions were clinically and histopathologically correspond to an acneiform eruption. The patient evolved favorably and fully recovered after suspending apremilast.

Determinación de Valores de Armonía del Perfil Facial en la Población Chilena

RESUMEN: El realizar un tratamiento ortodóntico sólo en base a referencias de tejidos duros, puede llevar a resultados estéticos desfavorables, debido a la gran variabilidad que existe en los tejidos blandos que los recubren. Arnett et al. (1999) presentaron un análisis basado en los tejidos blandos y determinó normas que definen un rostro armónico. Sin embargo, éstas normas se obtuvieron de pacientes norteamericanos y puede que no reflejen los conceptos estéticos de nuestra población. El objetivo del presente trabajo fue determinar valores de armonía facial para la población chilena, utilizando el análisis cefalométrico de tejidos blandos presentado por Arnett et al., y compararlos con los valores previamente establecidos para la población caucásica. Se analizaron 200 fotografías y se clasificaron los perfiles en balanceados y no balanceados según el criterio de un grupo de especialistas. Posteriormente se analizaron las telerradiografías correspondientes a los perfiles clasificados, con el análisis cefalométrico de tejidos blandos. Los valores de las diferentes variables fueron analiza dos separadamente por sexo, clase esqueletal y biotipo facial, y se determinaron las diferencias entre las variables presentadas por Arnett et al. y las obtenidas en el presente estudio. Para ello se utilizaron pruebas de significancia estadística como el test t y otros no paramétricos. Sólo se encontró diferencias significativas en dos variables respecto de las normas sugeridas por Arnett et al., correspondientes a un menor espesor del labio inferior en ambos sexos, y una mayor prominencia del pómulo en mujeres chilenas, por lo que consideramos que los valores de armonía de Arnett et al., pueden ser también aplicados como parámetro estético para la población chilena.

ABSTRACT: Performing an orthodontic treatment based only on hard tissue references can lead to unfavorable aesthetic results due to the great variability that exists in soft tissues that cover them. In 1999, W.Arnett, presented an analysis based on soft tissues and determined norms that define a harmonious face. However, these standards that were obtained from North Americans and Chilean aesthetic concepts could be different. The aim of the study was to determine the values of facial harmony for the Chilean population, using the cephalometric analysis of soft tissues presented by Arnett, and compare them with the values previously established for the Caucasian population. In this study 200 photographs were analyzed, and the profiles were classified in balanced and unbalanced according to the criteria of a group of specialists. Subsequently, teleradiographs corresponding to the classified profiles were analyzed, with the cephalometric analysis of soft tissues. The values of the different variables were analyzed separately by sex, skeletal class and facial biotype, and the differences between the variables presented by Arnett et al., and those obtained in the present study. For this purpose, statistical significance tests such as the t test and other non- parametric tests were used. There were only significant differences in two variables: inferior lip variables in both sexes, and a greater prominence of the cheekbone in Chilean women, therefore we consider that the values of harmony of Arnett, can also be applied as an aesthetic parameter for the Chilean population.

Craniofacial growth predictors for class II and III malocclusions: A systematic review.

OBJECTIVE: To evaluate the validity of craniofacial growth predictors in class II and III malocclusion. MATERIAL AND METHODS: An electronic search was conducted until August 2020 in PubMed, Cochrane Library, Embase, EBSCOhost, ScienceDirect, Scopus, Bireme, Lilacs and Scielo including all languages. The articles were selected and analyzed by two authors independently and the selected studies was assessed using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The quality of evidence and strength of recommendation was assessed by the GRADE tool. RESULTS: In a selection process of two phases, 10 articles were included. The studies were grouped according to malocclusion growth predictor in (1) class II (n = 4); (2) class III (n = 5) and (3) class II and III (n = 1). The predictors were mainly based on data extracted from cephalometries and characterized by: equations, structural analysis, techniques and computer programs among others. The analyzed studies were methodologically heterogeneous and had low to moderate quality. For class II malocclusion, the predictors proposed in the studies with the best methodological quality were based on mathematical models and the Fishman system of maturation assessment. For class III malocclusion, the Fishman system could provide adequate growth prediction for short- and long-term. CONCLUSIONS: Because of the heterogeneity of the design, methodology and the quality of the articles reviewed, it is not possible to establish only a growth prediction system for class II and III malocclusion. High-quality cohort studies are needed, well defined data extraction from cephalometries, radiographies and clinical characteristics are required to design a reliable predictor.

