Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis.

This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.

Comparison of the Clinical Effectiveness of Intra-Articular Injection with Different Substances After TMJ Arthroscopy: A Systematic Review and Meta-Analysis.

Objective: This systematic review aims to describe the clinical outcomes after TMJ arthroscopy followed by intra articular infiltration with different substances. Materials and Methods: A literature search was carried out, the variables were Arthroscopy with different substances, pain and maximal mouth opening. The inclusion criteria were articles that reported infiltration of different substances after arthroscopy. Case series, observational studies, and randomized clinical trials were included. Exclusion criteria were studies that included arthrocentesis, animal studies, connective tissue disease, patients with previous surgeries. Results: Of the 5 studies finally included, the population studied were 346 subjects, of which 315 were female. The mean age was 34.7 (16-77). Regarding diagnoses, Wilkes III and Wilkes IV were taken into account. The most commonly used substance was sodium hyaluronate/hyaluronic acid in 4 of the 5 studies. Conclusion: Multiple substances have been infiltrated within the temporomandibular joint, with sodium hyaluronate/hyaluronic acid being the most studied. However, the benefit of substances like ATM artroscopia adyuvantes has not been clearly established. It is recommended in future studies that the substances and results be evaluated in the same way to obtain more homogeneous studies.

Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review.

The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21-81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.

Correlation Between Demographic Variables and Complications in Nonsyndromic Craniosynostosis.

PURPOSE: This retrospective cross-sectional, observational study aims to determine the correlation between demographic variables and nonsyndromic craniosynostosis. METHODS: A cross-sectional study was carried out. The inclusion criteria were nonsyndromic craniosynostosis and the exclusion criteria were patients who did not have complete records. RESULTS: The sample included 49 patients and mainly women. Patients with more than 4 days in the intensive care unit were related with more complications. Intracranial Hypertension was seen predominantly in patients between 6 and 8 months P =0007. CONCLUSION: Some variables can modificate complications risk but future studies are needed to further investigate the influence of such variables on craniofacial care.

A Novel Method for Lengthening Iliac Crest Grafts for Mandibular Reconstruction.

The objective of this article is to propose a technique for mandibular reconstructions of up to 17 cm, in order to obtain anterior iliac crest grafts smaller than those required, and then lengthen them using corticotomies. This technique has been performed in 5 patients with an indication for reconstruction after partial mandibulectomy due to pathology. Reconstruction of the body of the mandible, including the angle in some cases, was performed using nonvascularized anterior iliac crest grafts. These were elongated using corticotomies and fixed to cover the defect using reconstruction plates and screws (2.4 system). The wedge spaces that were formed by lengthening the bone block were grafted with autologous medullary bone and platelet-rich plasma. There was no loss of any of the grafts and there was no need for second surgical times to place more grafts. All cases were able to be rehabilitated with removable prostheses or dental implants. This method optimizes the amount of graft obtained, favors revascularization of the graft, reduces hypoxia times and allows the placement of osteoconductive and/or osteoinductive grafts directly on the exposed medullary areas, with the aim of promoting integration and reducing the resorption rate in large grafts.

Clinical outcomes of operative arthroscopy and temporomandibular medical infiltration with platelet-rich fibrin in upper and lower articular space.

This study aims to describe the short-term therapeutic results of patients treated with operative arthroscopy and medical infiltration with platelet-rich fibrin in upper and lower articular space. The study design is descriptive observational with retrospective case series of patients with Wilkes II and III. These patients were managed with operative arthroscopy viscosupplementation with platelet-rich fibrin (PRF) and were followed up for up to 8 months to evaluate their response to treatment. 17 patients were included in the study. In the pre-surgical assessment (T1) mean VAS was 7.1 and MID was 22.2 mm. Eight months later (T4) a relevant improvement in both mentioned variables MID 38.2 ± 4.1 and VAS 1.1 ± 0.2 was observed. Regarding the reduction of pain, a significant improvement in symptoms were found, this being 84.6% ± 3.5% and in mandibular mobility satisfactory results were also obtained, improving in 41.7% ± 20.9%. Within the limitations of the study temporomandibular joint arthroscopy and medical infiltration platelet-rich fibrin viscosupplementation is a procedure of limited invasiveness that shows promising results.

