Quiste dentígero en relación con tercer molar inferior retenido

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente.

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction.

Virus-Specific T Cells From Cryopreserved Blood During an Emergent Virus Outbreak for a Potential Off-the-Shelf Therapy.

During the first outbreak of an emergent virus, methods need to be developed to rapidly establish suitable therapies for patients with high risk of severe disease caused by the pathogen. Considering the importance of the T-cell response in controlling viral infections, adoptive cell therapy with virus-specific T cells has been used as a safe and effective antiviral prophylaxis and treatment for immunocompromised patients. The main objective of this study was to establish an effective and safe method to cryostore whole blood as starting material and to adapt a T-cell activation and expansion protocol to generate an off-the-shelf antiviral therapeutic option. Additionally, we studied how memory T-cell phenotype, clonality based on T-cell receptor, and antigen specificity could condition characteristics of the final expanded T-cell product. Twenty-nine healthy blood donors were selected from a database of convalescent plasma donors with a confirmed history of SARS-CoV-2 infection. Blood was processed using a fully automated, clinical-grade, and 2-step closed system. Eight cryopreserved bags were advanced to the second phase of the protocol to obtain purified mononucleated cells. We adapted the T-cell activation and expansion protocol, without specialized antigen-presenting cells or presenting molecular structures, in a G-Rex culture system with IL-2, IL-7, and IL-15 cytokine stimulation. The adapted protocol successfully activated and expanded virus-specific T cells to generate a T-cell therapeutic product. We observed no major impact of post-symptom onset time of donation on the initial memory T-cell phenotype or clonotypes resulting in minor differences in the final expanded T-cell product. We showed that antigen competition in the expansion of T-cell clones affected the T-cell clonality based on the T-cell receptor ß repertoire. We demonstrated that good manufacturing practice of blood preprocessing and cryopreserving is a successful procedure to obtain an initial cell source able to activate and expand without a specialized antigen-presenting agent. Our 2-step blood processing allowed recruitment of the cell donors independently of the expansion cell protocol timing, facilitating donor, staff, and facility needs. Moreover, the resulting virus-specific T cells could be also banked for further use, notably maintaining viability and antigen specificity after cryopreservation.

Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation.

Background: Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation. Methods: Sixty patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops, and recurrence of AFL during follow-up. Results: Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5 ± 8.2 years, 20% were female, and 32% had atrial fibrillation before being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4 ± 4.4 minutes vs 7.6 ± 4.5 minutes, respectively; P = 0.15). There was a trend to less acute reconnection in the HNS group compared with NS (13.3% vs 26.6%; P = 0.46). Steam pops occurred in 4 patients using HNS vs none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS; P = 0.5). There was no difference in time to recurrence (7.6 ± 6.9 vs 4.9 ± 4.5 months; P = 0.6). Conclusions: In this small pilot randomized controlled trial, there was no significant difference between HNS and NS for CTI ablation; however, HNS may increase the incidence of steam pops.

