Prevalence of three-rooted primary mandibular first and second molars / Prevalencia de primeros y segundos molares primarios mandibulares con tres raíces

ABSTRACT The aim of this study was to determine prevalence and describe the clinical and radiographic findings of three-rooted primary mandibular first and second molars in a Mexican population. Intraoral periapical radiograph, orthopantomogram or cone beam computed tomography (CBCT) were obtained. A total 2284 children from the state of Puebla, Mexico were examined, of whom 20 presented an anatomic variant in tooth crown shape. Of the total teeth with crown alterations, 10 first and 5 second primary mandibular molars were found to have supernumerary roots. In one case, it was possible to obtain micro-CT images. The study recorded prevalence, unilateral or bilateral occurrence, and ratio between sexes. Data were analyzed using descriptive statistics. Clinical findings were presence of an anatomical variation (tuberculum paramolare / right and/or left cervical convexity) in primary mandibular first molars. Second molars presented conventional crown morphology. Prevalence of three-rooted primary mandibular first and second molars was 0.44% and 0.22%, respectively. Male: female ratio for presence of threerooted primary mandibular first molars was 4:1, showing genetic predisposition in males, and for second molars it was 1.5:1, with no predisposition according to sex. The clinical and radiographic anatomical variants in primary molars should be considered by pediatric dentists during routine care because they may cause difficulties in restorations.

RESUMEN El objetivo de este estudio fue determinar la prevalencia, así como los hallazgos clínicos y radiográficos de los primeros y segundos molares primarios mandibulares con tres raíces en una población mexicana. Se obtuvieron radiografías periapicales intraorales, ortopantomografía o tomografía computarizada de haz cónico (TCHC). Fueron revisados en total 2284 niños originarios del estado de Puebla, México, de los cuales 20 sujetos presentaron una variante anatómica en la forma de la corona dental. En el total de dientes con alteraciones coronarias, se encontraron 10 primeros y 5 segundos molares primarios mandibulares con raíces supernumerarias. En un caso fue posible la obtención de imágenes de micro tomografía computarizada (micro-CT). Fueron registradas la prevalencia, la ocurrencia uni o bilateral y la relación entre sexos. Los datos se analizaron mediante estadística descriptiva. Los hallazgos clínicos fueron: presencia de una variación anatómica (tuberculum paramolare / convexidad cervical derecha y/o izquierda) en los primeros molares primarios mandibulares. Los segundos molares presentaron una morfología coronal convencional. Entre los hallazgos radiográficos, fue común encontrar un conducto en cada raíz. La prevalencia fue de 0,44% y 0,22% para los primeros y segundos molares primarios mandibulares con tres raíces, respectivamente. La relación por sexo en los primeros molares primarios mandibulares con tres raíces fue de 4:1, indicando una predisposición genética para el sexo masculino, mientras que, en los segundos molares, la razón fue de 1,5:1 sin predisposición por sexo. Las variantes anatómicas clínicas y radiográficas presentes en los molares primarios deben ser tomadas en cuenta por los odontopediatras durante su rutina de atención, ya que pueden ocasionar dificultades para la restauración.

Certificación, Recertificación y Acreditación en Medicina Familiar y Comunitaria en Iberoamérica / Certification, Recertification and Accreditation in Family and Community Medicine in Iberoamerica / Certificação, Recertificação e Acreditação em Medicina de Família e Comunidade na Ibero-América

Objetivo: Conocer el estado de la Certificación, Recertificación y Acreditación en los países de la región de Iberoamérica como seguimiento a la primera encuesta realizada en la V Cumbre Iberoamericana de Medicina Familiar en 2014 en Quito, Ecuador. Métodos: Diseño transversal descriptivo. La población estuvo conformada por diez países: Ecuador, Perú, Chile, Venezuela, México, Brasil, Paraguay, Colombia, Puerto Rico y Costa Rica. A los presidentes de las Asociaciones de Medicina Familiar, se les envió por e-mail una encuesta estructurada de doce preguntas acerca de la Certificación, Recertificación y Acreditación; la respuesta se recibió por la misma vía. Se efectuó un análisis estadístico descriptivo, frecuencias simples y relativas. Resultados: Las Sociedades Científicas participan en los procesos de Certificación, Recertificación y Acreditación en los países en los cuáles están instalados. La certificación se realizó en 60% de los países encuestados, este proceso fue voluntario en 40%. La Recertificación está instalada y es operativa en 30% de los países participantes, este proceso es voluntario en 80% y lo ejecutan diferentes organismos, entre los cuales están las sociedades científicas, actuando solas o como parte de un equipo evaluador. De estos países, 50% de los países realizan la Acreditación de los programas de medicina familiar a través de las Universidades. Conclusiones: La Certificación todavía no se instaura en algunos países de Iberoamérica, es voluntaria. Un menor porcentaje de países tienen implementado el proceso de Recertificación, el cual también es voluntario en su mayoría. Apenas la mitad de los países efectúan el proceso de Acreditación de las Unidades Formadoras.

