Lesiones traumáticas en la mucosa oral de los adultos mayores / Traumatic lesions of oral mucosa in older adults

Dentro de la patología oral asociada con mayor frecuencia al paciente geriátrico nos encontramos con las lesiones con origen traumático. Los cambios fisiológicos que tienen lugar durante el envejecimiento hacen que las estructuras orales sean más susceptibles a la acción de agentes irritantes o agentes traumáticos, por lo que es importante establecer protocolos de prevención y diagnóstico precoz. En este artículo abordaremos las principales lesiones traumáticas que encontramos en el paciente anciano en función del tiempo de evolución, así clasificaremos las lesiones en agudas y crónicas (AU)

Among the oral pathology associated with geriatric patients we found more often we with traumatic injuries. The physiological changes that occurs during aging, makes that oral structures would be more susceptible to the action of irritants or traumatic agents, so it is important to establish different protocols for prevention and early diagnosis. In this paper we will review the major traumatic injuries found in the elderly patient depending on the time of evolution and so we classify the lesions in acute and chronic (AU)

Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2 / Family physician attitudes towards insulinization in type II diabetics

Objetivo: Determinar las actitudes de los médicos de familia del Área Sanitaria de Toledo ante el inicio de la insulinización en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio observacional, descriptivo, transversal, mediante encuesta elaborada ad hoc con datos sociodemográficos y laborales, e inclusión de la versión española del cuestionario Diabetes Attitude Scale (DAS-3sp) para evaluar actitudes y motivaciones relacionadas con la diabetes, enviada a 353 médicos de familia del Área Sanitaria de Toledo. Resultados: Se recibieron 66 encuestas, siendo mujeres el 50,8%, con una edad media (± desviación estándar) de 49,97 ± 7,40 años. Los resultados en las diferentes subescalas (valores de 1 a 5) del DAS-3sp fueron, respectivamente: S1 (necesidad de entrenamiento especial): 4,52 ± 0,38; S2 (percepción de gravedad): 4,18 ± 0,42; S3 (valoración del control estricto): 4,15 ± 0,39; S4 (valoración del impacto psicosocial): 3,79 ± 0,48, y S5 (autonomía del paciente): 3,72 ± 0,55. No se obtuvieron diferencias estadísticamente significativas al comparar las 4 primeras subescalas con el sexo, la formación vía MIR, el ser tutor de residentes, el tipo de contrato o la ubicación de la consulta. Se encontraron diferencias en la subescala S5 por sexo (3,90 ± 0,60 en varones vs 3,54 ± 0,45 en mujeres; t = 2,701; p = 0,009) y por ser tutor de residentes (3,99 ± 0,58 frente a 3,64 ± 0,52 de los no tutores; t = 2,188; p = 0,033). Conclusiones: Entre los médicos de familia del Área Sanitaria de Toledo, las actitudes con respecto al inicio del tratamiento con insulina en pacientes con DM2 son positivas, especialmente en lo referido a los aspectos clínicos, siendo menor en los aspectos más relacionados con el impacto psicosocial en el paciente y su autonomía (AU)

Aim: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. Materials and methods: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. Results: A total of 66 responses were received, of which 50.8% were from females. Mean age (± standard deviation) was 49.97 ± 7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52 ± 0.38; S2 (seriousness of type 2 diabetes): 4.18 ± 0.42; S3 (value of tight control): 4.15 ± 0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72 ± 0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54 ± 0.45 in women; t = 2.701; P = .009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t = 2.188; P = .033). Conclusions: The attitudes regarding starting insulin treatment in type 2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy (AU)

[Family physician attitudes towards insulinization in type II diabetics]. / Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2.

AIM: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS: A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS: The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.

Benign familial macrocephaly in a mother-son pair.