Sistematización de experiencias como método para la retroalimentación de la práctica educativa / Systematization of experiences as a method for feedback on educational practice

RESUMEN. El proceso de enseñanza-aprendizaje hace prioritario valorar las experiencias y perspectivas de los actores involucrados, para ello, es necesario promover la dialogicidad entre estudiantes y docentes, como una actividad de retroalimentación que oriente a la reflexión y análisis en busca de la adaptación y mejora del mismo. El objetivo del estudio fue valorar la práctica educativa sustentada en el enfoque de pensamiento complejo, a partir de la perspectiva estudiantil. El presente trabajo muestra los datos obtenidos a partir de sistematización de experiencias académicas desarrollada con 23 estudiantes del segundo semestre de Licenciatura en Educación Física, con respecto, al primer objeto de estudio del proyecto formativo implementado que atiende la asignatura Bases Psicopedagógicas en el semestre enero-junio 2018, para lo cual se atendieron tres fases procedimentales: reconstrucción, interpretación y potenciación de la experiencia. Haciendo uso de la videograbación y observación participante, se analizó como unidad de observación al pensamiento complejo y como unidades de análisis 1. La planeación analítica de clase compuesta por 2. Estrategias docentes innovadoras y 3. La metodología de evaluación. Los resultados muestran que los estudiantes manifiestan interés y motivación por las unidades de análisis 2 y 3, expresando que les favorecen las clases dinámicas y la valoración de su trabajo con un carácter formativo y no memorístico. En cuanto a la unidad de observación 1, manifestaron un dominio limitado acerca de la propuesta presentada por la docente. Se rescata su interés y satisfacción porque las asignaturas teóricas los sitúen en su realidad laboral.

ABSTRACT. In the teaching-learning process it becomes a priority to assess the experiences and perspectives of the actors involved, for this it is necessary to promote dialogue between students and teachers, as a feedback activity that guides reflection and analysis in search of adaptation and of the improvement of it. The objective was to assess the educational practice based on the complex thinking approach from the student perspective. The present work shows the data obtained from Systematization of Academic Experiences developed with 23 students of the second semester of the Degree in Physical Education, with respect to the first object of study of the formative project implemented that attends the subject Psychopedagogical Bases in the semester January -June 2018, for which three procedural phases were attended: reconstruction, interpretation and enhancement of the experience. Using video recording and participant observation, it was analyzed as a unit of observation to complex thinking and as units of analysis 1.The analytical class planning, 2. The teaching strategies implemented and 3. The evaluation methodology. The results show that the students express interest and motivation for the analysis units 2 and 3, expressing that they favor dynamic classes and the valuation of their work with a formative and non-memorial character. Regarding the observation unit 1, they expressed limited mastery of the proposal presented by the teacher. Their interest and satisfaction are rescued because the theoretical subjects place them in their work reality.

Características craneofaciales de pacientes obesos en Chile. Estudio Preliminar / Craniofacial characteristics of obese patients in Chile. Preliminary study

Resumen Introducción: La obesidad es un problema a nivel global que enfrenta el siglo XXI y Chile no se escapa de esta realidad. Así como existen características mórbidas de pacientes con obesidad, también existen características craneofaciales similares en estos pacientes. El estado nutricional es un factor que influencia el desarrollo de una persona en general, lo que tiene implicancias en el tratamiento ortodóncico, ortopédico y quirúrgico de las alteraciones maxilo - mandibulares de los pacientes. Objetivo: Investigar si la morfología craneofacial difiere entre los adolescentes obesos y los de peso normal. Métodos: Estudio retrospectivo, se basó en la comparación de medidas craneofaciales obtenidas del análisis cefalométrico, utilizando teleradiografías laterales, de dos grupos: grupo estudio (IMC mayor a 30, obeso) y grupo control (IMC normal). Resultados: Se observaron dimensiones maxilares y mandibulares mayores en el grupo estudio comparado con los pacientes del grupo control. Las medidas para la dimensión maxilar tuvieron diferencia significativamente estadística. Conclusiones: El aumento de peso es un factor importante que puede afectar los patrones de crecimiento craneofacial y debe ser tomado en consideración durante la planificación del tratamiento ortodoncico en pacientes adolescentes.

