Vessel distance mapping: A novel methodology for assessing vascular-induced cognitive resilience.

The association between cerebral blood supply and cognition has been widely discussed in the recent literature. One focus of this discussion has been the anatomical variability of the circle of Willis, with morphological differences being present in more than half of the general population. While previous studies have attempted to classify these differences and explore their contribution to hippocampal blood supply and cognition, results have been controversial. To disentangle these previously inconsistent findings, we introduce Vessel Distance Mapping (VDM) as a novel methodology for evaluating blood supply, which allows for obtaining vessel pattern metrics with respect to the surrounding structures, extending the previously established binary classification into a continuous spectrum. To accomplish this, we manually segmented hippocampal vessels obtained from high-resolution 7T time-of-flight MR angiographic imaging in older adults with and without cerebral small vessel disease, generating vessel distance maps by computing the distances of each voxel to its nearest vessel. Greater values of VDM-metrics, which reflected higher vessel distances, were associated with poorer cognitive outcomes in subjects affected by vascular pathology, while this relation was not observed in healthy controls. Therefore, a mixed contribution of vessel pattern and vessel density is proposed to confer cognitive resilience, consistent with previous research findings. In conclusion, VDM provides a novel platform, based on a statistically robust and quantitative method of vascular mapping, for addressing a variety of clinical research questions.

Emerging clinical issues and multivariate analyses in PET investigations.

PET using 18F-2-fluoro-2-deoxy-D-glucose (FDG-PET) has been gradually introduced in the diagnostic clinical criteria of the most prevalent neurodegenerative diseases. Moreover, an increasing amount of literature has shown that the information provided by FDG-PET enhances the sensitivity of standard imaging biomarkers in less frequent disorders in which an early differential diagnosis can be of paramount relevance for patient management and outcome. Therefore emerging uses of FDG-PET may be important in prion diseases, autoimmune encephalitis (AE) and amyotrophic lateral sclerosis. Interestingly, FDG-PET findings can also be observed in the early phases of these conditions, even in the presence of normal magnetic resonance imaging scans. Thalamic hypometabolism is a common finding in sporadic Creutzfeldt-Jacob disease and fatal familiar insomnia patients, with further cortical synaptic dysfunction in the former. Limbic and extra-limbic metabolic abnormalities (more often hypermetabolism) can be observed in AE, although specific patterns may be seen within different syndromes associated with antibodies that target neuronal surface or synaptic antigens. FDG-PET shows its usefulness by discriminating patients with amyotrophic lateral sclerosis associated to upper motor neuron onset that evolve to frontotemporal dementia. Besides visual and voxel based image analysis, multivariate analysis as interregional correlation analysis and independent/principal component analysis have been successfully implemented to PET images increasing the accuracy of the discrimination of neurodegenerative diseases. The clinical presentation and current diagnostic criteria of these neurologic disorders as well as the emerging usefulness of FDG-PET in the diagnostic workup are presented and discussed in this review.

Influence of plasma cleaning procedure on the interaction between soft tissue and abutments: a randomized controlled histologic study.

