Deglución post extubación de pacientes críticos con y sin diagnóstico de COVID-19 durante la pandemia / Post extubation swallowing in critical patients with and without COVID-19 during the pandemic

Estudios previos han caracterizado la disfagia en pacientes críticos hospitalizados que requieren intubación y ventilación mecánica invasiva. A raíz de la pandemia COVID-19 es necesario conocer las características deglutorias de pacientes diagnosticados con la enfermedad para su manejo. El objetivo de este estudio es analizar las características deglutorias de pacientes críticos extubados con y sin diagnóstico de COVID-19. Se llevó a cabo un estudio de cohorte retrospectivo con una muestra a conveniencia de 43 sujetos mayores de 15 años, ingresados al Hospital San Juan de Dios (Santiago, Chile) entre el 01 de junio y el 31 de agosto de 2020, intubados con o sin diagnóstico de COVID-19. Del total de sujetos, 22 padecieron de COVID-19 quienes estuvieron significativamente más días intubados que aquellos sin la patología (p=0,002). Inmediatamente posterior a la extubación orotraqueal, más del 90% de la muestra presentó disfagia. No hubo diferencia significativa en el nivel FILS ni asociación significativa en el grado de severidad de la disfagia entre sujetos con y sin COVID-19. Tampoco hubo diferencia significativa en el nivel FILS entre los grupos a los 10 días post-extubación. El nivel FILS a los 10 días aumentó significativamente en aquellos sujetos con COVID-19 (p=0,016) y sin COVID-19 (p=0,004). En la muestra, el nivel FILS y grado de severidad de la disfagia de los pacientes con y sin COVID-19 no mostraron diferencias estadísticas, siendo alto el porcentaje de disfagia en ambos grupos, lo que se podría asociar a la intubación orotraqueal y al tubo orotraqueal. Es necesaria la incorporación del fonoaudiólogo dentro de los equipos de Unidades de Pacientes Críticos para el manejo de los pacientes con COVID-19 y disfagia. Además, se recomienda continuar con más estudios en el área.

Previous research have described the deglutition disorders in critical hospitalised patients who required intubation and mechanical ventilation. In the pandemic context, it is mandatory to study both level and grade of dysphagia in patients suffering from COVID-19. The aim of this study is to analyse the deglutition features of extubated critical patients with and without COVID-19. A retrospective cohort study was performed, considering a convenience sample of 43 patients from 15 years old hospitalised at 'Hospital San Juan de Dios' between June 1st and August 31th 2020, who were intubated, with and without the diagnosis of COVID-19. 22of out 43 patients were diagnosed with COVID-19 who were intubated for significantly more days in comparison with those without COVID-19 (p=.002). After the intratracheal extubation, 90% of the sample was diagnosed with dysphagia. There was no significant difference in the FILS score nor significant association in dysphagia severity between patients with and without COVID-19. After 10 days post extubation, there was no significant difference in the FILS score between both groups. The FILS score increased significantly in the COVID-19 (p=.016) and non-COVID-19 (p=.004) patients after 10 days post extubation. Post extubation, there are no statistical differences in the FILS score and dysphagia severity in critical ill patients with and without COVID-19, with a high percentage of dysphagia in both groups which could be associated with intratracheal intubation and endotracheal tubes. The incorporation of speech and language therapists in Critical Care Units is mandatory. Furthermore, it is recommended to perform extra research in the area.

Correction to: Diagnosis of Cutaneous Melanoma: the Gap between the Knowledge of General Practitioners and Dermatologists in a Brazilian Population.

The original version of this article unfortunately contained a mistake. The name of "Carolina Ledsham" is now corrected in the author group of this article.

Diagnosis of Cutaneous Melanoma: the Gap Between the Knowledge of General Practitioners and Dermatologists in a Brazilian Population.

The early diagnosis of cutaneous melanoma provides less aggressive treatment reducing mortality. General practitioners are responsible for cancer diagnoses in the Brazilian Public Health System and therefore play a crucial role in the prevention and early detection of melanoma. To assess the melanoma knowledge of a primary healthcare physician, the general practitioner, compared to a dermatologist. General practitioners and dermatologists answered a questionnaire about melanoma and the management of suspected cases. The results of both groups were compared. The sample consisted of 80 specialists and 160 general practitioners. When asked about the "ABCDE" rule, 96.2% of the dermatologists knew about it, compared to 34.4% of the general practitioners. The percentage of dermatologists who examined the whole skin of the patient at high risk for melanoma was 90% vs. 24.5% amongst general practitioners. The most cited reasons for the absence of the examination of patients at risk for melanoma were lack of time at the consultations (17.6% specialists, 66.1% generalists) and an excessive number of patients (17.6% specialists, 61.5% generalists). General practitioner has less knowledge about melanoma compared to the dermatologists and presents deficient behaviors about patients at risk or who have suspicious lesions, indicating the need for training and continuing education.

