Técnica de preservación del volumen alveolar post-extracción utilizando hueso liofilizado y lámina ósea cortical / Preservation techniques of alveolar post-extraction volume using liophilisate bone and cortical bone sheets

Se evaluó la eficacia del hueso liofilizado humano (Matriz Ósea UNC en Polvo) injertado en cavidades alveolares post-extracción, recubierto por una lámina ósea cortical (Matriz Ósea UNC en membrana), en el tratamiento de preservación del perfil volumétrico del reborde alveolar.La metodología de trabajo se fundamentó en: 1) El estudio de una casuística de 27 casos clínicos en pacientes de ambos sexos que poseían elementos dentarios unirradiculares con indicación de extracción. Se injertó en las cavidades óseas resultantes hueso liofilizado, contenido in situ mediante una lámina ósea cortical parcialmente desmineralizada. Los pacientes fueron evaluados clínica y radiográficamente, mediante modelos de estudio, Rx convencional y radiovisiografía que permitieron mensurar las modificaciones producidas por resorción durante un año. Se realizaron controles pre y post-operatorios, a los 7, 15, 30, 60, 90, 120, 180 y 360 días. A los modelos de yeso preliminares y a los obtenidos a los 120 y 360 días se les efectuaron cortes transversales en las zonas de estudio y se los escaneó. Las imágenes obtenidas se procesaron mediante un analizador de imágenes (Image Pro-Plus). Los datos se analizaron estadísticamente con software específico (SPSS). El estudio demostró que las mayores modificaciones dimensionales del reborde se observaron sobre el área superficial del alvéolo y en los primeros 4 meses post-extracción. La lámina cortical presentó características físicas, estructurales y biológicas que le permitieron actuar como barrera física oclusiva, minimizando los fenómenos de inhibición celular heterotípica y favoreciendo los procesos osteogénicos por el mecanismo de osteopromoción...

Human efficacy lyophilized bone (UNC Bone Matrix Powder) grafted post-extraction alveolar sacs, covered by a cortical bone plate (UNC Bone Matrix membrane), in the treatment volume preservation ridge profile was evaluated. The working methodology was based on: 1) The study of a case series of 27 clinical cases in patients of both sexes who had single-rooted tooth elements indicating extraction. It was grafted bone cavities in the resulting lyophilized bone content in situ by a partially demineralized cortical bone plate. Patients were evaluated clinically and radiographically, using study models, and conventional Rx radiovisiography that allowed mensurar resorption induced changes for a year. Pre and post-operative controls at 7, 15, 30, 60, 90, 120, 180 and 360 days were performed. A preliminary plaster models and those obtained at 120 and 360 days transects were conducted in the study areas and were scanned. The images obtained were processed by an image analyzer (Image Pro-Plus). The data were statistically analyzed with software (SPSS) .The study showed that older flange dimensional changes were observed on the surface area of the alveoli and in the first 4 months post-extraction. The cortical sheet submitted physical, structural, and biological characteristics that allowed him to act as occlusive physical barrier, minimizing heterotypic cellular inhibition phenomena and processes favoring osteogenic mechanism osteopromoción...

Cardiovascular disease in HIV infection

Cardiovascular disease has been well documented in patients with Human Immunodeficiency Virus infection, especially after the introduction of highly active antiretroviral therapy. At present, HIV infection is one of the leading causes of acquired cardiovascular disease including heart failure. Some of the changes observed in these patients include left ventricular systolic dysfunction, dilated cardiomyopathy, congestive heart failure, myocarditis, lipodystrophy, dyslipidemia, insulin resistance, accelerated atherosclerosis including myocardial infarction, prothrombotic state, pericardial effusion, pulmonary hypertension, autonomic dysfunction, and malignancy. This article summarizes the main findings in the principal HIV-associated cardiovascular manifestations in order to stimulate its early recognition so helping in early intervention and therapy.

Evidence based secondary prevention of coronary artery disease in the elderly-2006

Eighty percent of coronary deaths occur in people above 65 years of age. Fifty percent of deaths in persons above 85 years of age is due to coronary artery disease. The overall aging of the population and the improvement in survival of patients with coronary artery disease has been creating a growing large population of elderly adults who are elegible for secondary prevention. Multiple clinical trials and research trials have revealed evidence based information confirming the usefulness and effectiveness of secondary prevention of coronary artery disease in the elderly patient. The secondary prevention beneficial results have been obtained by addressing and controlling the predisposing items recognized a coronary risk factors. Secondary preventive measures, including lifestyle modifications and pharmacotherapy, modifying risk factors in elderly patients, have been shown to reduce morbidity and mortality from coronary artery disease. Evidence based data on prevention in elderly patients with coronary artery disease concerning smoking cessation, treatment of hypertension, control of hyperlipidemia, improved dietary patterns, physical activity, moderation in alcohol intake, management of diabetes, weight management, use of antiplatelet agents, beta blockers and renin-angiotensin-andosterone blockers is summarized. Emphasis has been given to AHA/ACC consensus statements on the prevention of coronary artery disease.

Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences

La Troponina Cardiaca, Marcador Biológico para el Diagnóstico de Necrosis Miocáirdica / Cardiac Troponin, a biological marker for the diagnosis of myocardial necrosis

Cardiovascular diseases are the main cause of death in Puerto Rico and all over the World. Among these, the most frequent one is ischemic heart disease. The diagnosis is primarily based upon clinical findings, electrocardiography, and the use of biological markers for cardiac injury and necrosis. In the last years, cardiac troponins have been available as the most useful biological markers due to its high sensitivity and specificity for myocardial necrosis. Information concerning the fundamental studies and trials that confirm thejustification for the use of cardiac troponins as biological markers for myocardial necrosis is presented.

Status of cardiovascular disease in Puerto Rico

For the last 40 years diseases of the heart has ranked as the primary cause of death in Puerto Rico, being cancer the second. In the National Vital Statistics of the Department of Health of Puerto Rico for the year 2002, cancer is listed as the main cause of death and diseases of the heart ranks as the second most frequent. This unexpected change is mainly due a new classification by ICD-10, that now substitutes ICD-9, in association to a change introduced by using the 2000 population census rather than the 1990 census used until 1999. Additional relevant information concerning life expectancy at birth, death by specific causes in the last 5 years and statistics about invasive surgical and medical services rendered to cardiovascular patients in the year 2003 are included. A summary of the situation concerning postgraduate training programs in Puerto Rico in different cardiovascular subspecialties is also included.

Control of blood lipids in the elderly

In individuals 65 years of age and older cardiovascular disease is the leading cause of death around the world. Hypercholesterolemia is among the major risk factors for the development of cardiovascular disorders. Most of the scientifically based studies on preventive measures for cardiovascular conditions have been conducted in subjects younger then 65 years of age. In the last 10 years some clinical trials have included a considerable number of individuals older than 65 years of age providing a scientific basis for therapeutic and preventive intervention in the aged. In this article we summarize the main studies concerning lipids as risk factors for cardiovascular disease in the elderly and we present the indicated primary and secondary preventive measures for reducing cholesterol levels in the elderly leading to a reduction in total and cardiac mortality, and to lesser development of myocardial infarction and coronary artery disease

Clinical trials in isolated systolic hypertension in the elderly

The presence of isolated systolic hypertension in elderly subjects predisposes to the development of coronary artery disease, myocardial infarction, heart failure, cardiovascular events, stroke and cardiovascular mortality. Whether pharmacologic management of isolated systolic hypertension in the elderly is justified or not has not received attention until the recent years. In this era of the practice of evidence based medicine it is important to review the results of clinical trials about the management of isolated systolic hypertension involving thousands of elderly patients. The main trials and their results will be presented. These demonstrate a 17 per cent reduction in total mortality, 25 per cent reduction in cardiovascular mortality, 37 per cent reduction in stroke and a 25 per cent reduction in myocardial infarction for those patients under pharmacologic treatment.

Experimental study to test the potential tumor promotion effect of a tooth bleaching agent

Carbamide Peroxide is routinely employed as a whitener for tooth enamel. Oral mucosa protection is recommended to avoid inflammatory reactions. Experimental work has demonstrated its irritative effect on gastric mucosa when swallowed. The activity of certain oxidizing agents as tumoral promoters has been demonstrated and associated to their capacity to induce hyperplasia. Within this context it seemed of interest to assess the possible action of carbamide peroxide as a tumoral promoter in oral mucosa with or without a precancerous condition. Its action was tested in 2 models which are highly sensitive to chemical cancerization: a) Dorsum skin or SENCAR mice treated with carbamide peroxide daily or twice a week with or without prior initiation with dimethylbenz(a)anthracene (DMBA). Control mice were submitted to the standard carcinogenesis protocol, i.e. initiation with DMBA and promotion with 12-O-tetradecanoyl phorbol acetate (TPA). b) Hamster cheek pouch submitted to topical application of carbamide peroxide 3 times a week with or without prior initiation with DMBA, hamster cheek pouch submitted to repeated topical application of DMBA as a complete carcinogen: application twice a week in the control group and identical treatment + 1 weekly application of carbamide peroxide to evaluate its capacity to enhance the process. The effects were assessed between 1 and 14 weeks of treatment at different intervals for the different experimental protocols. The control cases exhibited hyperplasia and tumor induction in keeping with the known sequence for both carcinogenesis models. None of the cases revealed a promoter or enhancer capacity of carbamide peroxide. These results indicate the lack of risk involved in the application of carbamide peroxide even in oral mucosa with a precancerous condition due to the action of initiation agents such as tobacco and alcohol.

Primary and secondary prevention of cardiovascular disease in the elderly

Cardiovascular disease is the commonest cause of death and hospitalization in patients 65 years of age or older. The main offenders among the cardiovascular disorders in this age are CHD and hypertension. Many non-pharmacologic and pharmacologic measures in the middle-aged persons have confirmed for many years the effectiveness of primary and secondary prevention. Multiple intervention trials in the recent years have also demonstrated the effectiveness of these measures in patients 65 years of age and older. A summary of the main primary and secondary non-pharmacologic and pharmacologic measures that have been proven to be effective and useful in elderly patients has been presented with particular attention to hypertension and CHD. It also has been demonstrated that elderly patients have the capacity to follow the instructions of their physicians and that, as younger patients, they respond to these measures