Macrocephaly can be found isolated or associated with other anomalies as a part of specific syndrome. Benign Familial Macrocephaly (BFM) is a primary macrocephaly and autosomal dominant and multifactorial inheritances had been proposed. Cole and Hughes (5), described clinically seven patients. We report two BFM cases, a boy and his mother. The male propositus showed macrocephaly with dolicocephaly shape, frontal bossing, narrowing biparietal and a square-shaped face. Neurological examination was normal. He had two computed tomography (CT) scans of the skull, one at 7 months of age showing extracerebral fluid collection in the anterior convexity and increased interhemispheric subarachnoid space and a second normal CT scan at 3 years of age. The mother showed macrocephaly with dolycocephaly shape and dished-out mid-face. This family exhibited the full clinical spectrum of BFM, with an autosomal dominant inheritance.

Problem-based learning versus lectures: Comparison of academic results andtime devoted by teachers in a course on Dentistry in Special Patients

Objectives: Problem-Based Learning (PBL) is a teaching-learning technique centred on the complete developmentof the student. It has been successfully implemented in several universities, notably in the health sciences. Theprocess of creating the European Higher Education Area, initiated in Bologna, encourages European universitiesto use new methodologies in the teaching-learning process, including PBL. Our objectives were to analyze theresults obtained by using PBL with fifth-year Dentistry students. Study design: Comparison of academic resultsbetween students receiving lectures and PBL participants, and assessment of differences between them in the timedevoted to tasks by students and teachers. Results: PBL participants obtained higher grades compared to thosereceiving lectures only(p<0.05). The two student groups devoted the same amount of time to this subject but thetime distribution of tasks was very different, with PBL students spending more time on group work and analysisof the literature. The teachers devoted much more time to the PBL group. Conclusions: PBL is a teaching-learningmethodology that improves student academic results. PBL diverts student time to more complex tasks but requiresa greater commitment from the teachers (AU)

Problem-based learning versus lectures: comparison of academic results and time devoted by teachers in a course on Dentistry in Special Patients.

OBJECTIVES: Problem-Based Learning (PBL) is a teaching-learning technique centred on the complete development of the student. It has been successfully implemented in several universities, notably in the health sciences. The process of creating the European Higher Education Area, initiated in Bologna, encourages European universities to use new methodologies in the teaching-learning process, including PBL. Our objectives were to analyze the results obtained by using PBL with fifth-year Dentistry students. STUDY DESIGN: Comparison of academic results between students receiving lectures and PBL participants, and assessment of differences between them in the time devoted to tasks by students and teachers. RESULTS: PBL participants obtained higher grades compared to those receiving lectures only (p<0.05). The two student groups devoted the same amount of time to this subject but the time distribution of tasks was very different, with PBL students spending more time on group work and analysis of the literature. The teachers devoted much more time to the PBL group. CONCLUSIONS: PBL is a teaching-learning methodology that improves student academic results. PBL diverts student time to more complex tasks but requires a greater commitment from the teachers.

Interstitial 1q42-q44 deletion defined by FISH in a short-lived female.

We report a female newborn with a de novo 1q4 deletion ascertained by G bands but refined as an interstitial one by FISH with a subtelomeric 1q probe; hence, the final karyotype was 46,XX,del(1)(q42q44).ish subtel1q x 2. She presented a few typical features of the del(1q42) syndrome. Additionally, she showed occipital skin aplasia, interauricular communication, and intestinal perforation-obstruction and she died at 24 days of age. This observation illustrates the clinical variability of the syndrome as well as the occasional reduced survival. The redefinition by molecular cytogenetics of a terminal deletion as an interstitial one suggests that interstitial deletions are more common than reported by classic cytogenetics and can partially account for the phenotypic variability in some deletion syndromes.

Schilbach-Rott syndrome in a third family: further delineation of an autosomal dominant trait.

We describe a father-son Mexican pair with typical features of Schilbach-Rott syndrome (SRS): ocular hypotelorism, cleft palate, hypospadias (only in the child), and microcephaly. This observation documents for the first time a male to male transmission and therefore confirms that the SRS is inherited as an autosomal dominant trait with variable expressivity.

Apert syndrome with preaxial polydactyly showing the typical mutation Ser252Trp in the FGFR2 gene.

