Prevalencia de conductos en C de segundos molares mandibulares evaluados en tomografía de haz cónico / Prevalence of C-ducts of Mandibular Second Molars Evaluated on Cone Beam Tomography

Introducción: El conocimiento adecuado de la configuración de conductos radiculares es fundamental en endodoncia; la evaluación tomográfica permite una correcta evaluación de su disposición radicular. Objetivo: Determinar la prevalencia de conductos en C de segundos molares mandibulares, evaluados en tomografía de haz cónico. Métodos: Se realizó un estudio descriptivo y de corte transversal; la muestra estuvo conformada por 200 segundos molares mandibulares permanentes de una población peruana, observadas en tomografías cone beam, donde se registró la presencia del conducto en C, su configuración según la clasificación de Fan y el sexo del paciente. Resultados: La prevalencia de la configuración radicular en forma de C en segundos molares inferiores fue del 65,5 por ciento; según la Clasificación de Fan se observó mayor prevalencia en el tercio cervical del conducto radicular el tipo C1 con 85,7 por ciento; en el tercio medio el tipo C2 con 42,9 por ciento; a nivel apical fue el tipo C3C con 72,1 por ciento; según el sexo, el 65,2 por ciento de los conductos en C correspondió al femenino. Conclusión: La prevalencia de los conductos en C de los segundos molares mandibulares evaluados en tomografías de haz cónico fue de 65,5 por ciento con mayor predominio en el sexo femenino. La evaluación tomográfica permite una mejor identificación y configuración interna de los conductos radiculares(AU)

Introduction: Adequate knowledge of the configuration of root canals is fundamental in endodontics; tomographic evaluation allows a correct assessment of their radicular arrangement. Objective: To determine the prevalence of C-shaped canals in mandibular second molars, evaluated by cone beam tomography. Methods: A descriptive and cross-sectional study was carried out; the sample consisted of 200 permanent mandibular second molars from a Peruvian population, observed in cone beam tomography, where the presence of the C-shaped canal, its configuration according to Fan's classification and the patient's gender were recorded. Results: The prevalence of the C-shaped root canal configuration in lower second molars was 65.5 percent; according to the Fan classification, the highest prevalence was observed in the cervical third of the root canal, type C1 with 85.7 percent; in the middle third, type C2 with 42.9 percent; at the apical level it was type C3C with 72.1 percent; according to gender, 65.2 percent of the C-shaped canals corresponded to females. Conclusion: The prevalence of C-shaped canals in mandibular second molars evaluated in cone beam tomography was 65.5% with a higher predominance in the female gender. The tomographic evaluation allows a better identification and internal configuration of the root canals(AU)

Gamete and embryo donation regulation in human assisted reproduction technologies: Disclosure or nondisclosure?

The use of donated gametes and embryos in assisted reproduction techniques (ART) makes it necessary to examine interests that involve relevant ethical and legal considerations, which include the autonomy and privacy rights of the intended parents, donors’ right to privacy and the right of the minors to know their genetic origin. This article presents arguments to consider policies of more openness to obtain information from donors in order to protect the child’s best interest in knowing his/her genetic origins. It concludes with the situation in Mexico, where ART has been carried out with donated gametes since several years ago; however, due to the absence of regulations to control these procedures, each establishment imposes its own criteria for the operation of its programs.

Psychologist in Italian hospital settings: An exploratory analysis of hospital physicians' representations and demands of psychological intervention