Atresia biliar por citomegalovirus: un reporte de caso / Cytomegalovirus-associated biliary atresia: Case report

Resumen La atresia biliar asociada con inmunoglobulina M (IgM) positiva para citomegalovirus (CMV) es una entidad infrecuente que se caracteriza por la obliteración inflamatoria progresiva de los conductos intra- o extrahepáticos producida por una reacción autoinmune perinatal contra el CMV. El diagnóstico se realiza con IgM positiva para CMV y biopsia hepática con evidencia de atresia de las vías biliares. El conocimiento y la identificación temprana de esta patología conduce a un manejo quirúrgico temprano, mejorando considerablemente el pronóstico de estos pacientes. Se presenta un caso clínico de una paciente de 82 días de edad con un cuadro de acolia, coluria e ictericia de inicio tardío, asociado con hiperbilirrubinemia a expensas de la directa, elevación de perfil hepático e IgM positiva para CMV. La colangiorresonancia intraoperatoria confirmó el cuadro de atresia de las vías biliares. Se realizó una derivación biliodigestiva tipo Kasai y la toma de biopsia hepática que confirmó el cuadro clínico.

Abstract Biliary atresia associated with positive cytomegalovirus IgM results is a rare condition characterized by progressive inflammatory obliteration of the intra- or extrahepatic ducts. It is caused by a perinatal autoimmune reaction against cytomegalovirus (CMV). Diagnosis is made based on positive IgM for CMV and liver biopsy with evidence of bile duct atresia. Knowledge and timely identification of this disease leads to early surgical management, considerably improving the prognosis of these patients. This is the clinical case of an 82-day-old female patient with late-onset acholia, choluria, and jaundice, associated with conjugated hyperbilirubinemia, elevated liver function tests and positive CMV IgM results. Intraoperative cholangioresonance confirmed bile duct atresia. The Kasai procedure was performed, and a liver biopsy was taken, confirming the diagnosis.

Piezoelectric Cutting Devices for Osteotomy in Temporomandibular Joint Condylectomy.

Condylar hyperplasia is an alteration in mandibular growth that can cause facial asymmetry and occlusal changes that usually affect the aesthetics and function of patients. To date, condylectomy for its part remains a key part of the treatment. Although there are still controversies regarding the amount of bone to remove and the surgical approach, there are still other concerns, such as finding the benefit in terms of intraoperative safety and postoperative results with different cutting devices, including the use of piezoelectric, which is increasing its use in the maxillofacial field. This is why the main objective of this study is to compare the results found in medical records and databases of condylectomy procedures performed between 2017 and 2019 with different cutting devices.

Enfermedad cardiaca inducida por radioterapia / Radiation induced heart disease

Resumen La enfermedad cardiaca inducida por los tratamientos para el cáncer, como la quimioterapia y radioterapia, se considera cada vez más una enfermedad prevalente, que por tanto amerita conocimiento para el seguimiento adecuado, la prevención y el tratamiento de la misma. Anteriormente, este grupo de investigación publicó el artículo ``Cardiotoxicidad inducida por la quimioterapia: desde las bases moleculares hasta la perspectiva clínica'', en la que se hace una revisión acerca de los diferentes aspectos, incluyendo diagnóstico, fisiopatología, tratamiento y pronóstico de la enfermedad cardiaca inducida por radioterapia.

Abstract The heart disease induced by cancer treatments, such as chemotherapy and radiotherapy, is increasingly being seen as a prevalent disease, and as such it needs to be taken into account for its appropriate follow-up, prevention and treatment. Previously, this research group published the review, ``Chemotherapy-induced cardiotoxicity from the molecular basis to the clinical perspective'', which included a review of the different aspects, including the pathophysiology, treatment, and prognosis of heart disease induced by radiotherapy.