Abstract Introduction: Obesity is a global problem in the the 21st century and Chile does not escape this reality. Just as there are morbid characteristics of patients with obesity, there also share similar craniofacial characteristics. Nutritional status is a factor that influences the a person´s general development , which has implications in the orthodontic, orthopedic and surgical treatments of maxillo-mandibular alterations. Objective: Investigate whether craniofacial morphology differs between obese and average-weight adolescents. Methods: A retrospective study based on the comparison of craniofacial measures obtained from the cephalometric analysis, using lateral cephalograms, from two groups: study group (BMI over 30, obese) and control group (normal BMI). Greater maxillary and mandibular dimensions were observed in the study group compared to the patients in the control group. The measurements for de maxillary dimension had a statistically significant difference. Conclusions: Weight gain is an important factor that can affect craniofacial growth patterns and should be taken into consideration during the planning of orthodontic treatment in adolescent patients.

Síndrome De Cotard Y Catatonía: Reporte De Un Caso / Cotard's Syndrome And Catatonia: A Case Report

Resumen El Síndrome de Cotard es una condición neuropsiquiátrica poco frecuente, descrito inicialmente por Jules Cotard como un delirio hipocondríaco y luego como Delirio de negación, en que el paciente niega la existencia de partes de su cuerpo, la propia existencia y/o del mundo entero. La aparición de un Síndrome Catatónico junto al Síndrome de Cotard es aún más infrecuente. Se presenta el caso de una paciente de 72 años con una Depresión psicótica, que desarrolla un Síndrome de Cotard y posteriormente Catatonía. Logra buena respuesta tras la adición de Lorazepam y Venlafaxina al esquema farmacológico en curso, por lo que se desestima el uso de Terapia Electroconvulsiva. Se constata remisión total de síntomas y posterior recuperación funcional ad integrum, siendo evaluada a través de entrevista clínica, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale e Índice de Barthel. Además, se revisan otros reportes de caso sobre esta comorbilidad, y a diferencia de la mayoría de éstos, se destaca la favorable evolución de la paciente sin necesidad de Terapia Electroconvulsiva. Aún no se ha dilucidado la relación entre ambos síndromes, aunque algunos autores han planteado la hipótesis de vías neurobiológicas compartidas y otros han postulado la aparición de síntomas catatónicos como la progresión del Síndrome de Cotard. Para aclarar estas interrogantes, son necesarios más estudios al respecto que permitan conocer la etiopatogenia de esta inusual combinación.

Cotard's Syndrome is a rare neuropsychiatric condition, initially described by Jules Cotard as a hypochondriacal delusion and then as Delusion of negation, in which the patient denies the existence of parts of his body, his own existence and / or the entire world. The appearance of a Catatonic Syndrome together with Cotard Syndrome is even more infrequent. We present the case of a 72-year-old patient with a psychotic depression, who developed Cotard's Syndrome and later Catatonia. She achieves good response after the addition of Lorazepam and Venlafaxine to the current pharmacological treatment, so the use of Electroconvulsive Therapy is dismissed. Total remission of symptoms and subsequent functional recovery ad integrum was observed, being evaluated through clinical interview, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale and Barthel Index. In addition, other case reports on this comorbidity are reviewed, and unlike most of these, the favorable evolution of the patient stands out without the need for Electroconvulsive Therapy. The relationship between the two syndromes has not been elucidated, although some authors have proposed the hypothesis of shared neurobiological pathways and others have postulated the appearance of catatonic symptoms such as the progression of Cotard's Syndrome. To clarify these questions, more studies are needed in order to know the etiopathogenesis of this unusual combination.

Association between a medical nutrition therapy program and eating behavior with gestational weight gain in women with diabetes.

Introduction: To assess the association of medical nutrition therapy (MNT) consultations and eating behavior with gestational weight gain (GWG) in Mexican women with type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM).Material and methods: Cross-sectional study conducted at (Blinded for Review) from 2013 to 2014. Fifty-seven patients with T2DM or GDM were invited to participate. The dependent variable was GWG and the main independent variables were MNT and eating behaviors. Data were obtained from medical records or interviews. Multiple linear regression models were used to assess associations.Results: Per each additional MNT consultation, GWG was reduced by 1.2 kg (ß = -1.2; 95% CI: -2, -0.3; p = .007). After adjusting for age, in women with normal pregestational weight, for each unit, increase in the EE behavior index, there was a GWG increase of 2.8 kg (ß = 2.8; 95% CI: 1.2, 4.4; p = .003).Conclusions: This study reinforces the need for additional research to determine how eating behaviors are related to GWG during pregnancy. ClinicalTrials.gov Identifier: NCT03767699.