Aunque la Organización Mundial de la Salud ha evidenciado la importancia de adoptar modelos integrados de asistencia basados en el enfoque bio-psico-social, en los servicios de salud, como los hospitales, existe todavía mucha resistencia para su implementación. Se presenta un estudio exploratorio cualitativo dirigido a comprender las representaciones y las demandas de los médicos hospitalarios con respecto a la intervención psicológica en los contextos hospitalarios italianos. Conforme a este objetivo se desarrolló un guión de entrevista semi-estructurada y se entrevistaron 15 médicos italianos divididos por género, edad y especialidad médica. Fueron investigados las representaciones de la enfermedad, el acercamiento a los pacientes y los modelos de intervención, la experiencia de colaboración con psicólogos, las representaciones de dónde, cuándo y cómo los psicólogos podrían ser útiles en el contexto hospitalario, las visiones generales del hospital y de su futuro, los puntos de fuerza y de debilidad de su trabajo, las estrategias utilizadas para superar las dificultades diarias y las estrategias propuestas para mejorar el sistema hospitalario. El análisis de contenido de las entrevistas ha revelado que la intervención psicológica está representada predominantemente como una intervención a nivel individual dirigida a contener el distrés emocional en relación con la enfermedad. Además se ha evidenciado la falta de consideración de la competencia psicológica como útil para promocionar el funcionamiento organizativo de los servicios hospitalarios. Estos resultados pueden apoyar la investigación futura en esta área y son utilizados para discutir las oportunidades de un diálogo constructivo entre ciencias médica y psicológica en los contextos hospitalarios.

During the years, the World Health Organization has been emphasising the importance of promoting integrated models of care consistent with a bio-psycho-social approach to health-illness. Nonetheless, healthcare services still show much resistance to the implementation of such models and the use of multidisciplinary teams. As a consequence, and despite the efforts made over the years by psychologists, the role and specificity of psychological competence in healthcare settings continues to remain unclear. This is particularly true as regards hospital settings. Based on these considerations, this article presents an exploratory qualitative study aimed at understanding hospital physicians' representations of, and demands for, psychological intervention in Italian hospital settings. The main argument on which the study was based is that the integration of psychological competence into hospital settings very much depends on other professionals' representation of the psychological profession, as well as on the emotional symbolization of their work context and professional practice. A key role is played by physicians, whose representations of the psychological intervention in hospital settings have been under studied at the international level, and almost not studied with regard to the Italian context. The purpose of this study was to respond to this gap in the literature. In this regard, a semi-structured interview script was developed and used to interview 15 Italian hospital physicians varying in gender, age, and medical speciality. Participants were selected by convenience and interviews were carried out individually in the hospital settings. Representations of disease; approach to patients and models of intervention; experiences of collaboration with psychologists; representations of where, when and how psychologists could be useful in the hospital context; overall visions of one's hospital and its future; strengths and weaknesses of one's own work; strategies used to overcome everyday difficulties and strategies advocated to improve the hospital were focus of analysis. The interviews, administered by two researchers, were audio-recorded and transcribed. Then a content analysis was developed by three analysts that coded the units of the text (sequences) according to the categories and subcategories identified. The categories were: (a) perspective on medical intervention; (b) problems and weaknesses; (c) strengths; (d) current and future strategies; (e) psychosocial component of disease, and (f) relationship between Medicine and Psychology. Transcripts were analyzed independently by the analysts, and the interrater agreement was 83%. Results revealed a widespread view that psychological science is of limited relevance in the hospital context. The difficulty in perceiving psychologists as a medical resource appeared to be largely related to physicians' endorsement of a bio-medical approach, as well as to their lack of opportunities for formal and / or informal collaboration with psychologists. Psychologists were thought of primarily as diagnosticians or therapists, and psychological intervention was mainly characterized as an individual- level intervention whose main objective is to support the patient and manage his / her emotional response to the disease (and the response of his / her family). Despite physicians felt the hospital system plagued by problems, especially at the structural and functional levels, they did not envisage psychological competence as useful for fostering hospital organisational functioning. On the contrary, they advocated a top-down change in the hospital system, delegating responsibility for change to hospital management or policy makers. As a consequence, an urgent demand for Psychology remains unexpressed. Although based on a small sample, the present study provides useful insights which may prompt further research in this area. Furthermore, it provides information about the demand for psychological intervention in the hospital context which can be used to develop strategies to promote multidisciplinary care and integrated mind-body interventions. Results suggest the necessity to rethink professional roles and to promote a constructive dialogue between medical and psychological science in Italian hospital settings.