Contexte: Pour prévenir la récurrence d'un flutter auriculaire (flutter) typique, l'ablation de l'isthme cavotricuspidien exige un bloc de conduction bidirectionnel permanent. Dans des modèles expérimentaux, l'irrigation par cathéter au moyen d'un soluté demi-salin produit des lésions plus larges et plus profondes, comparativement à un soluté physiologique salin. La présente étude a été réalisée dans le but de comparer l'efficacité clinique et l'innocuité de l'irrigation au moyen d'un soluté demi-salin à celles de l'irrigation par un soluté physiologique salin dans les cas d'ablation d'un flutter. Méthodologie: Soixante patients soumis à une ablation d'un flutter typique par cathéter ont été répartis au hasard dans un rapport de 1:1 en deux groupes d'irrigation, soit par soluté demi-salin, soit par soluté physiologique salin. Les critères d'évaluation de l'étude étaient les suivants : temps écoulé jusqu'au bloc de l'isthme cavotricuspidien, reconnexion aiguë, jet de vapeur sonore (steam pop) et récidive de flutter durant le suivi. Résultats: Les caractéristiques initiales étaient comparables dans les deux groupes. Les patients avaient une moyenne d'âge de 68,5 ± 8,2 ans, 20 % étaient des femmes et 32 % présentaient une fibrillation auriculaire avant leur admission à l'étude. Un bloc bidirectionnel dans l'isthme cavotricuspidien a été obtenu chez tous les patients, sans différence entre les groupes en ce qui a trait au temps écoulé jusqu'à l'obtention du bloc isthmique (6,4 ± 4,4 minutes vs 7,6 ± 4,5 minutes, respectivement; p = 0,15). Une tendance vers un nombre plus faible de cas de reconnexion aiguë a été notée dans le groupe d'irrigation par soluté demi-salin, comparativement au soluté physiologique salin (13,3 % vs 26,6 %; p = 0,46). Un jet de vapeur sonore est survenu chez 4 patients recevant un soluté demi-salin contre aucun dans le groupe sous soluté physiologique salin, mais aucune complication importante n'a été relevée. Durant le suivi, le taux de récidive de flutter a été similaire dans les deux groupes (6,7 % sous soluté demi-salin vs 10 % sous soluté physiologique salin; p = 0,5). Aucune différence n'a été notée pour ce qui est du temps écoulé jusqu'à la survenue d'une récidive (7,6 ± 6,9 vs 4,9 ± 4,5 mois; p = 0,6). Conclusions: Dans cette petite étude pilote contrôlée et avec répartition aléatoire, aucune différence significative n'a été observée entre le soluté demi-salin et le soluté physiologique salin pour l'ablation de l'isthme; toutefois, le soluté demi-salin augmenterait la fréquence des cas de jet de vapeur sonore.

Electrocardiographic predictors of atrial fibrillation in patients with cryptogenic stroke.

BACKGROUND: Empiric anticoagulation is not routinely indicated in patients with cryptogenic stroke without documentation of atrial fibrillation (AF). Therefore, identification of patients at increased risk of AF from this vulnerable group is vital. OBJECTIVES: To identify electrocardiographic (ECG) predictors of AF in patients with cryptogenic stroke or transient ischemic attack (TIA) undergoing insertion of an implantable cardiac monitor (ICM). METHODS: In this single-center study, 48 patients with cryptogenic stroke or TIA had an ICM implanted for detection of AF between January 2013 and September 2019. Patients with and without AF were compared in terms of p-wave duration and a novel index (MVP score). RESULTS: During a mean follow-up of 16 ± 14 months, AF was detected in seven patients (15%). Diagnosis of AF was made after a mean of 10 ± 14 months, with time to first AF detection ranging between 1 and 40 months. Patients with AF had a longer p-wave duration (136 ± 9 ms vs. 116 ± 10 ms; p = .0001) and a higher MVP score (4.5 ± 1.2 vs. 2.0 ± 0.9, p = .0001) than those without AF. Advanced interatrial block (IAB) was observed in 43% of patients with ICM evidence of AF and 0% of those without AF (p = .002). Age, LA size or LVEF were not predictors of AF. CONCLUSION: An increased p-wave duration, advanced IAB and high MVP score are associated with AF occurrence in patients with cryptogenic stroke. Identifying patients with these markers may be helpful as they may benefit from more exhaustive and prolonged monitoring.