The Apert syndrome is characterized by craniosynostosis and syndactyly of hands and feet. Although most cases are sporadic, an autosomal dominant mode of inheritance is well documented. Two mutations in the FGFR2 gene (Ser252Trp and Pro253Arg) account for most of the cases. We report a patient with a rare form of Apert syndrome with polydactyly. The proposita has turribrachycephaly. complete syndactyly of 2nd to 5th digits ("mitten hands" and cutaneous fusion of all toes). The X-rays revealed craniosynostosis of the coronal suture and preaxial polydactyly of hands and feet with distal bony fusion. Molecular analysis found a C755G transversion (Ser252Trp) in the FGFR2 gene. Only eight patients with Apert syndrome and preaxial polydactyly have been reported and this is the first case in which molecular diagnosis is available. On the basis of the molecular findings in this patient, polydactyly should be considered part of the spectrum of abnormalities in the Apert syndrome. This assertion would establish the need for a new molecular classification of the acrocephalopolysyndactylies.

[Diagnostic evaluation of endouterine manual aspiration for the detection of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding]. / Validación diagnóstica de la aspiración manual endouterina para la detección de hiperplasia y cáncer de endometrio en pacientes con sangrado uterino anormal.

The objective was to determinate the diagnostic value of manual vacuum aspiration with Karman cannula (MVA) for the detection of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. Fifty patients with abnormal uterine bleeding were evaluated with MVA prior to dilatation and curettage (D&C). The needing of cervical dilatation was noted. A matched analysis of the histological reports with Wilcoxon contrast test was performed. In order to calculate the diagnostic value, the histological examination of the tissue recollected by D&C was defined as gold-standard. Sensitivity, specificity, pre-test probability (prevalence), post-test probabilities (predictive values) and likelihood-ratios were calculated. No significant difference between either histological reports in matched analysis and the insufficient samples proportion was detected. Cervical dilatation was performed more frequently to D&C (p = 0.0002). The pre-test probability (prevalence) of endometrial hyperplasia/cancer was 20%. Two cases of hyperplasia were not detected by MVA (negative false 20%). The endometrial biopsy for MVA showed a sensitivity of 71% and specificity 93%. The post-test probabilities for an abnormal and normal biopsy (positive and negative predictive values) were 62.5% and 95.2%, respectively. The corresponding likelihood-ratios were 10.23 and 0.3, respectively. The endometrial biopsy for MVA has a high diagnostic value, similar to D&C, in the detection of endometrial hyperplasia/cancer in patients with abnormal uterine bleeding with the advantage to be an office procedure without either risks and costs of D&C.

Dot blot assay for detection of antidiacyltrehalose antibodies in tuberculous patients.

A simple dot blot test with diacyltrehalose (DAT) as the antigen was developed to detect anti-DAT antibodies in tuberculous patients. To enhance antigen-antibody reaction detection, rabbit serum raised against human immunoglobulins was used prior to incubation with a protein A-colloidal gold complex. With the dot blot system, it was possible to obtain a sensitivity similar to that of enzyme-linked immunosorbent assay (ELISA) and a specificity of 97.14%, versus a specificity of 94.29% by the ELISA. We conclude that this simple and fast assay could be used in places where ELISA equipment is not easy available and that it might also be applicable with other Mycobacterium tuberculosis immunogenic antigens.

Lepra versus SIDA: comparación de la actitudes que generan ambos conceptos mediante un diferencial samántico (D. S)

Para medir el perfil connotativo de las palabras y analisar las actitudes que éstas evocan se utiliza el Diferencial Semántico (D.S), de gran interés en psicología de la salud puesto que nos permite analizar las connotaciones de diversas palabras alusivas a la enfermedad. Así hemos analizado y contrastado el perfil connotativo-actitudinal que nos evocan las palabras LEPRA y SIDA, mediante un D.S de elaboración propia, según las variables, SEXO, EDAD, SER O NO PERSONAL SANITARIO y SER O NO UNIVERSITARIO, en una muestra de 144 sujetos de ambos os sexos, de 21 a 60 años, de la provincia de Cádiz. Tras el análisis de los datos se ofrecen varias conclusiones, entre las que destacan el que el SIDA está ocupando el espectro semántico negativo-"ignominioso" que antes ocupaba la lepra, abundando los juicios "morales" negativos hacia ambos conceptos, y el que se desconozca o niegue la posibilidad preventiva en ambos casos.