Comportamiento de los parámetros hemodinámicos evaluados por el monitoreo ambulatorio de presión arterial de 24 horas / Behavior of hemodynamic parameters assessed with 24-hour ambulatory blood pressure monitoring

Resumen Objetivo: Describir el comportamiento de los parámetros hemodinámicos en un grupo de individuos sometidos al estudio de monitoreo ambulatorio de la presión arterial. Materiales y métodos: Estudio observacional descriptivo sobre el comportamiento de los parámetros hemodinámicos en el estudio de monitoreo ambulatorio de la presión arterial en un grupo de pacientes atendidos en dos instituciones de Medellín. Resultados: Se analizaron un total de 108 pacientes atendidos en el período comprendido entre septiembre de 2012 y octubre de 2013. Los promedios de la presión arterial sistólica y presión arterial diastólica en 24 horas fueron de 128.34 ± 12.79 mmHg y 75.87 ± 8.74 mm Hg, respectivamente. La media de la presión del pulso fue de 52.47 ± 11.12 mmHg. Las presiones arteriales medias diurna y nocturna fueron de 96,23 ± 9,5 mmHg y 85.19 ± 10,23 mmHg, respectivamente. La frecuencia cardiaca fue de 71.4 ± 10.03 latidos por minuto, para la carga sistólica la media fue de 39,38 ± 27,80% y para la carga diastólica fue de 26,26 ± 24,32%. Conclusiones: El monitoreo ambulatorio de la presión arterial es considerado actualmente como el método más confiable y exacto para el diagnóstico y evaluación de la hipertensión arterial. Permite no solo el diagnóstico y seguimiento del comportamiento de las cifras tensionales en los hipertensos, sino la evaluación de otras variables, como es mostrado en este estudio, con un comportamiento de los resultados muy similar a otros estudios locales.

Abstract Objetive: To describe the behavior of hemodynamic parameters in a group of individuals undergoing ambulatory blood pressure monitoring. Material and methods: Descriptive, observational study on the behavior of hemodynamic parameters in ambulatory blood pressure monitoring of a group of patients assisted in two institutions in Medellín. Results: A total of 108 patients were analysed, assisted between September 2012 and October 2013. Average 24-hour systolic and diastolic blood pressure values were 128.34 ± 12.79 mmHg and 75.87 ± 8,74 mmHg, respectively. Average pulse pressure was 52.47 ± 11.12 mmHg. Day and night blood pressure values were 96.23 ± 9.5 mmHg and 85.19 ± 10.23 mmHg, respectively. Heart rate was 71.4 ± 10.03 beats per minute, it was 39.38 ± 27.80% for the systolic load and 26.26 ± 24.32% for the diastolic load. Conclusions : Ambulatory monitoring of blood pressure is considered nowadays to be the most reliable and exact method for diagnosing and assessing arterial hypertension. Not only does it allow diagnosis and control of the behavior of blood pressure levels in hypertensive patients, but also assesses other variables, like the ones shown in this study, with results being similar to those of other local studies.

Dependence to legally prescribed opioid analgesics in a university hospital in Medellin-Colombia: an observational study.

BACKGROUND: In some countries the misuse and diversion of prescribed opioid analgesic is increasing considerably, but there is no official data regarding the situation in Colombia. The aim of this study was to identify all dependent to opioid analgesics legally prescribed patients that were treated in a University Hospital in Medellin, Colombia during 4 years and to characterize this population. METHODS: Observational study in a University Hospital in Medellin, Colombia, searching for patients with ICD-10 codes related with opioid related disorders, adverse events or pain and treated between January 2011 and December 2014. RESULTS: Sixty patients with opioid dependence according to DSM-IV criteria were found from 3332 clinical charts reviewed. The median age was 43 years. Although all patients met the DSM-IV criteria, 33 % of patients were wrongly diagnosed by other ICD-10 codes. Almost all patient (88 %) initiated opioids after medical prescription although the adherence to pain scale was low (25 %). The median time of consumption was 48 months. Tramadol was the opioid more frequently used by patients, followed by morphine and oxycodone. A statistically significant higher consumption of other psychotropic substances was observed in male than female (P = 0.005 by Fisher's test). After be diagnosed, 55 % of patients gone a methadone-based replacement therapy. CONCLUSION: Legally prescribed opioid dependence was belatedly diagnosed in 60 patients in a University hospital, after prolonged use of drugs to treat chronic pain and with low adherence to pain scale or guidelines. This is the first report in Colombia.