Objective: To determine the status of the Certification, Recertification and Accreditation in the countries of the region of Latin America as a follow up to the first survey in the V Ibero-American Summit Family Medicine in 2014 inQuito, Ecuador. Methods: Cross-sectional descriptive. The population consisted of 10 countries: Ecuador, Peru, Chile, Venezuela, Mexico, Brazil, Paraguay, Colombia, Puerto Rico and Costa Rica. To the presidents of associations of family medicine, they were sent by e-mail a structured survey of twelve questions about certification, recertification and accreditation; the response was received by the same route. Descriptive statistics and simple and relative frequencies was made. Results: Certification is carried out in 60% of the surveyed countries; this process is voluntary in 40% and performs scientific societies. The recertification is installed and is operational in 30% of the participating countries, this process is voluntary in 80% and running different organisms among which are scientific societies. 50% of countries conduct the accreditation of family medicine programs through universities. Conclusions: Certification not yet instituted in some countries in Latin America, continues to be voluntary, and only half of the countries make the accreditation process. Therefore, we must work more in each of the countries in the region to achieve certification, recertification and accreditation to ensure the quality of specialists in Family Medicine.

Objetivo: Conhecer a situação da Certificação, Recertificação e Acreditação nos países da região da Ibero-Americana como seguimento do primeiro levantamento realizado na V Cúpula Ibero-Americana de Medicina de Família em 2014 em Quito, Equador. Métodos: desenho transversal descritivo. A população do estudo foi composta por dez países: Equador, Peru, Chile, Venezuela, México, Brasil, Paraguai, Colômbia, Porto Rico e Costa Rica. Se enviou por email um questionário estruturado de doze perguntas sobre Certificação, Recertificação e Acreditação; a resposta foi recebida pela mesma via. Foi realizada uma análise estatística descritiva, com frequências simples e relativas. Resultados: As sociedades científicas envolvidas participam nos processos de Certificação, Recertificação e Acreditação nos países em que são implementados. A certificação foi realizada em 60% dos países pesquisados, este processo foi voluntário em 40%. Recertificação é implementada e está ativa em 30% dos países participantes, este processo é voluntário para 80% e são realizadas por diferentes organizações, entre as quais sociedades científicas, atuando isoladamente ou como parte de uma equipe de avaliação. Destes países, 50% procedem à acreditação de programas de medicina de família através de universidades. Conclusões: A Certificação ainda não está estabelecida em alguns países da Ibero-América, é voluntária. Uma porcentagem menor de países implementaram o processo de recertificação, o qual é voluntário em sua maioria. Apenas metade dos países realizam o processo de acreditação das Unidades Formadoras.

Analisis comparativo de la certificación, recertificacion y acreditación en Latinoamerica para la especialidad de Medicina Familiar y Comunitaria / Comparative analysis of certification, certification and accreditation in Latin America for the specialty of Family and Community Medicine / Análise comparada dos processos de certificação, recertificação e acreditação em Medicina de Família e Comunidade na América Latina

La certificación y acreditación de competencias profesionales son actividades de cualquier área de formación profesional que existen en el mundo, y la profesión médica no ha estado ajena a ellas. Este estudio inicia en la V Cumbre Iberoamericana de Medicina Familiar realizada en Quito, Ecuador; en la cual se planifica una investigación de tipo descriptivo basada en la aplicación del método comparado denominado análisis entre países o cross-national, que analiza información comparativa de 8 países de Latinoamérica (México, Ecuador, Brasil, Bolivia, Argentina, Paraguay, Venezuela y Chile). El análisis documental muestra que hay diferencias importantes entre países; desde Ecuador, que no tiene implementado ningún proceso de certificación, recertificación y acreditación; Argentina, que tiene proceso de certificación, y en marcha los procesos de recertificación y acreditación; Brasil, Chile y Venezuela, que tienen sólo los procesos de certificación y acreditación; Venezuela no tiene implementado el proceso de recertificación; México, Paraguay y Bolivia que tienen los tres procesos implementados. El estudio demuestra cómo los países del concierto latinoamericano han avanzado a ritmos distintos en sus procesos de certificación, recertificación y acreditación, y tienen estructuras de organización diferentes para los mismos fines.

