Maxillary Lipofibromatosis in a pediatric patient. Case report

This report discusses a rare case of a soft palate deformity in a young girl due to lipofibromatosis (LPF). This rare benign pediatric soft tissue tumour usually arises in the distal extremities. We believe this case represents the first report of lipofibromatosis involving only the maxillary bone.

Risk of bias in dentistry-related randomized controlled trials in spanish language journals

Objectives: To assess the risk of bias (RoB) of randomized controlled trials (RCTs) published in dental journals in the Spanish language. Methods: A systematic retrospective survey was conducted of all RCTs published from 1980 to 2019 in dentistry Spanish and Latin American journals. We extracted data and performed RoB assessments using the Cochrane Risk of Bias tool. Results: 292 RCTs published in 51 journals were included. The best-rated domains were incomplete outcome data, selective reporting, and other biases. The domains assessed with higher proportions of an unclear or high risk of bias were sequence generation, allocation concealment, and blinding of outcome assessment. There is a low proportion of RCTs published in Spanish language journals. However, the number has been increasing over the years, and the low risk of bias assessment rates across domains show an increasing trend. Conclusions: A low percentage of Spanish-language dental journals issue RCTs. Our assessment of these RCTs' RoB suggests higher difficulties in the design and conduction phase than in the posterior reporting stage.

Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Systematic Mapping Review of Orthognathic Surgery (Protocol).

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in orthognathic surgery (OS) and their outcomes. Methods: Systematic reviews (SRs), randomized controlled trials (RCTs), and observational studies that evaluate perioperative OS co-interventions and surgical modalities will be identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature will also be screened. Results: Expected results include identification of all PICO questions available in the evidence regarding OS and generation of evidence bubble maps, involving a matrix of all identified co-interventions, surgical modalities, and outcomes presented in the studies. This will achieve identification of research gaps and prioritization of new research questions. Conclusions: The significance of this review will result in a systematic identification and characterization of the available evidence, leading to a reduction in research waste and a guidance of future efforts in developing studies for unsolved questions.

Reporting of conflict of interests, source of funding, and ethics committee approval in randomized trials of three clinical specialties published in Spanish language

Background: Confidence in the results reported by randomized clinical trials (RCTs) depends mainly on the internal validity of the trial and its conduct, but also on other aspects related to health research such as the complete reporting of conflicts of interest (COI), funding sources and approval by ethics committees. Bias in the study results may arise from any one of these elements. Prior studies have explored the reporting of these items in the medical literature, but there are no reports on RCTs published in Spanish and Latin American journals. This study aimed to evaluate the reporting of COIs, funding sources, and approval by ethics committees of RCTs published in Spanish and Latin American journals in dentistry, geriatrics and neurology. Methods: We did a systematic retrospective survey of all RCTs published from 1990 to 2018 in dentistry, neurology, and geriatrics journals published in Spain and Latin America and included in the BADERI database (Iberoamerican journals and trials database by its initials in Spanish). We completed with hand searching. We included RCTs with a recoverable full text published between 1990 and 2018. We extracted data on sources of funding, COI statements, and ethics reviews. The extraction of these items in the RCTs included was done independently by two pairs of reviewers and in parallel for each article, with a third independent reviewer resolving discrepancies. We analysed compliance for each item. Results: We identified RCTs in 69 journals from Spain and Latin American countries. Dentistry accounted for 75% (n = 52) of the journals, neurology 20.6% (n = 14), and geriatrics 4.4% (n = 3). Of the total number of RCTs included in this study (n = 392), only 102 (26%) reported the presence or absence of a COI, 103 (26%) studies reported funding, and 43 (36%) included the ethics committee approval. Conclusions: RCTs published in the Spanish language in dentistry, neurology, and geriatrics had poor compliance with the reporting of a COI, source of funding, and ethics committee approval. Future research should evaluate the accuracy and completeness of COI statements and their relationship to the funding source and direction of the results.