Microarquitectura ósea y otros parámetros de composición corporal en pacientes con sobrepeso u obesidad agrupados según alteraciones del metabolismo hidrocarbonado / Bone microarchitecture and other body composition parameters in patients with overweight or obesity grouped by glucose metabolism disorders

Introducción: la obesidad y la diabetes mellitus tipo 2 (DM-2) disminuyen el entramado trabecular óseo aun cuando puede coexistir aumento del hueso cortical. Otro hallazgo en común es la presarcopenia/sarcopenia secundaria posiblemente a la insulinorresistencia y el estrés oxidativo. Queda por aclarar si estos cambios dependen fundamentalmente de las alteraciones glucídicas precoces (pre DM-2) o tardías (DM-2 establecida), o más bien estarían vinculadas de forma predominante por el exceso de masa grasa en individuos obesos. Objetivos: evaluar y comparar parámetros de composición corporal (compartimentos óseo, muscular y adiposo-visceral) en pacientes con sobrepeso/obesidad agrupados según presenten o no alteraciones glucídicas. Analizar si existen diferencias comparando FRAX vs. FRAX ajustado a trabecular bone score (TBS) en ambos grupos. Métodos: se incluyeron 16 pacientes con sobrepeso/obesidad. A todos se les realizó evaluación clínica-antropométrica, bioimpedanciometría, absorciometría de rayos X de energía dual o densitometría ósea (DXA) y análisis, y se les agrupó según glucemia en tres grupos: a) normal; b) glucemia basal alterada en ayunas (GBA); y c) DM-2. Para el análisis estadístico empleamos pruebas no paramétricas. Resultados: no se encontraron diferencias estadísticamente significativas en los grupos respecto a microarquitectura ósea, masa muscular o grasa visceral. El grupo GBA mostró el mayor promedio de masa muscular y grasa visceral. Tras reclasificar en solo dos grupos, glucemia normal en el grupo 1 y glucemia alterada en el grupo 2 (GBA y DM-2), encontramos diferencias estadísticamente significativas con detrimento de la microarquitectura ósea trabecular en el grupo 2 (p = 0,031) y cifras de fósforo con niveles inferiores en el grupo 1 (p = 0,42). Conclusiones: en nuestro estudio, la microarquitectura ósea está deteriorada en pacientes con glucemia alterada y obesos. Hacen falta estudios con mayor tamaño muestral para establecer en qué momento se instauran estos cambios en la evolución natural de la diabetes

Introduction: obesity and DM-2 decrease trabecular bone mass even though cortical bone increase may coexist. Another common finding is presarcopenia/sarcopenia, possibly due to insulin resistance and oxidative stress. It remains to be clarified whether these changes depend on either early (prediabetes) or late (established DM) glucidic alterations, or rather they would be linked predominantly by excess fat mass in obese patients Objectives: to evaluate and compare body composition parameters (bone, muscle and adipose-visceral tissues) in overweight/obese patients grouped by whether or not they present glucidic metabolism disorders. Analyze if there are differences between FRAX vs FRAX adjusted to trabecular bone score TBS in both groups. Methods: sixteen overweight/obese patients were included. In all of them clinical-anthropometric evaluation, bioimpedance, DXA and analysis were performed. They were grouped by glycemia as: a) normal; b) impaired fasting glycemia (IFG); and c) DM-2. Non-parametric tests were performed. Results: no statistically significant differences were found among groups regarding bone microarchitecture, muscle mass or visceral fat. The IFG group showed the highest average muscle mass and visceral fat. Then, patients were reclassified in only two groups, normal glycemia in group 1 and altered glycemia in group 2 (IFG and DM-2), and statistically significant differences were found at the expense of lower trabecular bone microarchitecture in group 2 (p = 0.031) and phosphorus lower levels in group 1 (p = 0.042). Conclusions: in our study, the bone microarchitecture is impaired in patients with altered glycemia and obesity. Studies with larger sample size are needed to establish when these changes take place in the natural evolution of diabetes

[Bone microarchitecture and other body composition parameters in patients with overweight or obesity grouped by glucose metabolism disorders]. / Microarquitectura ósea y otros parámetros de composición corporal en pacientes con sobrepeso u obesidad agrupados según alteraciones del metabolismo hidrocarbonado.

