Endogenous testosterone, muscle strength, and fat-free mass in men with chronic kidney disease.

OBJECTIVE: Testosterone deficiency is a common finding in men with chronic kidney disease (CKD). Testosterone is thought to play an important anabolic role in muscle synthesis, and muscle wasting is an important and deleterious characteristic of protein-energy wasting (PEW) in CKD. It is presently unknown if reduced endogenous testosterone associates with features of muscle wasting in men with CKD. METHODS: This was a cross-sectional observational study of 267 men with CKD stages 2-4 (mean ± standard deviation age 67 ± 13 years, estimated glomerular filtration rate 42.9 [interquartile range 30.2-56.7] mL/min/1.73 m²) with measurements of endogenous testosterone and surrogates of PEW such as albumin, prealbumin, high-sensitivity C-reactive protein (CRP) and normalized protein nitrogen appearance (nPNA). Fat-free mass was estimated by bioelectrical impedance vector analysis (BIVA) and muscle strength by handgrip dynamometry. RESULTS: Across decreasing thirds of testosterone distribution, patients were incrementally older and CRP levels rose significantly. Prealbumin, hemoglobin, nPNA, handgrip strength, and BIVA estimated surrogates of muscle mass and nutritional status (fat-free mass, body cell mass, and phase angle) were progressively reduced (P < .05 for all). In multivariate regression analyses including age, renal function, and other important confounders, testosterone significantly and independently contributed to explain the variances of handgrip strength and fat-free mass (P < .05 for all). CONCLUSIONS: Endogenous testosterone independently associates with muscle strength and fat-free mass in men with moderate CKD. It is plausible that the reduction in testosterone levels that accompanies CKD may further contribute to the procatabolic environment leading to muscle wasting.

Hemodynamic changes during the surgical removal of lower third molars.

PURPOSE: This study was conducted to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molars, and to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. PATIENTS AND METHODS: A prospective study was made of 80 normotensive individuals (40 females and 40 males, mean age, 27 years [range, 18 to 67 years]) seen in the Service of Oral Surgery in the context of the Master's Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, for surgical extraction of the lower third molars. Local anesthesia comprised 4% articaine with vasoconstrictor (adrenalin 1:100.000). The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SaO(2)). Finally, tests of patient anxiety (Corah's Dental Anxiety Scale and Kleinknecht's Dental Fear Scale) were carried out, and the degree of pain experienced during the surgical procedure was assessed by means of a visual analog scale. RESULTS: The females showed higher levels of anxiety. The most anxious patients had the lowest BP values and the highest HR, although the differences did not reach statistical significance. The variations in BP and HR during surgical extraction of the molars were within normal limits. In the case of BP, no significant changes were recorded; the highest mean SBP and DBP values were observed at the time of ostectomy and/or tooth sectioning. The lowest HR values were recorded at baseline, before the start of the surgical procedure, whereas the highest values were obtained during incision and flap raising. The SaO(2) values showed no significant changes and were lower at the start of the surgical procedure. CONCLUSIONS: Most of the cardiovascular changes induced by the surgical extraction of molars were within normal ranges, considering the anxiety and stress induced by surgery. We consider it essential to avoid pain and minimize patient anxiety to ensure safe clinical practice.

The burnout syndrome and associated personality disturbances. The study in three graduate programs in Dentistry at the University of Barcelona.

OBJECTIVE: Determine the presence of "burnout" syndrome and characteristic personality patterns in the students and faculty of three graduate programs in Dentistry at the University of Barcelona: Department of Oral Surgery and Implantology, Department of Orthodontics and Department of Integrated Dentistry. MATERIALS AND METHODS: The study was carried out in 78 dentists. The level of "burnout" was evaluated using the Maslach Burnout Inventory, socio-demographic variables and, finally, the personality test. RESULTS: Oral surgeons constituted the group of high-level "burnout". The profile of an individual with a propensity to "burn out" is a single man, with a median age of 27, that is in the first years of the graduate program and that combines studies with 30 hours of clinical practice and/or other work (p<0,05). Narcissistic and borderline are the types of personality most frequently found in the individuals that present "burnout" syndrome (p<0,05). CONCLUSIONS: In general, no high levels of "burnout" were registered in the studied population, only 2-3%, if applying strict definition of "burnout", and 10% if these criteria were amplified. We believe it is necessary to identify the individuals with a tendency towards "burnout", in order to establish preventive measures and avoid future negative behaviour at work as well as at the personal level.

Uso de Internet por parte de pacientes con cáncer y sus familiares / Internet use by cancer patients and their relatives

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The burnout syndrome and associated personality disturbances. The study in three graduate programs in Dentistry at the University of Barcelona

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Objective: Determine the presence of “burnout” syndrome and characteristic personality patterns in the studentsand faculty of three graduate programs in Dentistry at the University of Barcelona: Department of Oral Surgeryand Implantology, Department of Orthodontics and Department of Integrated Dentistry.Materials and Methods: The study was carried out in 78 dentists. The level of “burnout” was evaluated using the Maslach Burnout Inventory, socio-demographic variables and, finally, the personality test. Results: Oral surgeons constituted the group of highlevel “burnout”. The profile of an individual with a propensity to “burn out” is a single man, with a median age of 27, that is in the first years of the graduate program and that combines studies with 30 hours of clinical practice and/or other work (p<0,05). Narcissistic and borderline are the types of personality most frequently found in the individuals that present “burnout” syndrome (p<0,05).Conclusions: In general, no high levels of “burnout” wereregistered in the studied population, only 2-3%, if applying strict definition of “burnout”, and 10% if these criteria were amplified. We believe it is necessary to identify the individuals with a tendency towards “burnout”, in order to establish preventive measures and avoid future negative behaviour at work as well as at the personal level