INTRODUCTION: Plasma application can lead to an improved adhesion between soft tissue and abutments and promotes cell spreading. OBJECTIVE: A triple-blinded randomized controlled clinical trial was performed to in vivo test the effect of cleaning abutment titanium surfaces with plasma of argon on cell adhesion and collagen fiber orientation at an early healing time. MATERIAL AND METHODS: Thirty healthy patients with 30 submerged implants, at the second surgery, randomly received either a specially designed abutment with no additional treatment (as they come from industry; control group, G1) or cleaned by plasma of argon (test group, G2). Two weeks thereafter, a small biopsy including abutment and soft tissues around the abutment was performed. Abutments were analyzed using scanning electron microscopy to assess cell adhesion to the abutment surface. Outcome measures were the following: percentage of area occupied by cells, the presence or absence of cells, aspect of adhered cells, and the presence of contaminants. At the same time, the soft tissue histological analysis evaluated density and orientation of collagen fibers. Statistical analysis was performed using the Kolmogorov-Smirnov normality test and Levene variance homogeneity test. Data were analyzed using a nonparametric ranking test. The associations between the different qualitative variables were studied using Pearson's chi-squared test. The Mann-Whitney U-test (for two independent samples) was applied for quantitative variables. RESULTS: Mean percentages of area occupied by cells were 15.14% (range 2.91-44.27) and 33.75% (range 2.37-68.4) for G1 and G2, respectively. Differences were close to significance (P = 0.089). The proportion of samples presenting adhered cells was homogeneous between the two groups (P = 0.142). In all cases, cells presented a flattened aspect, but not in three cases in the G2; in 17 cases, cells were efficiently adhered, and in 11 cases, cells presented filopodia with no statistical differences between groups (P > 0.05). No case from G2 showed contamination with cocobacteria with statistical differences between groups (P = 0.006). Collagen fiber density was higher in the basal, medial, and coronal area of G2 compared to G1 with a statistical difference in the internal area (P < 0.05). The orientation of the fibers varied according to the coordinate area with oblique fibers predominant in G2 than in G1. CONCLUSION: Plasma of argon may promote cell adhesion and positively influence collagen fiber orientation. A greater sample is necessary to confirm these preliminary results.

Functional neuroimaging studies in asymmetric hearing loss.

This article presents an analysis of the impact of functional neuroimaging studies (positron emission tomography, PET) in asymmetric hearing loss based on the clinical expertise obtained from a group of 21 patients. In these patients, PET studies are performed at rest and after auditory stimulation in order to measure the increase in brain activity in the ipsi- and contralateral cortex, providing supporting evidence to recommend a specific treatment and the side to implant. In conclusion, PET is a useful tool for selected cases in which information on the metabolic status of the auditory pathway can drive the decision regarding the treatment of the most appropriate ear. However, in view of our small sample, further research is needed to confirm our results in this topic.

Efficacy of the combination of water aerobics and metacognitive training on psychological and physical health variables and their relationship with SP1 and SP4 biomarkers in people with psychosis: a study protocol.

Background: Metacognitive Training (MCT) is widely used and effective in reducing positive symptoms in psychosis. Physical exercise, such as Water Aerobics (WA), improves general health, quality of life and symptoms as a low impact activity that allows social interactions. Preliminary results suggest a relationship between dopamine and psychotic symptoms, through SP transcription factors, SP1 and SP4 biomarkers. The aims of the project are to evaluate the efficacy of a combined intervention (WA and MCT) for psychosis to improve psychotic symptoms, physical health, and transcription levels of SP biomarkers. Materials and methods: This is a unicentric randomized controlled trial of three parallel intervention groups: MCT, WA and combined intervention. The estimated sample will be 48 patients with a psychotic spectrum disorder diagnosis. The assessment will be performed at baseline and at 2-months' follow-up. Instruments used in the assessment will include clinical, cognitive, metacognitive, social cognitive and psychosocial variables. Discussion: This will be the first study investigating the impact of the combination of MCT and WA in psychosis. Moreover, it will be the first study analyzing changes in the transcriptional biomarkers SP1 and SP4 after interventions. The results of this study may have clinical implications contributing to the improvement of treatment selection. Clinical trial registration: https://clinicaltrials.gov/, identifier: NCT05455593.

Pathological gambling in a psychiatric sample.