INTRODUCTION: Introduction: obesity and DM-2 decrease trabecular bone mass even though cortical bone increase may coexist. Another common finding is presarcopenia/sarcopenia, possibly due to insulin resistance and oxidative stress. It remains to be clarified whether these changes depend on either early (prediabetes) or late (established DM) glucidic alterations, or rather they would be linked predominantly by excess fat mass in obese patients Objectives: to evaluate and compare body composition parameters (bone, muscle and adipose-visceral tissues) in overweight/obese patients grouped by whether or not they present glucidic metabolism disorders. Analyze if there are differences between FRAX vs FRAX adjusted to trabecular bone score TBS in both groups. Methods: sixteen overweight/obese patients were included. In all of them clinical-anthropometric evaluation, bioimpedance, DXA and analysis were performed. They were grouped by glycemia as: a) normal; b) impaired fasting glycemia (IFG); and c) DM-2. Non-parametric tests were performed. Results: no statistically significant differences were found among groups regarding bone microarchitecture, muscle mass or visceral fat. The IFG group showed the highest average muscle mass and visceral fat. Then, patients were reclassified in only two groups, normal glycemia in group 1 and altered glycemia in group 2 (IFG and DM-2), and statistically significant differences were found at the expense of lower trabecular bone microarchitecture in group 2 (p = 0.031) and phosphorus lower levels in group 1 (p = 0.042). Conclusions: in our study, the bone microarchitecture is impaired in patients with altered glycemia and obesity. Studies with larger sample size are needed to establish when these changes take place in the natural evolution of diabetes.

INTRODUCCIÓN: Introducción: la obesidad y la diabetes mellitus tipo 2 (DM-2) disminuyen el entramado trabecular óseo aun cuando puede coexistir aumento del hueso cortical. Otro hallazgo en común es la presarcopenia/sarcopenia secundaria posiblemente a la insulinorresistencia y el estrés oxidativo. Queda por aclarar si estos cambios dependen fundamentalmente de las alteraciones glucídicas precoces (pre DM-2) o tardías (DM-2 establecida), o más bien estarían vinculadas de forma predominante por el exceso de masa grasa en individuos obesos. Objetivos: evaluar y comparar parámetros de composición corporal (compartimentos óseo, muscular y adiposo-visceral) en pacientes con sobrepeso/obesidad agrupados según presenten o no alteraciones glucídicas. Analizar si existen diferencias comparando FRAX vs. FRAX ajustado a trabecular bone score (TBS) en ambos grupos. Métodos: se incluyeron 16 pacientes con sobrepeso/obesidad. A todos se les realizó evaluación clínica-antropométrica, bioimpedanciometría, absorciometría de rayos X de energía dual o densitometría ósea (DXA) y análisis, y se les agrupó según glucemia en tres grupos: a) normal; b) glucemia basal alterada en ayunas (GBA); y c) DM-2. Para el análisis estadístico empleamos pruebas no paramétricas. Resultados: no se encontraron diferencias estadísticamente significativas en los grupos respecto a microarquitectura ósea, masa muscular o grasa visceral. El grupo GBA mostró el mayor promedio de masa muscular y grasa visceral. Tras reclasificar en solo dos grupos, glucemia normal en el grupo 1 y glucemia alterada en el grupo 2 (GBA y DM-2), encontramos diferencias estadísticamente significativas con detrimento de la microarquitectura ósea trabecular en el grupo 2 (p = 0,031) y cifras de fósforo con niveles inferiores en el grupo 1 (p = 0,42). Conclusiones: en nuestro estudio, la microarquitectura ósea está deteriorada en pacientes con glucemia alterada y obesos. Hacen falta estudios con mayor tamaño muestral para establecer en qué momento se instauran estos cambios en la evolución natural de la diabetes.