Caracterización clínica según la clasificación TNM de pacientes con cáncer de mama en su primera consulta en el Hospital Nacional de la Mujer de enero a diciembre 2015 / Clinical characterization according to the TNM classification of patients with breast cancer in their first consultation at the National Women's Hospital from January to December 2015

El estudio se realizó en el HNM en los meses de junio a noviembre de 2017. Se revisaron expedientes clínicos de las pacientes con diagnóstico de cáncer de mama, que consultaron por primera vez en 2015. En los últimos cinco años en el Hospital Nacional de La Mujer, el cáncer de mama ha constituido el 52% de todas las muertes por cáncer, según datos de Estadística y Documentos Médicos de este nosocomio. El objetivo del presente trabajo es determinar el síntoma principal que llevo a las pacientes a consultar, el tiempo de evolución que tenían de presentarlo y clasificarlas en el estadío o fase que se encontraban según la clasificación Tumor-Nódulo-Metástasis (TNM), al momento de su consulta; determinando el nivel de avance de la enfermedad. Para lo cual se revisaron los expedientes clínicos de las pacientes que se encontraban en quimioterapia por padecer de esta patología. La información se descargó en una ficha de recolección de datos para su posterior tabulación y análisis. Dentro de los principales resultados que se obtuvieron fue que síntoma principal que motivó en el 100% de las pacientes a consultar fue notar una tumoración en la mama, el tiempo de evolución de la misma es tan variado como de un mes hasta 10 años, el mayor porcentaje es un año de evolución con el 33.3 %, solo una mínima cantidad de pacientes han esperado más tiempo para consultar. Al ser evaluadas las pacientes según la clasificación Tumor-Nódulo-Metástasis, la mayoría se encuentra en el estadío T4N2M0, es decir un estadío avanzado

Neurofibroma de tireóide em uma paciente com neurofibromatose tipo 1 / Neurofibroma of thyroid in a patient with neurofibromatosis type 1

A neurofibromatose tipo 1 (NF1), também conhecida como doença de von Recklinghausen, é uma doença autossômica dominante com alto grau de variabilidade da expressão clínica, comumente envolvida na formação de tumorações na maioria das vezes de origem benigna, localizadas principalmente na região da cabeça e do pescoço, sendo a tireóide acometida raramente. Porém existe na literatura a associação com carcinoma medular da tireóide (CMT), necessitando sempre sua exclusão. Relatamos o caso de uma paciente com NF1, com um nódulo de tireóide não-funcionante e sintomas obstrutivos. Foi realizada ressecção cirúrgica da lesão, com achados histopatológicos compatíveis com neurofibroma em tecido tireoidiano. A importância desse caso deve-se não só à raridade dessa apresentação da NF1, mas também à possibilidade de associação desta com CMT, tumor agressivo com possibilidade de cura pela ressecção cirúrgica.

The neurofibromatosis type 1 (NF1), also known as von Recklinghausen’s disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.

Caries dental: frecuencia y calidad de la atención estomatológica / Dental caries: frequency and quality of dental attention

Con el objeto de determinar la frecuencia de caries y el número de acciones preventivas, mutilatorias y de limitación del daño que se realizan a los derechohabientes en la consulta estomatológica, se llevó a cabo un estudio transversal en tres unidades médicas durante el periodo de enero a septiembre de 1995. Se revisó 86.8 por ciento del total de casos con alta consignada en expediente clínico (1089), donde los grupos de menores de un año y crónico-degenerativos no alcanzaron la muestra prevista. Presentó caries 84 por ciento del total (cinco años y mayores), 53.7 por ciento recibió el manejo integral establecido por la norma institucional, sin embargo, con tratamiento incompleto. En las poblaciones de uno a 14 años y embarazadas, la atención estomatológica no se realizó en forma completa (p< 0.05)