Intervenciones quirúrgicas mínimamente invasivas complementarias a la ortodoncia quirúrgicamente asistida: Resumen estructurado de evidencia

Introducción: Existen procedimientos quirúrgicos que pueden generar una disminución en la duración de los tratamientos de ortodoncia (TO) mediante una aceleración del movimiento dental. La técnica más estudiada corresponde a la corticotomía clásica, la cual muchas veces es desechada por los pacientes debido a su invasividad. Es por esto que nacen las intervenciones quirúrgicas mínimamente invasivas (IQMI), tales como las micro osteoperforaciones (MOP) y la piezocisión, que buscan el mismo resultado, pero sin realizar colgajos de espesor total, otorgándole al paciente nuevas alternativas terapéuticas para acortar el tratamiento de ortodoncia. La evidencia al respecto aún es controversial, debido a que la certeza de la evidencia es baja o muy baja con relación a estos procedimientos. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 39 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales, 31 corresponden a ensayos aleatorizados. Concluimos que las intervenciones quirúrgicas mínimamente invasivas podrían aumentar la tasa de movimiento dental a las 12 semanas, la distancia total acumulada, la tasa de movimiento dental y reducir la duración total de tratamiento, pero la certeza de la evidencia es incierta. Además, podrían resultar en poca o ninguna diferencia sobre el índice gingival, la profundidad de sondaje y el índice de placa.

Introduction: There are surgical procedures that can generate a decrease in the orthodontic (OT) treatments duration through a Acceleration of tooth movement. The most studied technique corresponds to classical corticotomy, which is often discarded by patients due to its invasiveness. This is why minimally invasive surgical interventions (MISI) are born, such as micro osteoperforations (MOP) and piezocision, which seek the same result, but without making total thickness flaps, giving the patient new therapeutic alternatives to shorten orthodontic treatment. The evidence on this is still controversial, because the certainty of the evidence is low or very low in relation to these procedures. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 39 systematic reviews that together included 43 primary studies, of which 31 correspond to randomized clinical trials. We conclude that minimally invasive surgical interventions could increase the rate of tooth movement at 12 weeks, distance total accumulated, the rate of tooth movement and reduce the total duration of treatment, but the certainty of the evidence is uncertain. In addition, they could result in little or no difference in gingival index, probing depth and plaque index.

Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery

Background: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. Material and methods: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. Results: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. Conclusions: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions. (AU)

An exploratory study of citations in systematic reviews of randomized trials published in Latin American journals.

Introduction: The prevalence of inclusion of randomized controlled trials published in Latin American journals has not been evaluated yet. This study explores the extent to which randomized trials published in Latin American medical journals are cited and used in systematic reviews. Methods: We did a descriptive observational study on randomized trials published in MEDLINE-indexed Latin American journals from 2010 to 2015. The primary outcome was the inclusion of these trials in systematic reviews. The secondary outcome was the total number of citations each trial received, as reported by Google Scholar. Results: Twenty-nine journals were selected. After searching these journals, we found 135 trials that fulfilled the inclusion criteria accounting for 2% of all research articles published in these journals. Of these, 55 (41%) were included in 202 systematic reviews. Of the nine most-cited randomized trials by systematic reviews and meta-analyses, only two were published in Spanish. Nine received zero citations by any article type. Most had small sample sizes. Conclusions: The overall impact of randomized controlled trials published in Latin American journals is low. Little funding, language bias and small sample sizes may explain the low inclusion in systematic reviews and meta-analyses.

Introducción: La prevalencia de la inclusión de ensayos controlados aleatorizados publicados en revistas latinoamericanas aún no ha sido evaluada. Este estudio tiene como objetivo explorar el grado en que los ensayos aleatorizados publicados en revistas médicas latinoamericanas son citados y utilizados en revisiones sistemáticas. Métodos: Se realizó un estudio observacional descriptivo sobre los ensayos aleatorizados publicados en revistas latinoamericanas indexadas en MEDLINE entre 2010 y 2015. El resultado primario fue la inclusión de estos ensayos en revisiones sistemáticas. El resultado secundario fue el número total de citas que recibió cada ensayo según lo informado por Google Scholar. Resultados: Se seleccionaron 29 revistas. Después de buscar en estas revistas, se encontraron 135 ensayos que cumplían los criterios de inclusión, lo que representa el 2% de todos los artículos de investigación publicados en estas revistas. De estos, 55 (41%) fueron incluidos por 202 revisiones sistemáticas. De los nueve ensayos aleatorios más citados por las revisiones sistemáticas y los metaanálisis, sólo dos fueron publicados en español. Nueve recibieron cero citas por cualquier tipo de artículo. La mayoría tenían tamaños muestrales pequeños. Conclusiones: El impacto de los ensayos controlados aleatorios publicados en revistas latinoamericanas es bajo. La escasa financiación, el sesgo lingüístico y el pequeño tamaño muestral pueden explicar la escasa inclusión en las revisiones sistemáticas y los metaanálisis.