Instrumento para la evaluación de la educación en el trabajo de la asignatura Atención Integral a la Población / Instrument for the evaluation of education at work in the Comprehensive Attention to the Population subject

RESUMEN Fundamento: en el contexto actual de la educación médica superior, es necesario desarrollar una metodología de evaluación participativa en los diversos escenarios docentes prácticos-clínicos del proceso de formación que permita superar las formas tradicionales que históricamente se han basado en la identificación de conocimientos y habilidades. Objetivo: proponer un instrumento para evaluar el aprendizaje de los alumnos en la educación en el trabajo de la asignatura Atención Integral a la Población, que se imparte en el quinto año de la carrera de Estomatología. Métodos: investigación pedagógica desarrollada en la Universidad de Ciencias Médicas de Cienfuegos. Se utilizaron métodos teóricos: analítico-sintético e inductivo-deductivo y empíricos: análisis documental, entrevistas a profesores de la asignatura y técnicas participativas. El instrumento propuesto fue valorado por criterio de especialistas. Resultados: se confeccionó una rúbrica en correspondencia con el sistema de habilidades principales a dominar declarados en el programa de la asignatura. Para cada núcleo se estableció un puntaje de acuerdo con el nivel de ejecución o su dominio. Permite la heteroevaluación, la coevaluación y la autoevaluación, al proporcionar al alumno la posibilidad de reconocer sus avances, logros y dificultades, analizar su situación individual y grupal en dicho proceso educativo y desarrollar una actitud crítica y reflexiva sobre su proceso educativo. Conclusiones: la rúbrica es, sin duda, uno de los instrumentos con mayor potencial para el aprendizaje, posibilita la evaluación del grado de cumplimiento de los objetivos.

ABSTRACT Background: in the current context of higher medical education, it is necessary to develop a participatory evaluation methodology in the various practical-clinical teaching scenarios of the training process that allows overcoming the traditional forms that have historically been based on the identification of knowledge and skills. Objective: to propose an instrument to evaluate the students` learning in the education at work of the Comprehensive Attention to the Population subject, that is taught in the fifth year of the Stomatology career. Methods: pedagogical research developed at the Cienfuegos University of Medical Sciences. Theoretical methods were used: analytical-synthetic and inductive-deductive and empirical: documentary analysis, interviews with teachers of the subject and participatory techniques. The proposed instrument was evaluated according to the criteria of specialists. Results: a rubric was made in correspondence with the system of main skills to be mastered declared in the program of the subject. For each nucleus, a score was established according to the level of execution or its domain. It allows hetero-evaluation, co-evaluation and self-evaluation, by providing the student with the possibility of recognizing their progress, achievements and difficulties, analyzing their individual and group situation in said educational process and developing a critical and reflective attitude about their educational process. Conclusions: the rubric is, undoubtedly, one of the instruments with the greatest potential for learning, it enables the evaluation of the objectives` degree of fulfillment.

Wide Complex Tachycardia in Patient With Cardiac Device.

Electrocardiographic clues for a differential diagnosis of wide complex tachycardia in a patient with a pacemaker are presented. (Level of Difficulty: Intermediate.).

Percepción sobre sus habilidades especificas en estudiantes del tercer año de Estomatología. Cienfuegos, 2019 / Perception about their specific abilities in third-year stomatology students. Cienfuegos, 2019

RESUMEN Fundamento: el giro hacia una educación por habilidades supone una nueva cultura de aprendizaje. Comprender que cada estudiante progresa a diferentes ritmos en el dominio de una habilidad implica saber atender oportunamente sus necesidades y la personalización de sus trayectorias. Objetivo: describir la percepción que tienen los estudiantes del tercer año de la carrera de Estomatología sobre sus habilidades específicas. Métodos: estudio descriptivo de corte transversal realizado en la Clínica Estomatológica de Especialidades de Cienfuegos. Se trabajó con la totalidad de los estudiantes que cursan el tercer año de la carrera de estomatología, asignatura Operatoria Clínica en el quinto semestre. Resultados: los estudiantes perciben que deben seguir perfeccionando la mayoría de las habilidades, fundamentalmente en la confección de la historia clínica individual en los incisos: examen bucal y diagnóstico. El 50 % de los estudiantes tiene la percepción de que realizan el interrogatorio, identifican hábitos y plan de tratamiento muy bien. En los procedimientos clínicos solo la técnica de anestesia infiltrativa alcanza mayor porcentaje en el nivel superior de la escala de precepción representado por un 83,3%. Conclusiones: la percepción de los estudiantes respecto a las habilidades específicas está en correspondencia con el año académico que cursan. Perciben que deben seguir perfeccionando la mayoría de ellas. Los resultados expuestos permiten al claustro de profesores desarrollar estrategias docentes que contribuyan al desarrollo de dichas habilidades.

