Factors associated with the use of dental health services in primary care in northeastern Mexico / Factores asociados al uso de servicio de salud dental en atención primaria en el noreste de México

Abstract: in Mexico, as in many other Latin American countries, the use of dental health services (UDHS) has been scarcely studied, especially the one related with groups that are considered at risk in certain areas. The aim of this study was to evaluate the factors associated with UDHS in an at risk population in primary care. Material and Methods: Cross-sectional study, involving students (T), pregnant women (PW), workers (W) and older adults (OA) (n=368). Variables such as the use of dental health services and factors such as geographical, economic, and organizational barriers were measured. Descriptive statistics, Chi Square test and multivariate binary logistic regression analysis were used. Results: 40.2 percent (95 percent CI 30.2-50.2) of the W group had a history of UDHS in primary care, 20 percent (95 percent CI 11.8-28.2) of the PW group had spent more than a year without visiting the dentist and 33 percent (95 percent CI 23.7-43.9) had been treated at a private dental care service. Level of schooling, occupation, federal support from "Programa Oportunidades" and access to dental care services (p<0.01) were factors associated with UDHS, independent of potential confounders. Conclusion: The health system should guarantee health care by offering comprehensive dental health services and removing organizational barriers to promote a more equitable access to dental care.

Resumen: en México, como en muchos otros países latinoamericanos, se ha estudiado escasamente el uso de servicio de salud dental (USSD) especialmente el relacionado con grupos considerados de riesgo en dicha área. El objetivo fue evaluar los factores asociados al USSD en atención primaria en grupos de riesgo. Material y Métodos: Estudio transversal, participaron escolares (E), mujeres embarazadas (ME), trabajadores (TA) y adultos mayores (AM) (n=368). Se midieron variables de uso de servicio y factores asociados como barreras de acceso de origen geográfico; económico y organizacional, Se aplicó estadística descriptiva, chi cuadrada y análisis multivariado con regresión logística binaria. Resultados: El 40.2 por ciento (IC95 por ciento 30.2- 50.2) del grupo de TA tenía el antecedente de USSD en atención primaria, el 20 por ciento (IC95 por ciento 11.8-28.2) del grupo de ME tenía más de un año sin acudir al odontólogo y el 33 por ciento (IC95 por ciento 23.7-43.9), había acudido a servicio de salud privado para resolver problema de salud dental. La escolaridad, ocupación, apoyo federal del “Programa Oportunidades” y contar con servicios de salud dental (p<0.01), fueron factores asociados al USSD independiente de confusores potenciales. Conclusión: El sistema de salud debiera garantizar la atención ofreciendo servicios integrales de salud dental y eliminar barreras de acceso organizacionales para favorecer que los servicios de consulta dental sea más equitativos.

Encuesta nacional sobre los conocimientos impartidos en escuelas de medicina de Colombia sobre rehidratación parenteral en niños eutróficos mayores de un año con deshidratación por enfermedad diarreica / Intravenous rehydration for diarrheal dehydration of eutrophic children: survey of protocols provided at Colombian medical schools

Introducción. Ante la deshidratación grave por diarrea y la contraindicación para rehidratación oral, la rehidratación en niños debe realizarse por vía intravenosa. La Organización Mundial de la Salud (OMS) recomienda la rehidratación rápida. Objetivos. Describir los métodos de rehidratación intravenosa enseñados en las escuelas de medicina colombianas y confrontarlos con las recomendaciones de la OMS.Materiales y métodos. Se elaboró una encuesta para docentes de pediatría en escuelas de medicina. Se hicieron preguntas directas y se detallaron casos clínicos de niños deshidratados para ser resueltos. Se preguntó por las indicaciones para la hidratación intravenosa y la forma de hacerla (volumen, solución, concentraciones y velocidad de infusión). Resultados. Se aplicaron 41 encuestas (82 % de escuelas). Se mencionaron las contraindicaciones inadecuadas para el tratamiento de rehidratación oral en 41 % de ellas. Se recomendó rehidratación intravenosa rápida en 71 %, lenta en 29 % y con bolos en 57 %. Menos de la mitad de los encuestados recomendaron adecuadamente el volumen por infundir y, el 85 %, la concentración de sodio. En 56 % de las escuelas no se usa glucosa en las soluciones y en 65,9 % usan lactato de Ringer. También, se utilizan solución salina normal, dextrosa con electrolitos y solución polielectrolítica.Conclusiones. Existen ideas erróneas para contraindicar el tratamiento de la rehidratación oral. La tercera parte de las escuelas indican el tratamiento lento a pesar de la superioridad del rápido en la literatura. Falta uniformidad en los esquemas de tratamiento rápido. Es común la hidratación con bolos, sin sustento en la literatura científica. Es necesario actualizar los conceptos sobre hidratación en las escuelas de medicina y proponer una guía nacional para la rehidratación intravenosa.