Secuencia de Pierre Robin: implicación de la fisura palatina en la distracción mandibular / Pierre Robin sequence: implication of cleft palate for jaw distraction

Introducción y Objetivo: La secuencia de Pierre Robin se caracteriza por presentar la tríada de micrognatia, obstrucción de la vía aérea superior y glosoptosis, pudiendo presentar fisura de paladar. Esta última podría ser un factor pronóstico en el resultado final de la desobstrucción de la vía aérea durante el procedimiento de distracción mandibular. Nuestro objetivo es analizar si la presencia de fisura de paladar en pacientes sometidos a distracción mandibular incide en el resultado final de la desobstrucción de la vía aérea, así como evaluar la relación entre la discrepancia máxilo-mandibular y la fisura de paladar en el tratamiento con distracción osteogénica. Material y Método: Realizamos un estudio prospectivo randomizado en el Servicio de Cirugía Plástica del Hospital de Pediatría S.A.M.I.C. Juan P. Garrahan de Buenos Aires (Argentina), en el período comprendido entre 2013 y 2017. Analizamos 31 pacientes con diagnóstico de secuencia de Pierre Robin entre los 3 y los 90 días de edad, sometidos a distracción mandibular, 51.6% de sexo femenino y 48.4% de sexo masculino. El 80.6% presentaba fisura de paladar asociada. Resultados: Del análisis comparativo realizado vimos que cuando no se tuvo en cuenta la severidad de la discrepancia máxilo-mandibular, la diferencia no fue significativa entre ambos grupos. Ahora bien, cuando la discrepancia máxilo-mandibular fue mayor o igual a 7 mm, los pacientes que presentaban fisura de paladar tuvieron mejor resultado en el tratamiento quirúrgico mediante distracción mandibular para desobstruir la vía aérea. Conclusiones: Los pacientes con diagnóstico de secuencia de Pierre Robin a los que se les realizó distracción mandibular con el objetivo de desobstruir la vía aérea, que presentaban una discrepancia máxilo-mandibular mayor o igual a 7 mm y fisura de paladar asociada, tuvieron, de forma estadísticamente significativa un mejor resultado en dicho procedimiento (p< 0.01)

Background and Objective: The three mean features of the Pierre Robin sequence are micrognatia, airway obstruction and feeding problems, and the cleft palate may be associated. The cleft palate could be a prognosis factor in the final outcomes of the airway desobstruction during the jaw distraction. Our aim is to analyze if the cleft palate affects the final outcomes of the airway desobstruction in patients with jaw distraction, assessing the relationship between the maxillomadibular overjet and the cleft palate in the osteogenic distraction. Methods: We performed a prospective randomized study with patients between 2015 and 2017 in the Plastic Surgery Department of the Pediatric Hospital S.A.M.I.C. Juan P. Garrahan, Buenos Aires (Argentina). There were 31 patients with Pierre Robin sequence (57% boys and 43% girls), aged between 3 and 90 days, and they all had jaw distraction; 80.6% of patients had a cleft palate associated. Results: From the comparative analysis we obtained that if the severity of the maxillomandibular overjet wasn't taken into account, there wasn't difference between the analyzed groups. But, it the overjet was 7 mm or more, patients with cleft palate associated had les jaw distraction failure for the airway desobstruction and had better final outcomes. Conclusions: Patients with Pierre Robin sequence treated with jaw distraction for the airway desobstruction with a maxillomandibular overjet of 7 mm or more, had les treatment failure with p < 0.01

Manifestaciones mucocutáneas de intoxicación por metotrexato / 4pp Mucocutaneous manifestations of methotrexate toxicity

El metotrexato es un antimetabolito análogo al ácido fólico que inhibe competitivamente la enzima dihidrofolato reductasa y timidilato sintetasa, indispensables para la síntesis de ADN y ARN. Se utiliza ampliamente en dermatología y sus efectos adversos en la piel y mucosas son variados, incluyendo reacciones leves y graves. Las erosiones y úlceras cutáneas como manifestación de citotoxicidad por metotrexato son infrecuentes y representarían un signo cutáneo temprano de pancitopenia por toxicidad medular secundaria a dicha droga. En la mayoría de los casos existen enfermedades cutáneas previas a la ulceración, principalmente psoriasis. En ausencia de dermatitis subyacente, la presencia de ulceraciones es excepcional. Se presentan ocho casos de pacientes con signos cutáneos de intoxicación por metotrexato, con y sin dermatosis previas. En la mayoría hubo asociación de mucositis y compromiso medular. Se recomiendan pautas de tratamiento.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.