OBJECTIVE: This study determines the prevalence of gambling difficulties in a consecutive sample of psychiatric inpatients and compares it with a nonpsychiatric inpatient sample. In addition, the gambling prevalence among all psychiatric disorders is analyzed. METHOD: An observational study was conducted in psychiatric patients and sex- and age-matched nonpsychiatric patients. The psychiatric group (n = 100) included all consecutive patients admitted to the psychiatric unit of our hospital. The nonpsychiatric group (n = 100) included psychiatrically healthy inpatients from any other hospital unit. The National Opinion Research Center Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Screen for Gambling Problems was used to screen for gambling behavior. RESULTS: Gambling difficulties were experienced by 3% (2% pathological gambling and 1% problem gambling) of nonpsychiatric inpatients and 9% (8% pathological gambling and 1% problem gambling) of psychiatric inpatients, including 6 with psychotic disorders, 1 with mood disorder, 1 with adjustment disorder, and 1 with eating disorder. There were no statistical differences in gambling prevalence between groups. In terms of comorbidity, patients with psychotic disorder had a higher prevalence of gambling problems than other psychiatric disorders (P = .045). CONCLUSIONS: A higher prevalence of gambling disorders was found in psychiatric inpatients than in nonpsychiatric inpatients. It may be advisable for therapists to routinely assess for gambling difficulties as part of the psychiatric evaluation.

Impact of implant diameter on bone level changes around platform switched implants: preliminary results of 18 months follow-up a prospective randomized match-paired controlled trial.

OBJECTIVE: This prospective randomized match-paired controlled trial aimed to evaluate the impact of implant platform diameter on marginal bone level around implants restored according to the platform switching (PS) concept. MATERIAL AND METHODS: A total of 24 implants were examined in 12 patients. All patients received two adjacent implants inserted at the crestal level: 4.3 mm (control group) and 4.8 mm (test group) in diameter. Mesio-distal implant position was randomly performed. According to the PS concept, for restoration, a 3.8 and 4.3 mm diameter abutment was used, respectively in the control and test groups, resulting, in both groups, with 0.25 mm of implant/abutment mismatching. Implant restorations were splinted. Eighteen months after final restoration, periapical standardized digital radiographs were taken to evaluate marginal bone level alterations after loading. The Wilcoxon Signed-Rank Test was selected to identify differences between groups. RESULTS: At the last follow-up, control implants exhibited a mean bone loss value of 1.10 mm (SD: 0.47 mm); the test group showed a mean value of 1.09 mm (SD: 0.08 mm). No statistically significant differences were found between test and control groups. CONCLUSIONS: Within the limits of this study, the present results suggest that bone resorption is mostly related to biologic (biologic width re-establishment) rather than to biomechanical factors (implant platform diameter). Furthermore long-term studies with a wider sample size are needed to confirm the platform diameter influence on hard tissue response around implants restored according to the PS concept.

Methylprednisolone Pulses in Hospitalized COVID-19 Patients Without Respiratory Failure: A Randomized Controlled Trial.

Background: Corticosteroids are the cornerstone of the treatment of patients with COVID-19 admitted to hospital. However, whether corticosteroids can prevent respiratory worsening in hospitalized COVID-19 patients without oxygen requirements is currently unknown. Aims: To assess the efficacy of methylprednisolone pulses (MPP) in hospitalized COVID-19 patients with increased levels of inflammatory markers not requiring oxygen at baseline. Methods: Multicenter, parallel, randomized, double-blind, placebo-controlled trial conducted in Spain. Patients admitted for confirmed SARS-CoV-2 pneumonia with raised inflammatory markers (C-reactive protein >60 mg/L, interleukin-6 >40 pg/ml, or ferritin >1,000 µg/L) but without respiratory failure after the first week of symptom onset were randomized to receive a 3-day course of intravenous MPP (120 mg/day) or placebo. The primary outcome was treatment failure at 14 days, a composite variable including mortality, the need for ICU admission or mechanical ventilation, and clinical worsening, this last parameter defined as a PaO2/FiO2 ratio below 300; or a 15% decrease in the PaO2 from baseline, together with an increase in inflammatory markers or radiological progression. If clinical worsening occurred, patients received tocilizumab and unmasked corticosteroids. The secondary outcomes were 28-day mortality, adverse events, need for ICU admission or high-flow oxygen, length of hospital stay, SARS-CoV-2 clearance, and changes in laboratory parameters. Results: A total of 72 patients were randomized and 71 patients were analyzed (34 in the MPP group and 37 in the placebo group). Twenty patients presented with treatment failure (29.4 in the MPP group vs. 27.0% in the placebo group, p = 0.82), with no differences regarding the time to treatment failure between groups. There were no cases of death or mechanical ventilation requirements at 14 days post-randomization. The secondary outcomes were similar in MPP and placebo groups. Conclusions: A 3-day course of MPP after the first week of disease onset did not prevent respiratory deterioration in hospitalized COVID-19 patients with an inflammatory phenotype who did not require oxygen.