An exploratory study of citations in systematic reviews of randomized trials published in Latin American journals

Introduction The prevalence of inclusion of randomized controlled trials published in Latin American journals has not been evaluated yet. This study explores the extent to which randomized trials published in Latin American medical journals are cited and used in systematic reviews. Methods We did a descriptive observational study on randomized trials published in MEDLINE-indexed Latin American journals from 2010 to 2015. The primary outcome was the inclusion of these trials in systematic reviews. The secondary outcome was the total number of citations each trial received, as reported by Google Scholar. Results Twenty-nine journals were selected. After searching these journals, we found 135 trials that fulfilled the inclusion criteria accounting for 2% of all research articles published in these journals. Of these, 55 (41%) were included in 202 systematic reviews. Of the nine most-cited randomized trials by systematic reviews and meta-analyses, only two were published in Spanish. Nine received zero citations by any article type. Most had small sample sizes. Conclusions The overall impact of randomized controlled trials published in Latin American journals is low. Little funding, language bias and small sample sizes may explain the low inclusion in systematic reviews and meta-analyses.

Introducción La prevalencia de la inclusión de ensayos controlados aleatorizados publicados en revistas latinoamericanas aún no ha sido evaluada. Este estudio tiene como objetivo explorar el grado en que los ensayos aleatorizados publicados en revistas médicas latinoamericanas son citados y utilizados en revisiones sistemáticas. Métodos Se realizó un estudio observacional descriptivo sobre los ensayos aleatorizados publicados en revistas latinoamericanas indexadas en MEDLINE entre 2010 y 2015. El resultado primario fue la inclusión de estos ensayos en revisiones sistemáticas. El resultado secundario fue el número total de citas que recibió cada ensayo según lo informado por Google Scholar. Resultados Se seleccionaron 29 revistas. Después de buscar en estas revistas, se encontraron 135 ensayos que cumplían los criterios de inclusión, lo que representa el 2% de todos los artículos de investigación publicados en estas revistas. De estos, 55 (41%) fueron incluidos por 202 revisiones sistemáticas. De los nueve ensayos aleatorios más citados por las revisiones sistemáticas y los metaanálisis, sólo dos fueron publicados en español. Nueve recibieron cero citas por cualquier tipo de artículo. La mayoría tenían tamaños muestrales pequeños. Conclusiones El impacto de los ensayos controlados aleatorios publicados en revistas latinoamericanas es bajo. La escasa financiación, el sesgo lingüístico y el pequeño tamaño muestral pueden explicar la escasa inclusión en las revisiones sistemáticas y los metaanálisis.

Incidence of perioperative delirium at the hospital nacional arzobispo loayza, october to December 2021, Lima Peru / Incidencia de delirium perioperatorio en el Hospital Nacional Arzobispo Loayza, octubre a diciembre 2021, Lima Perú