ABSTRACT Background: the change towards skills-based education means a new learning culture. Understanding that each student progresses at different rates in the mastery of a skill implies knowing how to deal with their needs timely and personalize their trajectories. Objective: to describe the third year students Stomatology career perception about their specific abilities. Methods: descriptive, observational, cross-sectional study carried out at the Cienfuegos Specialties Stomatological Clinic. All the third year stomatology students who are in the fifth semester of a Clinical Operative subject participated in the research. Results: the students perceive that they must improve the skills, mainly in the preparation of the individual medical history in sections: oral exam and diagnosis. The 50% of the students make the questioning, identify habits and treatment plan very well. In clinical procedures, only the infiltrative anesthesia technique achieves a higher percentage at the upper level of the perception scale, represented by 83.3%. Conclusions: the students' perception regarding the specific skills is in correspondence with the academic year they study. They think that they must improve most of them. The results presented allow the faculty to develop teaching strategies that contribute to the development of these skills.

Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation.

Background: Reverse remodeling is a clinically relevant endpoint in heart failure with reduced ejection fraction (HFrEF). Rho-kinase (ROCK) signaling cascade activation correlates with cardiac remodeling and left ventricular (LV) systolic dysfunction in HFrEF patients. Cardiac resynchronization therapy (CRT) is effective in HFrEF, especially when there is a left bundle block, as this treatment may stimulate reverse remodeling, thereby improving quality of life and prolonging survival for patients with this severe condition. Here, we evaluate the hypothesis that ROCK activation is reduced after effective CRT in HFrEF. Methods: ROCK activation in circulating leukocytes was evaluated in 28 HFrHF patients, using Western blot (myosin light chain phosphatase subunit 1 phosphorylation, MYPT1p/t), before and three months after initiation of CRT. LV systolic function and remodeling were assessed by echocardiography. Results: Three months after CRT, LV ejection fraction increased an average of 14.5% (p < 0.001) in 13 patients (responders), while no change was observed in 15 patients (non-responders). End-systolic diameter decreased 16% (p < 0.001) in responders, with no change in non-responders. ROCK activation in PBMCs decreased 66% in responders (p < 0.05) but increased 10% in non-responders (NS). LV end-diastolic diameter was also 5.2 mm larger in non-responders vs. responders (p = 0.058). LV ejection fraction, systolic diameter, and ROCK activation levels were similar in both groups at baseline. Conclusion: In HFrEF patients, 3 months of effective CRT induced reverse myocardial remodeling, and ROCK activation was significantly decreased in circulating leukocytes. Thus, decreased ROCK activation in circulating leukocytes may reflect reverse cardiac remodeling in patients with heart failure.

Close-coupled pacing to identify the "functional" substrate of ventricular tachycardia: Long-term outcomes of the paced electrogram feature analysis technique.