Comparación de la fuerza adhesiva de 2 sistemas de cementos de resina en diferentes regiones radiculares en la cementación de postes de fibra / Comparison of bond strength of two resin cement systems in different roots region on the cementation of fiber posts

La causa de fracaso más común de los postes de fibra es su desalojo, principalmente debido a la compleja adhesión dentro del conducto radicular. El principal objetivo de este estudio fue determinar si existe diferencia significativa en la resistencia adhesiva mediante el test push-out en la cementación de postes de fibra con RelyX U-200® (U200) y Core Paste XP® (CPX) en diferentes regiones radiculares. MATERIALES Y MÉTODOS Se seleccionaron 40 premolares, se seccionaron a 15 mm del ápice, fueron tratados endodóncicamente y fueron divididos aleatoriamente en 2 grupos de 20, a los cuales se les cementó un poste de fibra translúcido Exacto® con U200 y CPX. Después de 24 h cada muestra fue seccionada transversalmente a nivel cervical, medio y apical. Fueron sometidas al test de push-out mediante la máquina Tinius Olsen HK5-S para cuantificar la resistencia adhesiva en megapascales. Se utilizó el test Shapiro-Wilk, test de ANOVA de 2 factores y Tukey con un nivel de significación del 95%. RESULTADOS No hubo diferencia significativa de ambos cementos (p = 0,457), pero sí hubo diferencia cuando se comparó el tipo de cemento y la región; CPX presentó valor significativamente mayor en el tercio cervical (p < 0,05), mientras que U200 presentó un valor significativamente mayor en el tercio apical (p < 0,05). CONCLUSIONES No hubo diferencia significativa en el valor de adhesión cuando se comparó solo el factor cemento entre U200 y CXP, sin embargo hubo un mayor valor de CXP a nivel cervical y de U200 a nivel apical.

Loosening is the most common failure of fiber posts, mainly due to complex adhesion within the root canal. The main objective of this study was to determine if significant differences in adhesive resistance, using the push-out test, in the cementation of fiber posts with RelyX U-200® (U200) and Core Paste XP® (CPX) in different root regions. MATERIALS AND METHODS A selection of 40 premolars were sectioned 15 mm from the apex, treated endodontically and then randomly divided in two groups of 20, using an Exacto translucent fiber post with U200 and CPX, respectively. After 24 hours, each sample was sectioned into cervical, middle and apical. The test push-out test was performed using a Tinius Olsen HK5-S machine to quantify the adhesive strength in Mega Pascals. The test Shapiro-Wilk, two-factor Anova and Tukey tests were used with a significance level of 95% RESULTS There were no significant differences between the cements (P = .457) but if there was difference when comparing the type of cement and region. CPX showed a value significantly higher in the cervical third (P < .05), while U200 presented a value significantly higher in the apical third (P < .05). CONCLUSIONS There was no significant difference in the value of the adhesive strength in the comparison between U200 and CXP, however there was a higher value of CXP at cervical and U200 at apical level.

Prevalencia de iiabetes mellitus en pacientes con fibrosis pulmonar idiopática

La prevalencia de diabetes mellitus tipo 2 (DM2) en México es del 10%. Objetivo: Determinar la prevalencia de DM2 en pacientes con fibrosis pulmonar idiopática (FPI), neumonitis por hipersensibilidad (NH) y cáncer pulmonar (CP) en la ciudad de México. Casos: 136 pacientes con FPI; controles: 53 pacientes con NH y 263 con CP. El diagnóstico de DM2 se basó en dos glicemias en ayuno por arriba de 126mg/dL. Resultados: Veintinueve pacientes (21.3%) con FPI, 4 (7.5%) con NH y 25 (9.5%) con CP, tuvieron DM2, con una prevalencia significativamente mayor en la FPI en relación con la NH razón de momios 3.3 (intervalo de confianza 95% 1.1-9.6) p < 0.01 y con CP [razón de momios 2.5 (intervalo de confianza 95% 1.4-4.6) p<0.01]. No se observaron diferencias estadísticamente significativas en relación con el género, obesidad y nivel socioeconómico Conclusión: La prevalencia de DM2 en FPI, es mayor que en los controles y en la población general. La obesidad, género y nivel socioeconómico no influyeron en la DM2.

Prevalence of type 2 diabetes mellitus (DM2) in Mexico is 10%. Objective: to describe the prevalence of DM2 in Idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP) and lung cancer patients (LC) in Mexico City. Cases: 136 patients with IPF. The control groups were 53 hypersensitivity pneumonitis patients (HP) and 263 lung cancer patients (LC). DM2 was determined by two preprandial serum glucose levels higher than 126 mg/dL. Results: 29 (21.3%) IPF patients, 4 (7.5%) HP patients and 25 (9.5%) LC patients had DM2, revealing a significantly higher prevalence of DM2 in IPF/HP [odds ratio 3.3 (95% CI 1.1-9.6) p<0.01] and IPF/LC [odds ratio 2.5 (95% CI 1.4-4.6) p<0.01]. No differences were seen when IPF patients were divided by gender, obesity and economic level. Conclusions: These results suggest that there is a higher prevalence of DM2 in IPF patients in comparison with HP, LC patients and the general population in Mexico City.