OBJETIVO: Determinar la incidencia de delirium perioperatorio (DPO) en el Hospital Nacional "Arzobispo Loayza", de octubre a diciembre del 2021. MÉTODOS: Estudio observacional cualicuantitativo y prospectivo, realizado en una población de 910 pacientes, en los que se aplicó: AMT Test Confussion Assessment Method (CAM) y el cuestionario de Pfeiffer (Short Portable Mental Status Questionnaire, SPMSQ). Utilizamos Chi2 para demostrar la existencia de asociación y las pruebas de V de Cramer y Phi para cuantificar la intensidad de dicha relación en caso existiera. RESULTADOS: Del total de pacientes (910) el 18,46% presentaron de delirium perioperatorio. El sexo y la religión no influye en esta. La edad si influye en la presentación del DPO puesto que el 50% (145) de los pacientes de 61 años o más la presentaron, a diferencia de los que tenían entre 36 -60 años solo el 5,31 % y los de 18 ­ 35 solo el 0,88 % presentaron DPO. Según el nivel de instrucción: el 100% sin instrucción presentaron DPO, el 73,1 con primaria presentaron DPO, el 18,5 con secundaria presentaron DPO y el 5,8 % con educación superior presentaron DPO. Según la técnica anestésica se encontró DPO en el 28,9% (60) del tipo raquídea con sedación, el 22,4% (11) del tipo epidural con sedación, el 16,7% (83) del tipo General TIVA TCI, el 12,9% (4) del tipo Bloqueo con sedación, el 9,5% (10) del tipo General balanceada; para los tipos de anestesia General TIVA manual, General Multimodal y Raquídea sin sedación no se presentaron casos de DPO. Según el tiempo operatorio: el 100% (9) de los pacientes con más de 6 horas de tiempo operatorio, el 27,1% (38) de los pacientes que tienen de 3 a 6 horas de tiempo operatorio y el 16,5% (121) de los pacientes que tienen de 1 a 3 horas de tiempo operatorio presentaron casos de DPO. Según el tiempo de hospitalización previo a la cirugía: el 48% (36) de los pacientes con tiempo de hospitalización de 16 a 30 días, el 20,5% (26) de los pacientes con tiempo de hospitalización de 8 a 15 días y el 16% (97) de los pacientes con tiempo de hospitalización de 3 a 7 días presentaron casos de DPO. Según la presencia de comorbilidades: el 51,6% (16) que tienen HTA y ER, el 41,7% (30) que tienen Diabetes y el 40,8% (20) que tienen HTA y DM2 presentan casos de DPO. Según presencia de demencia: el 100% (6) de los pacientes que tienen historia de demencia y el 17,9% (162) de los pacientes que no tienen historia de demencia presentaron DPO. según historia de antecedentes psiquiátricos, el 68,4% (13) de los que si tienen historia de trastorno psiquiátrico y el 17,4% (155) de los que no tienen historia de trastorno psiquiátrico presentaron DPO. Según historia de tratamiento psiquiátrico: el 100% (6) de los que si tienen historia de tratamiento y el 17,9% (162) de los que no tienen historia de tratamiento psiquiátrico presentaron DPO. Según cuestionario PFEIFFER pre-quirúrgico y post-quirúrgico: el 100% de los que tienen deterioro cognitivo leve, moderado o severo según el cuestionario PFEIFFER PRE QX presentaron DPO. Según diagnóstico de delirio pre-quirúrgico y post-quirúrgico: el 100% presentaron DPO. CONCLUSIONES: No existe una asociación entre el sexo y la religión y la presentación de DPO. Si existe una asociación entre la edad, grado de instrucción, tipo de anestesia, tiempo operatorio, tiempo de hospitalización previo a la cirugía, comorbilidades, historia de demencia, historia de trastorno psiquiátrico, historia de tratamiento psiquiátrico, cuestionario Pfeiffer pre, post quirúrgico, delirio pre quirúrgico y delirio post quirúrgico y la presentación de DPO,