La lepra y sus estereotipos: un estudio de sus connotaciones semánticas a la luz de un diferencial samántico (D. S.)

Introducción: El significado de nuestras palabras abarca dos aspectos: el denotativo (sistema de símbolos que tienen un significado compartido grupalmente y específico) y el connotativo que deriva de las asociaciones -más afectivas que cognoscitivas- que solemos hacer cuando oímos o empleamos una palabra. Para medir este perfil connotativo-actitudinal se suele utilizar el diferencial semántico (D.S.) formado por una lista, en un continuum bipolar de siete intervalos, de adjetivos antagónicos, reunidos en RADICALES (evaluación, potencia y actividad añadiendo nosotros AFECTIVIDAD)... Técnica que, en nuestro caso, hemos aplicado al concepto "LEPRA", para medir y contrastar las connotaciones que evoca puesto que -por desgracia- a veces es más difícil tratar los prejuicios y estereotipos que genera la propia enfermedad. Objetivos: Analiza las connotaciones semático-afectivas y actitudinales del concepto "LEPRA", mediante un D.S. de elaboración propia, contrastando las variables SEXO, EDAD, SER O NO PERSONAL SANITARIO y SER O NO UNIVERSITARIO. Metodología: a) Muestra: Hemos trabajado con 144 sujetos, de ambos os sexos, de 21 a 60 años, de Cádiz y su provincia, repartidos en subgrupos proporcionales y estratificados. b) Material: A esta muestra le hemos pasado un D.S. de elaboración propia y aplicación individual, efectuando la recogida de datos entre el 10/11/94 y el 20/11/94. c) Tratamiento estadístico: El análises estadístico de los datos se ha realizado en base al recuendo de las frecuencias, en suma algebraica, a los valores asignados en cada pareja de adjetivos, efectuándose la prueba de diferencia de medias mediante el test de Kurskal con un nivel de confianza del 95%. Análisis y discusión de los resultados: - En el radical EVALUACIÓN constatamos que la lepra recibe una evaluación negativa, aunque no extrema, percibiéndose como bastante mala e injusta, extraña y relativamente indigna,...

Effect of pinealectomy and melatonin treatment during pregnancy on the sexual development of the female and male rat offspring.

Sexual development of female and male rat offspring of control, pinealectomized (PIN-X) or melatonin (MEL 250 micrograms/100 g body wt)-treated mother rats during pregnancy was studied. Newborns were studied at the following phases of sexual development: neonate (5 days old), infantile (15 days old), juvenile (25 and 30 days old) and pubertal phase (55 days). In female offspring, MEL treatment during pregnancy significantly increased plasma luteinizing hormone (LH) in 15- and 25-day-old rats; however, at the end of the prepubertal period (30 days) the concentration of plasma LH decreased significantly as compared to control rats. This hormonal pattern was different from that observed in offspring of control and PIN-X rats, which had low LH levels at 25 days of age and higher LH levels at 30 days of age. Follicle-stimulating hormone (FSH) did not vary significantly among the three groups. Plasma prolactin levels were affected by PIN-X of the mother, showing significantly higher levels in the 5-day-old offspring than in the controls; plasma prolactin levels were also affected by MEL treatment of the mother, producing hyperprolactinemia in the 30-day-old female offspring. In male offspring, sexual development in control male rats progressed rapidly with significantly increased LH and FSH levels at 25 and 30 days compared to those measured during the neonatal and infantile periods.(ABSTRACT TRUNCATED AT 250 WORDS)