Satisfaction of patients fitted with implant-retained overdentures.

OBJECTIVE: to evaluate patient satisfaction with implant-retained overdentures, and its relationship with age, sex, period of follow-up, the rehabilitated jaw (maxilla, mandible or both), number of implants, splinting, type of attachment and the antagonist. MATERIAL AND METHODS: the study comprised patients with overdentures fitted between January 1996 and June 2007, and with a minimum follow-up of one year. Data regarding patients and prostheses were collected. The patients indicated their overall satisfaction on a visual analogue scale (VAS) from 0 to 10, as well as satisfaction for individual items such as aesthetics, speech, mastication, prosthetic stability and self-esteem. These data were collected one month after fitting the prostheses, at 12 months and at a final examination. Statistical analyses were made using the SPSS version 15, statistical significance was considered for p<0.05. RESULTS: the study included 95 patients, 43 men and 52 women, with a mean age of 55.9 years; 76 edentulous mandibles and 31 edentulous maxillae were rehabilitated with 107 overdentures. One hundred and thirty-seven implants were placed in the maxilla, and 224 in the mandible. The mean level of overall satisfaction was 9 at one month of fitting the prosthesis, 8.8 at 12 months and 8.7 at the final control (mean 71 months). CONCLUSIONS: the patients fitted with implant-retained overdentures expressed a high level of overall satisfaction, independently of age, sex, length of follow-up, rehabilitated jaw, number of implants per overdenture, whether splinted or non-splinted, and type of attachment. Men were more satisfied with mastication and stability.

Experience in the use of remdesivir in patients with SARS-CoV-2 pneumonia.

OBJECTIVE: To describe the effectiveness and safety of remdesivir in patients with SARS-CoV-2 pneumonia in real-world clinical practice  conditions. METHOD: Retrospective observational study that included all adults with  SARS-CoV-2 pneumonia admitted at the Moisès Broggi Hospital and  treated with remdesivir between July 1st and November 7th, 2020.  Efficacy outcomes were time to recovery, 28-day mortality, length of  hospital stay, and the need of mechanical ventilation after treatment. The  main safetyrelated endpoint was elevation of transaminases after  treatment. RESULTS: A total of 111 patients were included of whom 97 (87.4%) were receiving low-flow oxygen therapy. Median time to recovery was 9  days [6-14]. Seven patients (6.3%) died at 28 days' follow-up. Median  length of hospital stay was 12 days [9-22] and 15 patients (13.5%)  needed mechanical ventilation after treatment with remdesivir. Severe  hypertransaminasemia was observed in 4 patients (4%). CONCLUSIONS: Clinical outcomes of patients with SARS-CoV-2 pneumonia on low-flow oxygen therapy treated with remdesivir were  similar to those published in clinical trials, both in terms of time to  recovery and 28-day mortality.