OBJECTIVE: To determine the incidence of perioperative delirium (POD) at the Hospital nacioanl Arzobispo Loayza, from October to December 2021. METHODS: Qualitative and prospective observational study, carried out in a population of 910 patients, in which the AMT Test Confusion Assessment Method (CAM) and the Pfeiffer questionnaire (Short Portable Mental Status Questionnaire, SPMSQ) were applied. We used Chi2 to demonstrate the existence of association and Cramer's V and Phi tests to quantify the intensity of said relationship if it existed. RESULTS: Of the total of patients (910), 18.46% presented perioperative delirium. Sex and religion do not influence this. Age does influence the presentation of POD since 50% (145) of the patients 61 years of age or older presented it, unlike those between 36 -60 years of age only 5.31% and those of 18 - 35 only 0.88% presented POD. According to the level of education: 100% with no education, 73.1% with primary education, 18.5% with secondary education and 5.8% with higher education, presented DPO. According to the anesthetic technique, POD was found in 28.9% (60) of the spinal type with sedation, 22.4% (11) of the epidural type with sedation, 16.7% (83) of the General TIVA TCI type, 12.9% (4) of the Block type with sedation, 9.5% (10) of the General balanced type; for the types of general anesthesia manual TIVA, General Multimodal and Spinal anesthesia without sedation there were no cases of POD. According to the operative time: 100% (9) of the patients with more than 6 hours of operative time, 27.1% (38) of the patients who have 3 to 6 hours of operative time and 16.5% (121) of the patients who have 1 to 3 hours of operative time presented cases of POD. According to hospitalization time prior to surgery: 48% (36) of patients with hospitalization time of 16 to 30 days, 20.5% (26) of patients with hospitalization time of 8 to 15 days and 16% (97) of the patients with hospitalization time of 3 to 7 days presented POD. According to the presence of comorbidities: 51.6% (16) with AHT and RD, 41.7% (30) with Diabetes and 40.8% (20) with AHT and DM2 present POD. According to the presence of dementia: 100% (6) of the patients with a history of dementia and 17.9% (162) of the patients with no history of dementia presented POD. According to psychiatric history, 68.4% (13) of those who did have a history of psychiatric disorder and 17.4% (155) of those who did not have a history of psychiatric disorder presented POD. According to history of psychiatric treatment: 100% (6) of those who do have a history of treatment and 17.9% (162) of those who do not have a history of psychiatric treatment presented POD. According to the pre-surgical and post-surgical PFEIFFER questionnaire: 100% of those with mild, moderate or severe cognitive impairment according to the PFEIFFER PRE QX questionnaire presented POD. According to diagnosis of pre-surgical and post-surgical delirium: 100% presented POD. CONCLUSIONS: There is no association between sex and religion and the presentation of POD. If there is an association between age, educational level, type of anesthesia, operative time, hospitalization time prior to surgery, comorbidities, history of dementia, history of psychiatric disorder, history of psychiatric treatment, pre-, post-surgical Pfeiffer questionnaire, pre-surgical delirium and post-surgical delirium and the presentation of POD,

Systematic mapping review of orthognathic surgery.

STUDY DESIGN: Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS: Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS: Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION: Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.

Toxina Botulínica tipo A para el bruxismo del sueño en adultos

RESUMEN: Introducción: El bruxismo del sueño es un comportamiento que se caracteriza por la actividad repetitiva de los músculos masticadores. Varias terapias para el manejo del bruxismo del sueño se centran en la relajación de los músculos involucrados, incluyendo la inyección intramuscular de Toxina Botulínica tipo A (BoNTA). A pesar de que se ha comprobado la efectividad de esta terapia frente al dolor subjetivo, cuando se asocia a bruxismo del sueño, es necesario determinarla frente a desenlaces objetivos, tanto a nivel craneofacial como sistémico. Además, se debe evaluar también la seguridad de esta intervención frente a eventos adversos tales como afecciones estéticas, debilidad masticatoria y pérdida ósea mandibular, entre otros. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 11 revisiones sistemáticas que en conjunto incluyeron 9 estudios primarios, de los cuales, 8 corresponden a ensayos aleatorizados. Concluimos que la inyección intramuscular de toxina botulínica tipo A podría disminuir el dolor en reposo, presentar poca o nula diferencia en dolor durante la masticación y mejorar la autoevaluación del bruxismo, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si el uso de Toxina Botulínica Tipo A disminuye el número de eventos de bruxismo, ya que la certeza de la evidencia ha sido evaluada como muy baja. Finalmente y a pesar de la evidencia existente respecto de los potenciales eventos adversos producto de la intervención con Toxina Botulínica Tipo A en los músculos masticatorios, los ensayos clínicos fallan en evaluarlos y reportarlos.