The certification and accreditation of professional competences are activities that any area of vocational training in the world puts it, and the medical Profession has not been alien to her. This study began in the V Ibero-American summit of Family Medicine in Quito Ecuador, in which a descriptive research based on the planned application of the method called analysis compared between countries or cross-national, comparative information analyzing 8 countries Latin America (Mexico, Ecuador, Brazil, Bolivia, Argentina, Paraguay, Venezuela and Chile). The documentary analysis in each country shows that there are significant differences between countries, from Ecuador has not implemented any certification process, recertification and accreditation; Argentina has certification process; up processes certification and accreditation, Brazil, Chile and Venezuela, which have only the processes of certification and accreditation; Venezuela has not implemented the process of recertification. Mexico, Paraguay and Bolivia that have implemented the three processes. The study demonstrates how the Latin American countries have advanced concert at different rates in their certification processes, recertification and accreditation, which have different organizational structures for the same purposes.

Certificação e acreditação de competências são atividades de qualquer área de formação profissional no mundo, e a profissão médica não tem sido alheia a elas. Este estudo teve início na V Cumbre Ibero-Americana de Medicina de Família e Comunidade em Quito, Equador, com uma pesquisa descritiva baseada no método de análise comparada entre países, ou método cross-national, que analisa os processos de certificação, recertificação e acreditação em 8 países da América Latina (México, Equador, Brasil, Bolívia, Argentina, Paraguai, Venezuela e Chile). A análise dos resultados mostra que existem diferenças importantes entre os países, desde o Equador, que não implementou qualquer processo de certificação, recertificação ou acreditação; a Argentina tem processo de certificação e processos de recertificação e acreditação em andamento; Brasil, Chile e Venezuela têm apenas os processos de certificação e acreditação; chegando ao México, Paraguai e Bolívia, que contam com os três processos implementados. O estudo demonstra como os países da América Latina têm avançado em ritmos diferentes em seus processos de certificação, recertificação e acreditação e têm diferentes estruturas organizacionais para os mesmos fins.

Liver transplantation for hepatocellular carcinoma among African Americans in the United States

There is increased prevalence of hepatocellular carcinoma [HCC] among African Americans [AA]. Multicenter studies have shown advanced presentation, underutilization of treatment and decreased survival following liver transplantation [LT] among AA. However outcomes from single centers are not well reported. To determine the outcome of AA undergoing LT for HCC at Cleveland Clinic, Cleveland, Ohio, between May 2007 and December 2009. 245 consecutive patients undergoing evaluation and treatment for HCC within the mentioned time frame were studied, retrospectively. 80% of patients were male, 75.5% were Caucasian, 16.7% were AA and 7.8% were other ethnic groups. Compared to other ethnicities, AA subjects with HCC were more commonly female and were more likely to have hepatitis C virus [HCV] [83% vs. 51%, p<0.001]. There were higher occurrence of HCV genotype 1 among AA compared to others among patients with this information [100% vs. 65%, p<0.001]. In contrast to previous reports, there was no significant difference between the groups in terms of clinical presentation or management. 27% of AA underwent liver transplantation compared to 28% of the rest [p=0.88]. Of the 68 patients who had LT, 9% died with no difference in post-LT survival between the two groups. HCV [and genotype 1] is a significant risk factor for HCC in the AA population. LT results in similar survival compared to other ethnicities. AA patients with HCC benefit equally from LT compared to other ethnicities

Recurrence of disease following liver transplantation: nonalcoholic steatohepatitis vs hepatitis C virus infection