Objetivo: Describir la efectividad y seguridad de remdesivir en pacientes con neumonía por SARS-CoV-2 en condiciones de práctica clínica real.Método: Estudio observacional retrospectivo que incluyó a todos los pacientes tratados con remdesivir en el Hospital Moisès Broggi entre el 1 de julio y el 7 de noviembre de 2020. Como variables de efectividad se registraron el tiempo hasta la recuperación, la mortalidad a  los 28 días, la estancia hospitalaria y la proporción de pacientes que  requirió ventilación mecánica invasiva tras el tratamiento. Como variable  de seguridad se registró la alteración en las transaminasas tras el  tratamiento.Resultados: Se incluyeron 111 pacientes, 97 (87,4%) con oxigenoterapia de bajo flujo. El tiempo hasta la recuperación fue de 9 días [6-14] de  mediana y 7 pacientes (6,3%) habían fallecido a los 28 días de seguimiento. La estancia hospitalaria fue de 12 días [9-22] de mediana. Un total de 15 pacientes (13,5%) requirió ventilación mecánica  invasiva tras el tratamiento y 4 pacientes (4%) presentaron una alteración grave de las transaminasas.Conclusiones: El tratamiento con remdesivir en la práctica clínica habitual presenta resultados similares a los publicados en los ensayos  clínicos en el subgrupo de pacientes con oxigenoterapia de bajo flujo,  tanto en el tiempo hasta la recuperación como en la mortalidad a los 28  días.

Hippocampal vascularization patterns exert local and distant effects on brain structure but not vascular pathology in old age.

The hippocampus within the medial temporal lobe is highly vulnerable to age-related pathology such as vascular disease. We examined hippocampal vascularization patterns by harnessing the ultra-high resolution of 7 Tesla magnetic resonance angiography. Dual-supply hemispheres with a contribution of the anterior choroidal artery to hippocampal blood supply were distinguished from single-supply ones with a sole dependence on the posterior cerebral artery. A recent study indicated that a dual vascular supply is related to preserved cognition and structural hippocampal integrity in old age and vascular disease. Here, we examined the regional specificity of these structural benefits at the level of medial temporal lobe sub-regions and hemispheres. In a cross-sectional study with an older cohort of 17 patients with cerebral small vessel disease (70.7 ± 9.0 years, 35.5% female) and 27 controls (71.1 ± 8.2 years, 44.4% female), we demonstrate that differences in grey matter volumes related to the hippocampal vascularization pattern were specifically observed in the anterior hippocampus and entorhinal cortex. These regions were especially bigger in dual-supply hemispheres, but also seemed to benefit from a contralateral dual supply. We further show that total grey matter volumes were greater in people with at least one dual-supply hemisphere, indicating that the hippocampal vascularization pattern has more far-reaching structural implications beyond the medial temporal lobe. A mediation analysis identified total grey matter as a mediator of differences in global cognition. However, our analyses on multiple neuroimaging markers for cerebral small vessel disease did not reveal any evidence that an augmented hippocampal vascularization conveys resistance nor resilience against vascular pathology. We propose that an augmented hippocampal vascularization might contribute to maintaining structural integrity in the brain and preserving cognition despite age-related degeneration. As such, the binary hippocampal vascularization pattern could have major implications for brain structure and function in ageing and dementia independent of vascular pathology, while presenting a simple framework with potential applicability to the clinical setting.

Influence of oral hygiene and smoking on pain and swelling after surgical extraction of impacted mandibular third molars.

PURPOSE: To assess the pain and swelling during the first week after surgical extraction of impacted mandibular third molars and the relationship with oral hygiene and smoking before surgery and during the postoperative period. MATERIALS AND METHODS: A prospective study was performed on patients undergoing surgical extractions of impacted mandibular third molars. Pain was recorded on a visual analog scale from 1 to 10 and swelling on a 4-point descriptive scale at 2, 6, and 12 hours after surgery and daily during the first postoperative week. Oral hygiene and smoking before surgery and during the postoperative period were recorded. Statistical analysis was performed of all the variables. A P value less than .05 was considered statistically significant. RESULTS: A total of 50 patients (27 men and 23 women) with a mean age of 26.3 years (range 18 to 39) underwent surgical extraction of an impacted third molar. The maximum pain occurred during the first day and the maximum swelling at 24 hours after surgery. The patients with a lower brushing frequency before surgery reported greater pain. Likewise, the patients who smoked more after surgery experienced greater pain at 24 hours postoperatively. The hygiene after surgery and smoking before the surgical intervention had no statistically significant relationship to the occurrence of pain (P > .05). Swelling had no relationship with the variables studied (P > .05). CONCLUSIONS: Surgical extraction of an impacted third molar caused moderate pain and swelling during the first 24 hours after surgery. A lower brushing frequency before surgery and during the first postoperative week as well as smoking after surgery were related to greater pain scores.