ABSTRACT: Introduction: The sleep bruxism is a behavior that impacts the craniofacial musculoskeletal system characterized by repetitive activity of the masticatory muscles. Several management strategies for sleep bruxism are focused of the relaxation of the involved masticatory muscles, including the intramuscular injection of botulinum toxin type A (BoNTA). Although the effectiveness of BoNTA for myofascial pain, when related with the sleep bruxism in adult patients, it is necessary to determine its effectiveness using objective outcomes at both craniofacial and systemic levels. In addition, it is necessary to determine the safety of this intervention in the context of adverse events such as aesthetic alterations, reduced masticatory function, mandibular bone loss among others. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, with is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE assessment. Results and conclusions: 11 systematic reviews were identified, and 9 primary studies were included. 8 out of these 9 studies corresponded to randomized clinical trials. We conclude that the intramuscular injection of BoNTA may reduce the pain during rest and results in either little or none difference in pain during mastication, when pain is associated with sleep bruxism in adult patients. Also, low evidence is determined for auto-report and subjective evaluation of sleep bruxism among adult patients. Additionally, it is not possible to determine if the BoNTA intervention is effective to reduce the bruxism events due to the low evidence. Finally, although evidence regarding adverse events such as mandibular bone loss after BoNTA intervention in masticatory muscles has been published at preclinical and clinical levels, the clinical trials fail to consider and to report these outcomes.

Effectiveness of pre-surgical orthopedics on patients with cleft lip and palate: A systematic review and meta-analysis.

OBJECTIVE: Evaluate the effectiveness of pre-surgical orthopedics (PSO) in patients with cleft lip palate (CLP) in maxillary morphology (MM), facial growth and development (FGD), occlusal alterations (OA), parental satisfaction (PS), and side effects. DESIGN: Systematic review and meta-analysis of randomized and controlled clinical trials. Searches was performed in CENTRAL, MEDLINE, and EMBASE. RESULTS: From the eight studies included, three are randomized clinical trials, and five clinical trials are controlled. MM was evaluated by the intercanine width (Mean difference (MD) =1.44; CI95%= -0.30, 3.19; very low certainty), anteroposterior length (MD=1.32; CI95%= -0.59, 3.24; very low certainty) and intertuberocity width (MD=0.09; CI95%= -0.68, 0.49; certainty: very low). FGD was evaluated by SNA angle (MD: 1.29; P = 0.306; moderate certainty), SNB angle (MD: -0.79; P = 0.550; moderate certainty) and ANB angle (MD: 1; P = 0.362; moderate certainty). OA was evaluated by 5-years-old-index (MD= -0.09; P = 0.49; moderate certainty) and by Huddart score (MD=0.51; P = 0.736; moderate certainty). A valid questionnaire assessed PS only in one study (MD= -0.1; P = 0.199; moderate certainty). No studies reported side effects. CONCLUSION: Due to the uncertainty of the effect of PSO on MM and the lack of clinically relevant effect on FGD, OA, or PS, it is not reasonable to include this intervention as a treatment until future studies clarify its effect.

Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-Analysis.

Our aim was to assess the impact of combined orthodontic-surgical treatment on patients' oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence. METHODS: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before-after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models. RESULTS: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4-7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients' improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12-1.02). CONCLUSIONS: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients.

Changes in health-related quality of life after orthognathic surgery: a multicenter study.