Antecedentes ocupacionales documentados en la historia clínica de pacientes con diagnóstico de cáncer pulmonar / Occupational history documented in the medical records of patients diagnosed with lung cancer

Objetivo: El propósito de la investigación es describir el tipo de información relacionada con la vida laboral de pacientes con diagnóstico de cáncer pulmonar, registrada en sus historias clínicas (HC) y explorar posibles conductas o eventos relacionados con la documentación de dicha información. Metodología: Mediante un estudio descriptivo transversal se analizaron 367 HC de pacientes con diagnóstico de cáncer pulmonar durante el periodo 2007-2010 del Instituto Nacional de Cancerología (INC) de Bogotá (Colombia), en la que se identificó la información de tipo laboral registrada. Se realizaron análisis descriptivos de la información reportada y análisis de correspondencias múltiples para explorar posibles asociaciones entre variables y el reporte de información laboral. Resultados: Del total de historias analizadas, el 32% registró información relacionada con antecedentes ocupacionales. El criterio de mayor registro fue el nombre de la ocupación u oficio con un 29,7% del total de historias analizadas. El registro de información laboral no parece tener la intención de aportar elementos relevantes al diagnóstico de cáncer pulmonar ocupacional. Del mismo modo, las características demográficas de los pacientes y la documentación de algún tipo de criterio que sugiera una exposición a sustancias cancerígenas en el ambiente laboral no parecen influir en la profundización de los antecedentes ocupacionales. Conclusión: El registro de antecedentes ocupacionales dentro de las HC de pacientes con cáncer pulmonar del INC es escaso e impreciso y no se evidencia ningún tipo de conducta que motive su profundización.

Objetive: The purpose of the research is to describe the type of information relating to the working lives of patients diagnosed with lung cancer, recorded in their medical histories and explore possible behaviours or events associated with the documentation of this information. Methods: Using a cross-sectional study, 367 medical records of patients diagnosed with lung cancer were analysed for the period 2007-2010 from the National Cancer Institute in Bogota (Colombia), in which information of registered job type was identified. Descriptive analyses of the data reported were performed, as well as a multiple correspondence analysis to explore possible associations between variables and the occupational information report. Results: Of the medical records analysed, 32% reported information related to occupational background. The main variable registered was the name of occupation or job, 29,7% of the total records analysed. Recording occupational information does not seem to provide relevant elements to the diagnosis of occupational lung cancer. Similarly, the demographic characteristics of patients and documentation of any information that may suggest exposure to carcinogens in the workplace does not appear to influence the depth of occupational history. Conclusion: Registration of occupational background in the medical records of patients with lung cancer of the INC is scarce and imprecise and does not provide any evidence that it provides a deeper understanding.

La naturaleza polifónica de la opinión y la emergencia del nos-otros que construye lo público The Polyphonic Nature of Opinion and the Emergence of the Us-Them that Builds the Public / Polyphonic nature of opinion and the emergence of the us-them that builds the public

Se ofrece un panorama general alrededor de algunos planteamientos teóricos derivados del acompañamiento a comunidades de sectores urbanomarginales de la ciudad de Bogotá en la construcción de espacios públicos de opinión desde conversaciones polifónicas. Sin duda la figura de la opinión mantiene vigencia en el desarrollo de la sociedad civil, sobre todo a la hora de definir políticamente lo que nos es común desde una auténtica democracia participativa en una sociedad que pretende atemperar la injusticia y la exclusión. Estos planteamientos han surgido en la relación permanente entre teoría y práctica que desafían los “Encuentros comunitarios de voces”, lo cual no es casual: la estrechez de espacios para el encuentro cara a cara yel intercambio dialógico entre “extraños”, abre posibilidades para articular una “voz” que potencia los propios recursos sociales.