BACKGROUND: The conduction delay and block that compose the critical isthmus of macroreentrant ventricular tachycardia (VT) is partly "functional" in that they only occur at faster cycle lengths. Close-coupled pacing stresses the myocardium's conduction capacity and may reveal late potentials (LPs) and fractionation. Interest has emerged in targeting this functional substrate. OBJECTIVE: The purpose of this study was to assess the feasibility and efficacy of a functional substrate VT ablation strategy. METHODS: Patients with scar-related VT undergoing their first ablation were recruited. A closely coupled extrastimulus (ventricular effective refractory period + 30 ms) was delivered at the right ventricular apex while mapping with a high-density catheter. Sites of functional impaired conduction exhibited increased electrogram duration due to LPs/fractionation. The time to last deflection was annotated on an electroanatomic map, readily identifying ablation targets. RESULTS: A total of 40 patients were recruited (34 [85%] ischemic). Median procedure duration was 330 minutes (interquartile range [IQR] 300-369), and ablation time was 49.4 minutes (IQR 33.8-48.3). Median functional substrate area was 41.9 cm2 (IQR 22.1-73.9). It was similarly distributed across bipolar voltage zones. Noninducibility was achieved in 34 of 40 patients (85%). Median follow-up was 711 days (IQR 255.5-972.8), during which 35 of 39 patients (89.7%) did not have VT recurrence, and 3 of 39 (7.5%) died. Antiarrhythmic drugs were continued in 53.8% (21/39). CONCLUSION: Functional substrate ablation resulted in high rates of noninducibility and freedom from VT. Mapping times were increased considerably. Our findings add to the encouraging trend reported by related techniques. Randomized multicenter trials are warranted to assess this next phase of VT ablation.

Lesiones de la mucosa bucal asociadas al uso de prótesis estomatológica / Dental mucose lessions associated to dentures

RESUMEN Fundamento: la salud bucal debe ser vista como componente de la calidad de vida. El uso de prótesis durante largo tiempo, sin que sean cambiadas periódicamente, puede generar dolor e inestabilidad durante la masticación, factores que conjuntamente con otros pueden provocar el desarrollo de lesiones en los tejidos que están en contacto con el aparato protésico. Objetivo: caracterizar pacientes con lesiones en la mucosa bucal asociadas al uso de prótesis. Métodos: estudio descriptivo transversal realizado entre enero y junio de 2016 en la Clínica Estomatológica del Policlínico Universitario José Luis Chaviano Chávez del Área I, Cienfuegos. Se incluyeron los 51 pacientes que presentaron algún tipo de lesión asociado al uso de prótesis dentales, para lo que se realizó el examen clínico a cada uno. Se analizó: edad, sexo, tiempo de uso de la prótesis y su estado, tipo de lesión. Resultados: predominaron los pacientes del sexo femenino (74,51 %) y entre 60 y 74 años (52,94 % del total y 66,67 % femeninos); la lesión más observada fue la estomatitis subprótesis con un 83,33 % fundamentalmente en pacientes que usaban prótesis entre 11 y 20 años (35,56 %); la mayor cantidad de lesiones se registraron en el sexo femenino con un 74,07 %; tanto las prótesis ajustadas (deterioradas) como las desajustadas causaron la misma cantidad de lesiones (50 %). Conclusiones: los pacientes que usan prótesis en mal estado, fundamentalmente por más de diez años, suelen padecer, con mucha frecuencia, de lesiones en la mucosa bucal.

ABSTRACT Foundation: oral health should be viewed as a component part of quality of life. The use of dentures for a long time without changing them periodically may cause general pain and instability while masticating, factors which together with others may contribute to the development of lesions in tissues contacting the prosthetic device. Objective: to characterize patients with lesions in the oral mucosa associated to the use of dentures. Methods: Cross descriptive study developed from January to June 2016 at the Dental Clinic at the University Polyclinic José Luis Chaviano Chávez. Área I. Cienfuegos. Fifty one patients were included who presented any lesion related to the use of dentures. A clinical examination was performed to each of them. Age, sex, time of usage of prosthesis and their condition, and type of lesion were the factors analyzed. Results: female patients prevailed (74,51 %) between 60 and 74 years old, (52,94 % of the total and 66,67 % female); the most frequently observed lesion was sub-prosthetic stomatitis with a 83,33 % mainly in patients who use prosthesis for between 11 and 20 years (35,56 %); either in the tight dentures (deteriorated) so as the unadjusted ones caused the same number of lesions (50 %). Conclusion: patients who dentures in poor conditions, mainly for more than 10 years suffer from lesions of the oral mucosa very often.