Immediate implants after the removal of maxillary impacted canines: a clinical series of nine patients.

PURPOSE: When impacted maxillary canines are not amenable to orthodontic traction or reimplantation, extraction is the only solution available, followed by the option of implant placement. The aim of this study was to present a surgical technique that allows placement of immediate implants following extraction of impacted maxillary canines. MATERIALS AND METHODS: Included in the study were patients with impacted maxillary canines who refused orthodontic treatment or transplantation and/or in whom the position of the canine teeth did not allow fenestration and orthodontic traction. The canines were removed, with the apical and ridge crest bone preserved to allow immediate implant placement anchored bicortically with good primary stability. The full circumference of the implants had no bone coverage except for the apical and coronal parts and were covered with bone shavings collected by the filter of the surgical aspirator during ostectomy. The definitive restorations were positioned after a healing period of 2 to 3 months. After 12 months, data were recorded relating to the clinical and radiographic condition of the implants. RESULTS: Ten impacted maxillary canines were extracted from nine patients (in one patient, both impacted maxillary canines were extracted) with a mean age of 40.3 years (range, 32 to 63 years), and 10 immediate implants were placed. All the implants had primary stability with a mean Osstell value of 61.5 on the day of surgery. At 12 months of follow-up, all the implants were considered to be successful. Digital periapical radiographs demonstrated a mean peri-implant bone loss of 0.49 mm (range, 0.15 to 1.1 mm). CONCLUSION: The removal of impacted canines followed by immediate implant placement minimizes the number of surgical interventions and the waiting time, although increased surgical skill is needed to place the implants.

The nasopalatine canal as an anatomic buttress for implant placement in the severely atrophic maxilla: a pilot study.

PURPOSE: The aim of this study was to present an alternative treatment concept for the rehabilitation of the atrophic maxilla that used the nasopalatine canal as an anatomic buttress for dental implant insertion and to assess patient satisfaction with this treatment. MATERIALS AND METHODS: The inclusion criterion for the study consisted of the presence of severe resorption of the edentulous maxilla (Class V according to the Cawood and Howell classification). In each patient, one implant was positioned in the nasopalatine canal. Additional implants were also placed in the remaining maxillary bone. The patients were followed for a minimum of 2 years after prosthesis connection. Satisfaction with the prosthesis was evaluated after 12 months using a visual analog scale. RESULTS: Seven patients with severely resorbed edentulous maxillae received a total of seven implants in the nasopalatine buttress and 29 implants posterior to this structure. One of the seven implants in the nasopalatine canal was lost during the osseointegration phase. All patients had stable prostheses at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, and esthetics and function of the prosthesis. Five patients experienced minor sensory alterations during the first weeks after surgery. At the final examination, which took place after a mean of 5 years (range, 3 to 7 years), all patients expressed the presence of normal sensation. CONCLUSIONS: It appears that implants in the nasopalatine canal may be a viable treatment approach for the rehabilitation of the severely atrophied maxilla. Patients were satisfied with a prosthesis supported by implants in the nasopalatine canal.

Immediate loading of immediate mandibular implants with a full-arch fixed prosthesis: a preliminary study.