OBJECTIVE: To evaluate changes in general and oral health-related quality of life (HRQoL) in patients with dentofacial deformity undergoing orthognathic surgery, and whether these changes vary according to type of deformity. MATERIAL AND METHODS: This is a prospective longitudinal multicenter study of patients with dentofacial deformities (n = 90). The Orthognathic Quality of Life Questionnaire (OQLQ), Oral Health Impact Profile (OHIP-14), and Short-Form Health Survey version2 (SF-36v2) were self-completed by patients before surgery, 3 and 6 months after orthognathic surgery. Change was tested using paired t-test, and compared between Class II and Class III of dentofacial deformity by unpaired t-test. The magnitude of change was examined estimating the standardized response mean (SRM). RESULTS: The OQLQ and OHIP-14 showed statistically significant improvements 6 months after surgery, compared with the pre-surgical evaluation, but the SF-36v2 only in the physical component summary. The SRM was large in OQLQ oral function (-1.11) and dentofacial facial aesthetics (-0.76) dimensions, and moderate in most of OHIP-14 dimensions. Differences in mean change between Class II and III were statistically significant for global scores of OQLQ (-10.08 vs -20.30, p = 0.0271) and OHIP-14 (-3.79 vs -10.56, p = 0.0144). CONCLUSIONS: A significant improvement was observed in oral HRQoL and in the physical component of general health in patients with dentofacial deformities Class II and III after orthognathic surgery. Improvement was greater among Class III than in Class II patients. CLINICAL RELEVANCE: These results provide patients, oral health care professionals, and planners with valuable information to make evidence-based decisions and facilitate shared clinical decision-making, taking into account the patients' perspective.

Entrenamiento con sobrecarga, duración de la repetición e hipertrofia: una revisión de la literatura / Resistance training, repetition duration and hypertrophy: a literature review

RESUMEN En el contexto del entrenamiento con sobrecargas, la duración de la repetición (tempo) hace referencia al tiempo total que dura una sola repetición dentro de una serie de un ejercicio, siendo el resultado de la suma entre la fase concéntrica, isométrica y excéntrica del levantamiento (o viceversa, dependiendo del ejercicio). Ha existido controversia los últimos años respecto a la duración de la repetición (y sus fases) y su impacto en la hipertrofia. El objetivo de esta revisión fue analizar los efectos de programas de entrenamiento donde se hayan comparado distintos tempos de levantamiento y su impacto en la hipertrofia. Se realizó una búsqueda de literatura en la base de datos electrónica Pubmed, con los siguientes criterios de inclusión: i) programas de entrenamiento que induzcan fallo volitivo, ii) que los estudios se hayan realizado bajo acciones dinámicas y con ≥4 semanas de intervención y iii) que los sujetos de estudio sean mayores de 18 años hasta mediana edad. De un total de 473 estudios, cuatro fueron incluidos, donde participaron 113 sujetos (79 hombres y 34 mujeres) y los tempos utilizados variaron entre 1.5 y 90 segundos, con menores tempos asociados a mayor efecto hipertrófico. Un tiempo entre 2 y 6 segundos sería efectivo para inducir adaptaciones hipertróficas.

ABSTRACT In overload training the duration of the repetition (tempo) refers to the total time that a single repetition lasts within a set, the result being the sum between the concentric, isometric and eccentric phases of the lift (or vice versa depending on the exercise). There has been controversy in recent years regarding the duration of the repetition (and its phases) and its impact on muscle hypertrophy. The objective of this review was to analyze the effects of training programs and compare the different lifting tempos and their impact on hypertrophy. A literature search was carried out in the Pubmed electronic database, with the following inclusion criteria: i) training programs that induce volitional failure, ii) studies had been carried out under dynamic actions and with ≥4 weeks of intervention, and iii) study subjects are older than 18 years old to middle age. Of a total of 473 studies, four were included, where, 113 subjects (79 men and 34 women) participated and the tempos varied between 1.5 and 90 seconds, with lower tempos associated with a greater hypertrophic effect. A tempo between 2 and 6 seconds would be effective in inducing hypertrophic adaptations.

Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial / Efecto de la profilaxis antibiótica para prevenir complicaciones infecciosas después Cirugía de tercer molar mandibular impactado. Un ensayo controlado aleatorio

Background: The objective of this study was to determine the effect of antibiotic prophylaxis in preventing post-operative infections after extraction of impacted mandibular third molars.Material and Methods: A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patientswere randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery andcontrol (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was theneed for rescue analgesia.Results: 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis,1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Dif-ference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99,p=0.41) NNTB=26. Rescueanalgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49(95%CI 0.32-0.75, p<0.05) NNTB=3.Conclusions: The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk ofpostoperative infections from impacted mandibular third molars extraction, when compared to placebo. Neverthe-less, antibiotic prophylaxis was associated with a reduced need for rescue analgesia.(AU)