Caracterización de pacientes portadores de estomatitis subprótesis / Characterization of patients with stomatitis subprosthesis

Fundamento: la estomatitis subprótesis es una de las alteraciones que con más frecuencia se diagnostica dentro de la patología bucal. Objetivo: Caracterizar pacientes portadores de estomatitis subprótesis.Métodos: estudio descriptivo transversal sobre una muestra de 37 pacientes pertenecientes a la Clínica Estomatológica del Policlínico Universitario José Luis Chaviano Chávez, Área I, de Cienfuegos atendidos entre septiembre y diciembre de 2016. Se analizaron: sexo, edad, tipo de prótesis, hábito de uso, estado técnico de la prótesis, hábitos perjudiciales, grado y zona de la lesión.Resultados: predominó el sexo femenino, las edades entre 60 y 74 años. El tipo de prótesis más común fue la total, prevaleció como hábito perjudicial la higiene bucal deficiente; la mayor cantidad usaba continuamente las prótesis, el grado de mayor prevalencia resultó el II y la lesión se encontró con más frecuencia en la zona media; el mayor porcentaje de pacientes portaba prótesis desajustadas. Conclusiones: en los pacientes portadores de prótesis estomatológicas, la estomatitis subprótesis constituye indudablemente una lesión de etiología multifactorial.

Foundation: sub-prothesis stomatitis is one of the most frequently diagnosed disturbances within oral pathology. Objective: To characterize patients carrying subprothesis stomatitis. Methods: A descriptive cross-sectional study was carried out on a sample of 37 patients belonging to the José Luis Chaviano Chavez University Polyclinic Clinic, Area I, from Cienfuegos, attended between September and December 2016. Sex, age, type of prosthesis, use, technical state of the prosthesis, harmful habits, degree and area of injury were analyzed. Results: female gender predominated, between the ages of 60 and 74 years. The most common type of prosthesis was the total one, poor oral hygiene prevailed as a harmful habit, most the patients used prostheses continuously, the II degree was of higher prevalence and the lesion was more frequently found in the middle zone; the highest percentage of patients had maladjusted dentures. Conclusions: in patients with stomatologic prosthetics, sub-prothesis stomatitis constitutes undoubtedly a lesion with multifactorial etiology.

Psychopathological Symptoms and Psychological Wellbeing in Mexican Undergraduate Students.

College life involves a process of adaptation to changes that have an impact on the psycho-emotional development of students. Successful adaptation to this stage involves the balance between managing personal resources and potential stressors that generate distress. This epidemiological descriptive and transversal study estimates the prevalence of psychopathological symptomatology and psychological well-being among 516 college students, 378 (73.26%) women and 138 (26.74%) men, ages between 17 and 24, from the city of Monterrey in Mexico. It describes the relationship between psychopathological symptomatology and psychological well-being, and explores gender differences. For data collection, two measures were used: The Symptom Checklist Revised and the Scale of Psychological Well-being. Statistical analyses used were t test for independent samples, Pearson's r and regression analysis with the Statistical Package for the Social Sciences (SPSS v21.0). Statistical analyses showed that the prevalence of psychopathological symptoms was 10-13%, being Aggression the highest. The dimension of psychological well-being with the lowest scores was Environmental Mastery. Participants with a higher level of psychological well-being had a lower level of psychopathological symptoms, which shows the importance of early identification and prevention. Gender differences were found on some subscales of the psychopathological symptomatology and of the psychological well-being measures. This study provides a basis for future research and development of resources to promote the psychological well-being and quality of life of university students.

Dental management of patients receiving anticoagulant and/or antiplatelet treatment.