PURPOSE: To determine the survival of immediate dental implants with immediate loading in the partially edentulous mandible, by use of a full-arch screw-retained provisional restoration. MATERIALS AND METHODS: Patients who were partially edentulous in the mandible with indications for extraction of the remaining teeth and with a minimum follow-up of 12 months after implant placement were included in the study. They were treated in chronologic order by the insertion of 6 Defcon dental implants (Impladent, Sentmenat, Spain) subjected to immediate loading (4 interforaminal and 2 posterior placements). Implants with a minimum primary stability of 60 implant stability quotient were loaded. All resin screw-retained prostheses were inserted and loaded with fully functional occlusion within 24 hours of implant placement. RESULTS: Eleven patients were treated with immediate implants, although 2 patients were excluded from the study for having an implant stability quotient value below 60 in at least one of the implants after surgery and did not undergo restoration with immediate loading. Fifty-four implants were placed in 9 partially edentulous patients with immediate loading with a full-arch screw-fixed prosthesis. The patients wore this provisional prosthesis during the healing period (2 months) without complication and with a high level of comfort. The survival rate of the implants was 100% at 12 months of follow-up. CONCLUSION: Immediate mandibular loading with immediate full-arch implant-supported and screw-retained restorations is a viable treatment alternative, yielding a 100% success rate in this small series of patients.

Idiopathic trigeminal neuropathies: a presentation of 15 cases.

PURPOSE: The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. PATIENTS AND METHODS: We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months). RESULTS: The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients. CONCLUSION: Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Retrospective assessment of potential interaction between levofloxacin and warfarin.

OBJECTIVE: There is currently a controversy regarding interactions between levofloxacin and warfarin. The aim of this study was to determine the clinical relevance of this interaction in our setting. SETTING: A university hospital in Barcelona, Spain. METHODS: We carried out a retrospective evaluation of all patients hospitalized in our hospital during the period 2000-2005, selecting all those concomitantly treated with levofloxacin and warfarin for the study. The following data were compiled: demographic information, concomitant medication, comorbid conditions, and relevant analytical parameters, particularly the international normalized ratio (INR), including values taken before, during, and after concomitant administration of the two study drugs. Patients for whom INR values during concomitant administration were not available were excluded. Differences in INR before and during the potential interaction, and before and after the interaction were analyzed with the Wilcoxon t test using SPSS (V12.0). In addition, patients were stratified according to presence or not of toxic habits (smoking/alcohol consumption) to investigate the possible impact of these factors on the interaction under study. RESULTS: Among the 30 patients identified, 9 were excluded because INR data during concomitant administration of warfarin and levofloxacin were not available. Statistical analysis demonstrated significant increase in INR (P = 0.001) following addition of levofloxacin to warfarin therapy. CONCLUSIONS: The results of this study reaffirm the hypothesis that concomitant administration of levofloxacin and warfarin leads to INR increase; hence close monitoring of INR is advisable when patients are prescribed this combination of drugs.

Cuba's Role in International Atomic Energy Agency Regional Cooperation in Cardiology.

Cardiovascular diseases are the leading cause of death worldwide, and a health problem in low- and middle-income as well as high-income countries. They also constitute the main cause of death in Latin America, with ischemic heart disease as the principal cause in most countries of the region. In Cuba, heart disease is the first cause of death, followed by cancer and stroke. In its 2030 Agenda for Sustainable Development, the UN recognizes the importance of chronic non-communicable diseases, including cardiovascular diseases. Cuba has participated actively as lead partner in design and implementation of the two regional technical cooperation projects conducted over the last six years by the International Atomic Energy Agency to address cardiovascular diseases in Latin American and Caribbean member states. These projects have generated greater interest among participating countries in the use of myocardial perfusion for dilated cardiomyopathy and coronary artery disease compared to other imaging techniques; disseminated knowledge about nuclear cardiology techniques and clinical applications in heart failure and coronary artery disease; and made important contributions to implementing harmonized, appropriate and safe clinical protocols. Cuba's contribution to the International Atomic Energy Agency's regional cardiology projects has fostered development of human resources and harmonized protocols both nationally and regionally, and demonstrated the importance of region-based scientific cooperation that ensures greater opportunities and more equitable access to resources. This participation has also accrued important benefits to Cuba's own nuclear cardiology program. KEYWORDS Cardiovascular disease, myocardial perfusion imaging, nuclear cardiology, scientific cooperation, low-income populations, Latin America, Caribbean region, Cuba.