The article offers a general panoramic view of some theoretical statements derived from the accompaniment to urban marginal communities in Bogotà, especially regarding the building of public opinion spaces from polyphonic conversations. Opinion as a concept is indeed important in the development of a civilian society, especially when defining our commonalities from a political standpoint in an authentic democratic participative in a society that intends to control injustice and exclusion. These statements have emerged in the permanent relationship between theory and practice, defied by “Community Voice Encounters”, which is not casual: the narrowness of spaces for face to face encounters enables the possibility for a “voice” that moves social resources.

Contribución de la inmigración al incremento de las interrupciones voluntarias del embarazo / Contribution of immigration to increase of legal induced abortion

Fundamento y objetivo: Estimar qué proporción del incremento en la frecuencia de interrupciones voluntarias del embarazo (IVE) proviene de las realizadas en inmigrantes. Población y método: Se incluyeron todas las mujeres de edad fértil residentes en Asturias, Cataluña, Comunidad Valenciana y Comunidad de Madrid. En 2005 se calculó la tasa de IVE en el conjunto de las mujeres, en las mujeres españolas y en las mujeres inmigrantes. En 1991 se estimó la tasa de IVE en el conjunto de las mujeres y se asumió que esa tasa correspondía a las españolas. Resultados: La tasa de IVE en inmigrantes triplica la tasa de mujeres españolas. Un 76% del incremento observado proviene de las IVE realizadas en inmigrantes, aunque en mujeres de 30 y más años de edad representa el 100%. Las mujeres de 15 a 19 años son la excepción, ya que el incremento proviene fundamentalmente de las IVE realizadas en las españolas. Conclusiones: El incremento en el número de inmigrantes desde de la segunda mitad de la década de 1990 justificaría el incremento en la tasa de IVE en España entre 1991 y 2005, especialmente en las mayores de 30 años de edad (AU)

Background and objective: We aimed to estimate what proportion of the increase in the frequency of legally induced abortions in Spain can be attributed to abortions performed in immigrant women. Population and method: All women of reproductive age residing in Asturias, Catalonia, Valencia and Madrid were included. The rates of legally induced abortion in Spanish and immigrant women were calculated in 2005. It was estimated the rate in all women in 1991 assuming that that rate refers to Spanish women only. Results: The rate of legal abortions in immigrant women tripled those of Spanish women. A 76% increase in the rate was due to abortions carried out in immigrant women. Moreover, in women older than 30 years, the immigrant group represented 100% of the increment. Women aged 15 to 19 represented the exception, since the increase in these rates were primarily due to abortions performed in Spanish women. Conclusions. The increase in the number of immigrants in Spain since the second half of the 90s explains the increase in the rate of abortions between 1991 and 2005 in women aged 30 years and older (AU)

[Contribution of immigration to increase of legal induced abortion]. / Contribución de la inmigración al incremento de las interrupciones voluntarias del embarazo.

BACKGROUND AND OBJECTIVE: We aimed to estimate what proportion of the increase in the frequency of legally induced abortions in Spain can be attributed to abortions performed in immigrant women. POPULATION AND METHOD: All women of reproductive age residing in Asturias, Catalonia, Valencia and Madrid were included. The rates of legally induced abortion in Spanish and immigrant women were calculated in 2005. It was estimated the rate in all women in 1991 assuming that that rate refers to Spanish women only. RESULTS: The rate of legal abortions in immigrant women tripled those of Spanish women. A 76% increase in the rate was due to abortions carried out in immigrant women. Moreover, in women older than 30 years, the immigrant group represented 100% of the increment. Women aged 15 to 19 represented the exception, since the increase in these rates were primarily due to abortions performed in Spanish women. CONCLUSIONS: The increase in the number of immigrants in Spain since the second half of the 90s explains the increase in the rate of abortions between 1991 and 2005 in women aged 30 years and older.