INTRODUCTION: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can give rise to complications associated with important morbidity-mortality. The dental treatment of patients who tend to an increased risk of bleeding due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis, and the optimized management of such patients, are therefore very important issues. OBJECTIVES: A study is made of the anticoagulant / antiplatelet drugs currently available on the market, with evaluation of the risks and benefits of suspending such drugs prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. MATERIAL AND METHODS: A literature search was made in the PubMed, Cochrane Library and Scopus databases, covering all studies published in the last 5 years in English and Spanish. Studies conducted in humans and with scientific evidence levels 1 and 2 (metaanalyses, systematic reviews, randomized phase 1 and 2 trials, cohort studies and case-control studies) were considered. The keywords used for the search were: tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol. RESULTS AND CONCLUSIONS: Many management protocols have been developed, though in all cases a full clinical history is required, together with complementary hemostatic tests to minimize any risks derived from dental treatment. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from dental treatment. Key words:Tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol.

Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica / Clinical usefulness of biomarkers in cardiac failure

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

Utilización inadecuada de los avances científicos técnicos del laboratorio clínico y del método clínico: repercusión en los servicios de salud / Inadequate usage of the scientific-technical advances of clinical laboratory and clinical method: Repercussion on health care services

Las investigaciones de laboratorios clínico han estado influenciadas por los avances científico –técnico de los últimos años, por lo cual hoy se ofrece una gran variedad de exámenes, posibilitando una mejor prevención, diagnóstico, control y pronóstico de las enfermedades, pero no pueden, ni deben, sustituir al método clínico. Se realizó una revisión de las fuentes disponibles en Infomed y libros relacionados con el tema, y se analizó como la utilización inadecuada de las pruebas de laboratorio y el método clínico, sobre bases no científicas, afecta la calidad de los servicios de salud en nuestro medio, y se identifica que los principales problemas generados son el daño a la relación médico-paciente, la obstaculización y retraso del diagnóstico certero, el encarecimiento de los servicios de salud, la sobrecarga del trabajo de los laboratoristas y el aprendizaje incorrecto del uso de los medios diagnóstico por los estudiantes entre otros(AU)

The clinical laboratory research have been influenced by the scientific-technical advances of the last years, consequently nowadays there it is offered a great variety of examinations allowing a better diseases prevention, diagnosis, control and prognosis, but they cannot, and should not surrogate the clinical method. We carried out a review of the sources available in Infomed and books related with the theme, and analyzed how the inadequate usage of the laboratory tests and the clinical method, on non-scientific bases, affects the quality of the health services in our settings, and identified that main generated problems are the damage of physician-patient relationships, the obstruction and delay of the certain diagnosis, putting up the prices of the health care services, overwork for laboratory technicians, and the incorrect learning of the usage of diagnostic means by the students among others(AU)

Utilización inadecuada de los avances científicos técnicos del laboratorio clínico y del método clínico: repercusión en los servicios de salud / Inadequate usage of the scientific-technical advances of clinical laboratory and clinical method: Repercussion on health care services

Las investigaciones de laboratorios clínico han estado influenciadas por los avances científico –técnico de los últimos años, por lo cual hoy se ofrece una gran variedad de exámenes, posibilitando una mejor prevención, diagnóstico, control y pronóstico de las enfermedades, pero no pueden, ni deben, sustituir al método clínico. Se realizó una revisión de las fuentes disponibles en Infomed y libros relacionados con el tema, y se analizó como la utilización inadecuada de las pruebas de laboratorio y el método clínico, sobre bases no científicas, afecta la calidad de los servicios de salud en nuestro medio, y se identifica que los principales problemas generados son el daño a la relación médico-paciente, la obstaculización y retraso del diagnóstico certero, el encarecimiento de los servicios de salud, la sobrecarga del trabajo de los laboratoristas y el aprendizaje incorrecto del uso de los medios diagnóstico por los estudiantes entre otros.