Introduction. In all cases of severe dehydration from diarrhea, WHO recommends rapid rehydration. If oral rehydration in children is contraindicated, intravenous rehydration is recommended for immediate administration. However, methods of intravenous rehydration appear to be inadequately addressed in the medical schools of Colombia. Objective. Current approaches to oral rehydration were summarized, and instructors were informed concerning current WHO recommendations. Materials and methods. A survey was designed for pediatric instructors in Colombian medical schools. Direct questions about rehydration methods were included as well as presentation of theoretical clinical situations with dehydrated children. The survey also asked for the conditions necessary for intravenous rehydration and method of administration (volume, solution, concentration and speed of infusion).Results. Forty-one surveys were included (82% of medical schools in Colombia). Inadequate contraindications for oral rehydration therapy were made in 41%. Rapid and slow intravenous rehydration was recommended in 71% and 29%, respectively; 57% recommended fluid bolus to rehydrate. Adequate volumes were recommended by less than half of the respondents and adequate sodium concentration was recommended by 85%. In 56% of medical schools, glucose was not included in solutions and 66% use Ringer lactate. Normal saline solution, dextrose solution with electrolytes and polyelectrolytes solutions are also used.Conclusions. Misconceptions are common concerning the contraindications to oral rehydration therapy. One-third of medical schools promote a slow therapy despite the superiority of the rapid therapy. Uniformity for rapid therapy schemes is lacking. Bolus rehydration is commonly advocated despite the fact that this method is unsupported by the literature. Concepts about rehydration must be updated in medical schools and a national guide for intravenous rehydration is recommended.

Necrotizing nocardial scleritis after combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation: a case report and review of the literature

We report the history and clinical presentation of an 88-year-old female with Fuchs dystrophy who developed an acute anterior necrotizing scleritis in her left eye 23 months after an uncomplicated combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation which progressed to slceral perforation with uveal prolapses. The patient underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis. Surgical specimens of the area of scleral perforation were sent for histology and microbiologic studies. Analysis of surgical specimens revealed the presence of culture-proven Nocardia asteroides as a causative agent for the patient's scleral perforation. Results of her systemic autoimmune work-up were not conclusive. Successful treatment with tectonic scleral reinforcement with donor corneal tissue and preserved pericardium, oral and topical trimethoprim-sulfamethoxazole and topical amikacin salvaged the globe and increased vision. The patient's final best-corrected visual acuity sixteen months after her last operation remains 20/70. Prompt surgical intervention with submission of appropriate specimens for pathological diagnosis and microbiology, along with consultation with rheumatologic and infectious disease specialists, are mandatory to minimize visual loss in cases of suspected infectious necrotizing scleritis.

Relato de caso de esclerite necrosante aguda, evoluindo para perfuração escleral com prolapso uveal, 23 meses após procedimento de ceratoplastia penetrante e facoemulsificação com implante de lente intra-ocular no olho esquerdo sem intercorrências.A paciente foi submetida à avaliação completa auto-imune para esclerite. Biópsia da área de perfuração escleral foi encaminhada para avaliação patológica e microbiológica. Análise de material cirúrgico revelou presença de cultura proveniente de Nocardia asteroides como agente causal da perfuração escleral. Resultados de exames do sistema auto-imune não foram conclusivos. Tratamento foi um sucesso com reforço escleral tectônico do tecido corneano doador, utilização de pericárdio preservado, associado ao uso sistêmico e tópico de sulfametoxazol-trimetropina e amicacina colírio. Apresentou melhora visual após o tratamento e a melhor correção visual final, 16 meses após o último procedimento cirúrgico foi de 20/70. Intervenção cirúrgica precoce, análise patológica e microbiológica do material, associados a consulta a especialistas na área de doenças infecciosas e reumatologia, são primordiais para minimizar perda visual em casos de suspeitas de esclerite infecciosa necrosante.

Optimizing patients with symptoms and/or signs of dry eye prior to refractive surgery

Symptoms and signs of dry eye are common in patients who present for evaluation for LASIK surgery since these patients tend to consider refractive surgery because they are unhappy with contact lenses, including decreased wearing time associated with dry eye, and glasses. It is important to optimize these patients prior to LASIK surgery so that measurements such as wavefront analysis are not confounded and to reduce the incidence of LASIK-induced neurotrophic epitheliopathy [LINE] after surgery. Topical cyclosporine A has become a mainstay of pre-treatment for LASIK where it is available. Other treatments include artificial tears and ointments, oral doxycycline, and punctal plugs. With appropriate pre-treatment, the majority of patients with symptoms and signs of dry eye prior to surgery can have successful LASIK surgery