Ortopedia prequirúrgica en el tratamiento de pacientes con fisura labio y paladar / Presurgical orthopedics in the treatment of patients with cleft lip and palate

RESUMEN: Introducción: Dentro del tratamiento estándar de los pacientes con fisura labio-máxilo-palatinas se encuentra la ortopedia prequirúrgica. Esta se realiza con el objetivo de modular la posición, alineación y estabilización de los segmentos maxilares previo a la primera cirugía. Pese a que es ampliamente utilizada, su efectividad es controversial. Métodos: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, posteriormente se realizó un metaanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados y Conclusiones: Se identificaron 14 revisiones sistemáticas que en conjunto incluyeron 57 estudios primarios, de los cuales, cinco corresponden a ensayos clínicos aleatorizados. Concluimos que no es posible establecer con claridad si la ortopedia prequirúrgica mejora o perjudica la morfología maxilar, debido a que la certeza de la evidencia ha sido evaluada como muy baja. Por su parte, la ortopedia prequirúrgica podría resultar en poca o nula diferencia en el crecimiento y desarrollo facial, las alteraciones oclusales, la satisfacción parental, la alimentación, el habla y la apariencia facial y nasolabial, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Within the standard treatment of patients with labio-maxillo-palatal cleft is presurgical orthopedics. This procedure seeks to modulate the position, alignment and stabilization of the maxillary segments prior to the first surgery. Although it is widely used, its effectiveness is currently controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews that included 57 primary studies, five of which correspond to randomized trials. We conclude that it is uncertain whether presurgical orthopedics improves or deteriorates maxillary morphology, because the certainty of the evidence has been very low. On the other hand, presurgical orthopedics may make little or no difference to facial growth and development, occlusal alterations, parental satisfaction, feeding, speech, and facial and nasolabial appearance, but the certainty of the evidence is low.

A multiyear systematic survey of the quality of reporting for randomised trials in dentistry, neurology and geriatrics published in journals of Spain and Latin America.

BACKGROUND: The Iberoamerican Cochrane Network is currently developing an extensive project to identify Spanish-language journals that publish original clinical research in Spain and Latin America. The project is called BADERI (Database of Iberoamerican Essays and Journal) and feeds the research articles, mainly randomised clinical trials (RCTs), into CENTRAL (Cochrane Collaboration Central Register of Controlled Trials). This study aims to assess the quality of reporting of RCTs published in Spanish and Latin American journals for three clinical fields and assess changes over time. METHODS: We did a systematic survey with time trend analysis of RCTs for dentistry, geriatrics, and neurology. These fields were chosen for pragmatic reasons as they had not yet been completed in BADERI. After screening RCTs from 1990 to 2018 for randomised or quasi-randomised clinical trials, we extracted data for 23 CONSORT items. The primary outcome was the total score of the 23 predefined CONSORT 2010 items for each RCT (score range from 0 to 34). The secondary outcome measure was the score for each one of these 23 items. RESULTS: A total of 392 articles from 1990 to 2018 were included as follows: dentistry (282), neurology (80), and geriatrics (30). We found that the overall compliance score for the CONSORT items included in this study for all 392 RCTs analysed was 12.6 on a scale with a maximum score of 34. With time, the quality of reporting improved slightly for all RCTs. None of the articles achieved the complete individual CONSORT item compliance score. The lowest overall compliance percentage was for item 10 (Randomisation implementation) and item 24 (Protocol registration), with a dismal 1% compliance across all included RCTs, regardless of country. CONCLUSIONS: CONSORT compliance is very poor in the 392 analysed RCTs. The impact of the CONSORT statement on improving the completeness of RCT reporting in Latin America and Spain is not clear. Iberoamerican journals should become more involved in endorsing and enforcing adherence to the CONSORT guidelines.

Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis.

OBJECTIVE: The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) . METHOD: Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. EXCLUSION CRITERIA: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. DATA SOURCES: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane's tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. STATISTICAL ANALYSES: frequentist method performed with the 'netmeta' library, R package. RESULTS: 27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate. CONCLUSION: For cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692).