Distance between periapical lesion and mandibular canal as a factor in periapical surgery in mandibular molars.

PURPOSE: Mandibular molars with a periapical pathology that remains unresolved by endodontic treatment may be considered for periapical surgery (PS); even for those situated in close proximity to the mandibular canal. Our objective was to compare PS in mandibular molars situated close to the mandibular canal, and those at a greater distance, and to study the postoperative morbidity and prognosis of both groups. PATIENTS AND METHODS: A follow-up study was made on PS carried out using the ultrasound technique. The cases were classified into 2 different groups in function of the proximity of the periapical lesion to the mandibular canal; group A when the distance was less than 2 mm and group B when it was equal to 2 mm. Only patients undergoing PS in mandibular molars were included in this study; minimum follow-up was set at 12 months. The postoperative morbidity was evaluated, as well as the mid- and long-term overall success. SPSS 12 (SPSS Inc, Chicago, IL) was used for statistical analysis. All estimated association measures were then tested for statistical significance, and declared significant for P values less than .05. RESULTS: PS was carried out on 79 patients, with 98 lesions, involving 88 mandibular molars. Group A was made up of 22 patients with 27 periapical lesions in close proximity to the mandibular canal, involving 23 mandibular molars; and group B comprised 57 patients with 71 lesions not in close proximity to the mandibular canal, involving 65 molars. Sixty percent of the patients presented between no pain and mild pain on the second postoperative day and two thirds of the patients between mild and moderate swelling. Group A had higher average pain than group B (P < .05), peaking at 2 days, whereas in group B maximum pain was reached at 2 hours of the intervention. The success at 12 months in the mandibular molars was 66.6% with no statistically significant differences between the 2 groups (P > .05). CONCLUSION: The success obtained in mandibular molars shows that periapical surgery is a valid treatment option, even in molars situated in close proximity to the mandibular canal.

Periapical surgery in maxillary premolars and molars: analysis in terms of the distance between the lesion and the maxillary sinus.

PURPOSE: This study compares periapical surgery (PS) of the maxillary premolars and molars in close proximity to the maxillary sinus with those not in close proximity, and assesses postoperative morbidity and prognosis. PATIENTS AND METHODS: A prospective follow-up study was carried out on clinical cases of PS using the ultrasound technique. Only patients undergoing PS in maxillary premolars and molars were included in this study; minimum follow-up was set at 12 months. The cases were classified into 2 different groups in function of the proximity of the periapical lesion to the maxillary sinus: group 1, when the distance was less than 2 mm; group 2, when the distance was greater than or equal to 2 mm. Postoperative morbidity was measured, as well as a clinical and radiographic follow-up evaluating the overall mid- and long-term success rate using von Arx and Kurt criteria. SPSS 12 was used for the statistical analysis. All measures of estimated association were then tested for statistical significance, and declared significant for P less than .05. RESULTS: PS was carried out on 92 patients, 106 teeth, and 129 periapical lesions. Group 1 was composed of 43 maxillary premolars and molars with 59 lesions, and group 2 of 63 teeth and 70 lesions. Maximum pain occurred during the first 6 hours and swelling reached its peak on the second day. The overall healing in maxillary premolars and molars was 75% success, 10% improvement, and 15% failure at 1-year follow-up. There were no significant differences between the 2 groups regarding postoperative pain, swelling, and outcome (P > .05). CONCLUSIONS: The success of PS in maxillary premolars and molars at 12 months follow-up was 75%. Failure rates in premolars and molars in close proximity to the maxillary sinus were higher than unrelated premolars and molars, but the differences were not significant statistically.