Nonalcoholic steatohepatitis [NASH] is an increasing indication for orthotopic liver transplantation [OLT] in the United States and other countries. However, the incidence of disease recurrence and natural course following OLT remains incompletely understood. To estimate the incidence of recurrent disease, outcome and identify risk factors associated with disease recurrence in patients undergoing OLT for NASH as compared to those undergoing OLT for HCV cirrhosis. We identified all patients with end-stage liver disease secondary to NASH [n=53] or HCV [n=95] cirrhosis who underwent OLT at our institution between 1998 and 2005. Protocol liver biopsies were performed [Day 7, Month 4 and yearly] after OLT, and as clinically indicated. Kaplan-Meier survival analysis was performed to assess the fibrosis progression and survival. Cox regression analysis was performed to identify factors associated with disease recurrence. Five-year survival was 90.5% in NASH vs 88.4% in HCV group [p=0.97]. The median [25%ile, 75%ile] follow-up to last available biopsy was 12.7 [5.9, 26.3] months, during which 17 [32%] of NASH patients developed persistent fatty infiltration in their graft, 8 [15%] of whom had accompanying histologic features of recurrent NASH. There was no difference in the prevalence of post-OLT steatosis between HCV and NASH patients after adjusting for time of histologic follow-up [p=0.33]. Patients with HCV infection were more likely to develop hepatic fibrosis post-OLT than those with NASH [62.1% vs 18.9%, p<0.001]. Multivariate analysis identified post-OLT diabetes [HR=2.0, 95% CI: 1.2-3.2, p=0.007] as an independent risk factor for fibrosis development. Additionally, NASH subjects who received steroids had a significantly higher risk of developing hepatic fibrosis post-OLT than NASH patients who did not receive steroids and all HCV subjects [p<0.001]. Recurrence of steatosis post-OLT is common. Corticosteroid use may contribute to fibrosis progression in this population

IL-2 receptor antagonist [basiliximab] is associated with rapid fibrosis progression in patients with recurrent hepatitis c after liver transplantation using serial biopsy specimens

Recurrence of hepatitis C virus [HCV] infection following orthotopic liver transplantation [OLT] is universal. There is paucity of data on the safety and efficacy of interleukin [IL]-2 receptor antagonist [IL-2RA] when added to the standard immunosuppression regimen in OLT recipients with recurrent HCV infection. To evaluate the efficacy of IL-2RA [Basiliximab] in preventing acute cellular rejection [ACR] in patients with recurrent HCV infection after OLT and to assess the impact of IL-2RA in promoting fibrosis progression in post-OLT recurrent HCV infection. Using an electronic pathology database, we identified all OLT/HCV patients with at least 2 post-OLT liver biopsies [1998-2006]. Standard immunosuppression consisted of steroids and calcineurin inhibitor with and without mycophenolate mofetil. All patients who were transplanted after May 2004 received IL- 2RA induction therapy. The Ludwig-Batts system was used to stage all biopsies [593 biopsies from 124 patients]. The first biopsy that showed post-OLT fibrosis or the last follow-up biopsy was used for time- to-progression analysis. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify factors associated with the progression of fibrosis. ACR was significantly [p<0.001] lower in patients who received IL-2RA [20 of 70, 29%] compared to those who did not [33 of 54, 61%]. The median [25%ile, 75%ile] follow-up was 12.1 [6.1, 23.9] months during which 61% of patients had progression of fibrosis. Univariate analysis revealed that a higher HCV RNA load at 4 months post-OLT [p=0.002], cytomegalovirus [CMV] infection [p<0.001], use of steroid therapy for ACR [p=0.043], and use of IL-2RA [p<0.001] were associated with higher hazards for the pro- gression of fibrosis. Viral load at 4 months post-OLT was significantly [p=0.025] higher in patients who had IL-2RA therapy [median [25%ile, 75%ile]: 2.9 [1.0, 5.0] _10[6] vs. 1.4 [1.0, 2.3] _10[6]]. In multivariate analysis, patients who received IL-2RA therapy were 3.1 [95% CI: 1.8-5.3] times more likely to develop fi- brosis than those who did not treated with IL-2RA. Steroid therapy for ACR remained significantly [Hazard Ratio=2.9, p=0.002] associated with the progression of fibrosis. IL-2RA [Basiliximab] decreases the rate of ACR. However, it may be associated with more rapid histological progression of the disease in post-OLT recurrent HCV

Variación en la frecuencia de micosis en México / Variation in mycoses frequency in Mexico

We show the records about diagnosed mycoses in a hospital in Mexico City in two periods of time: from 1967 to 1977 and from 1993 to 1997. In the former 15,429 patients were studied and in the latter, 5,998. Striking differences among frequency, etiological agents and clinical outcome, were observed. The most frequent infections in both lapses were the superficial ones, however the most recent scores showed a notorious increase in opportunistic infections. We diagnosed only one histoplasmosis case during the period from 1993 to 1997. Etiological agents have also changed, dermatophytes frequency like Trichophyton mentagrophytes and T. tonsurans have diminished while T. rubrum increased from 60 to 80 of the whole dermatophytoses cases. Even though Criptococcus neoformans used to be the only agent causing criptococosis, in the most recent report we found that C. laurentii, C. terreus and C. unigutulatus were also isolated. Another important difference was mortality in rhinocerebral mucormicosis: twenty years ago it was fairly 80, nowadays it has decreased to 20.