The clinical laboratory research have been influenced by the scientific-technical advances of the last years, consequently nowadays there it is offered a great variety of examinations allowing a better diseases prevention, diagnosis, control and prognosis, but they cannot, and should not surrogate the clinical method. We carried out a review of the sources available in Infomed and books related with the theme, and analyzed how the inadequate usage of the laboratory tests and the clinical method, on non-scientific bases, affects the quality of the health services in our settings, and identified that main generated problems are the damage of physician-patient relationships, the obstruction and delay of the certain diagnosis, putting up the prices of the health care services, overwork for laboratory technicians, and the incorrect learning of the usage of diagnostic means by the students among others.

Alternative to oral dicoumarin anticoagulants: Considerations in dental care.

INTRODUCTION: For over 50 years, vitamin K antagonists such as warfarin (Aldocumar®) and acenocoumarol (Sintrom®) have been the gold standard for reducing the risk of cerebrovascular events. In the last 5 years alternative anticoagulants have been evaluated that act directly upon a concrete target within the coagulation cascade, thereby affording a more predictable anticoagulant effect. The present study offers an update on the new oral anticoagulants and reviews the implications referred to the dental care of patients administered these substances. MATERIAL AND METHODS: An exhaustive PubMed-Medline and Cochrane Library search was made of the main alternatives to conventional oral anticoagulation, covering those studies published in English and Spanish over the last 10 years. Specialized textbooks and pharmaceutical catalogs were also consulted. A total of 184 articles were identified, of which 76 met the inclusion criteria. RESULTS: The new oral anticoagulants dabigatran, rivaroxaban and apixaban are safe and effective, and offer a series of advantages, including rapid action, no need for constant monitoring, few drug and food interactions, and a broad therapeutic margin. These drugs are expensive, however, and some lack a specific antidote, while others must be administered twice a day. Regarding the dental treatment of patients receiving these drugs, suspension or modification of the background medication is not required when performing invasive dental procedures, except where indicated by the prescribing physician. CONCLUSIONS: The new oral anticoagulants do not pose significantly greater risks than conventional oral anticoagulants when providing invasive dental treatment, and their suspension is not strictly required in such situations. Key words:Dabigatran, rivaroxaban, apixaban, dental, hemostasis.

[Clinical usefulness of biomarkers in cardiac failure]. / Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica.

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

[Comparison of isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy]. / Isosorbide y dinoprostona en inducción del trabajo de parto.

BACKGROUND: it has been suggested that nitric oxide generators, such as isosorbide dinitrate, may be an alternative to mimic the effects of signal transduction mechanisms leading to cervical ripening, without affecting uterine contractility. OBJECTIVE: to compare the isosorbide dinitrate and dinoprostone for induction of labor in term pregnancy. MATERIAL AND METHODS: in a randomized controlled blinded clinical trial, we studied 66 patients divided into 2 groups: 33 patients were given 20 mg of isosorbide dinitrate and to the other 33 were administered 0.5 mcg of dinoprostone; in both groups the drugs were administered vaginally each 6 h and at maximum 3 times. It was carried out a cardiotocographic study in order to determine the presence or absence of uterine activity and to exclude disorders of the fetal heart frequency; it was performed a vaginal examination to assess cervical conditions determining the Bishop score at 0, 6 and 12 h. RESULTS: there were no differences between the groups in the determinations of mean arterial pressure, maternal heart frequency, fetal heart frequency and Bishop score registered at 6 y 12 h followed the drugs administration. The time of delivery was 20.7 +/- 1.8 h in the group of women treated with dinoprostone; and 16.3 +/- 1.4 h in women treated with isosorbide dinitrate (p=0.032). The cost was higher in women treated with dinoprostone ($560 vs $12, respectively, p=0.001). There was no difference between the groups related to: frequency of meconium stained liquid (p=1.000), mode of delivery by caesarean section (p=0.918), Apgar score at 1 minute (p=0.764) and 5 minutes (p=0.294) and mother discharged with healthy baby (p=1.000). CONCLUSIONS: the isosorbide dinitrate is associated with lower duration of labor compared with dinoprostone. There was no difference in the maternal-fetal outcome by using whatever drug.