Coumel tachycardia in children / Taquicardia de Coumel en niños

Abstract Background: Coumel tachycardia is an infrequent form of supraventricular tachycardia (SVT) that usually occurs in infants and children. It is a tachycardia mediated by an accessory pathway with retrograde slow conduction that explains the classic ECG pattern with long RP' interval and negative P waves in leads II, III, and aVF. In this study, we describe the clinical course and management of Coumel tachycardia in children. Case report: We conducted a retrospective review of five consecutive pediatric patients, mean age 11 ± 3 years (range 6 to 14). The first episode of SVT was at a mean age of 10.4 ± 4.8 years (range 2 to 14) with a mean evolution of 7.4 ± 9.4 months (range 1 to 24). Pharmacological therapy was unsuccessful despite the combination of antiarrhythmic drugs. The tachycardia was incessant with a density > 85% by 24-hour Holter monitoring; one patient developed tachycardia-induced cardiomyopathy. All children underwent successful radiofrequency catheter ablation, mean 5 ± 3 applications (range 1 to 8) with a single session and with no complications. After a mean follow-up of 24 ± 16 months, all patients were asymptomatic and recurrence-free without antiarrhythmic treatment. Conclusions: Coumel tachycardia is clinically persistent and usually refractory to antiarrhythmic treatment with substantial risk of tachycardia-mediated cardiomyopathy. Catheter ablation is effective and safe in children; thus, it should be indicated promptly and based on individual selection.

Resumen Introducción: La taquicardia de Coumel es una forma poco frecuente de taquicardia supraventricular que suele presentarse en lactantes. Es una taquicardia mediada por una vía accesoria de conducción lenta retrógrada que explica el patrón ECG clásico con intervalo RP' largo y ondas P negativas en las derivaciones II, III y aVF. En este trabajo se describe el curso clínico y el manejo de la taquicardia de Coumel en niños. Caso clínico: Se llevó a cabo una revisión retrospectiva de cinco pacientes pediátricos consecutivos, con una media de edad de 11 ± 3 años (intervalos 6 a 14). El primer episodio de taquicardia 10.4 ± 4.8 años con evolución de 7.4 ± 9.4 meses. El tratamiento farmacológico fue ineficaz a pesar de la combinación de antiarrítmicos. La taquicardia era incesante con una densidad > 85% por Holter-24h; un paciente desarrolló miocardiopatía inducida por taquicardia. Todos los niños fueron sometidos a ablación con catéter y radiofrecuencia con éxito, y un promedio de 5 ± 3 aplicaciones en una sola sesión y sin complicaciones. Después de un seguimiento de 24 ± 16 meses, todos los pacientes fueron asintomáticos y libres de recurrencia sin tratamiento antiarrítmico. Conclusiones: La taquicardia de Coumel es clínicamente persistente y generalmente refractaria al tratamiento antiarrítmico con un riesgo sustancial de miocardiopatía mediada por taquicardia. La ablación con catéter es eficaz y segura en niños, por lo que debe indicarse de forma temprana y en lactantes de una selección individual.

Idiopathic left fascicular ventricular tachycardia in children and adolescents / Taquicardia ventricular fascicular izquierda idiopática en niños y adolescentes

Abstract Background: Idiopathic ventricular tachycardia (VT) in children with structurally normal hearts is generally unrelated to the risk of sudden arrhythmic death. Still, it may be associated with deterioration in the quality of life. VT involving the fascicular conduction system is the most typical form of idiopathic left VT. In this retrospective study, we describe the experience of the clinical presentation, catheter ablation, and long-term follow-up of left fascicular VT in children. Methods: An electrophysiological study was performed on consecutive children at a single tertiary center. Clinical fascicular left VT was induced by programmed stimulation, and catheter ablation was guided searching for Purkinje potentials. Results: We included 18 patients (0.8 patients/year): 14 (77.8%) males and four females. The mean age of the first VT episode was 8.5 ± 5 years. Intravenous verapamil administration was effective for paroxysmal fascicular VT but not for prevention of recurrences. The mean age at the time of catheter ablation was 11.1 ± 3.8 years (8 months-16 years). The mean weight was 36.8 ± 16.4 kg (8.7-58 kg). A 100% success rate was observed with catheter ablation after repeated procedures without major complications. Mean follow-up was 2.0 ± 1.2 years (1.0-4.0 years, median 1.5), with permanent success in all patients and no antiarrhythmic drug administration. Conclusions: Fascicular VT has an adverse clinical course in children. In most cases, this condition is drug refractory. Catheter ablation is successful and safe treatment and should represent the first-line approach in symptomatic children.

Resumen Introducción: La taquicardia ventricular (TV) idiopática en niños con corazón estructuralmente normal generalmente no se relaciona con el riesgo de muerte súbita arrítmica, pero puede asociarse con deterioro de la calidad de vida. La TV que involucra el sistema de conducción fascicular es la forma más común de TV izquierda idiopática. En este estudio retrospectivo se describe la experiencia de presentación clínica, ablación con catéter y seguimiento a largo plazo de TV fascicular en niños. Métodos: Se llevó a cabo un estudio electrofisiológico en niños consecutivos en un centro terciario. La TV fascicular clínica se indujo mediante la estimulación programada y la ablación con catéter fue guiada buscando el registro de potenciales de Purkinje. Resultados: Se incluyeron 18 pacientes (0.8 pacientes/año): 14 (77.8%) de sexo masculino y cuatro de sexo femenino. La media de edad a la cual ocurrió el primer episodio fue de 8.5 ± 5 años. La administración intravenosa de verapamilo fue eficaz para la TV fascicular paroxística, pero no para prevención de recurrencias. La media de edad de la ablación con catéter fue de 11.1 ± 3.8 años (8 meses-16 años). La media del peso fue 36.8 ± 16.4 kg (8.7-58 kg). Se observó el 100% de éxito con la ablación con catéter después de procedimientos repetidos sin complicaciones mayores. La media de seguimiento fue de 2.0 ± 1.2 años (1.0-4.0, mediana de 1.5 años) con éxito permanente en todos los pacientes y sin administración de fármacos antiarrítmicos. Conclusiones: En niños, el curso clínico de la TV fascicular es adverso. Además, en la mayoría de los casos, esta condición es refractaria a fármacos. La ablación con catéter resulta exitosa y segura y debe representar el abordaje de primera línea en niños sintomáticos.

Reducción de eventos cardiovasculares de Lomitapida versus Estatinas en pacientes con diagnóstico de hipercolesterolemia fa-miliar. Protocolo de revisión sistemática / Reduction of cardiovascular events of Lomitapida versus Statins in patients with a diagnosis of familial hypercholesterolemia: A systematic review protocol

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.

Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.

Reducción de eventos cardiovasculares de Lomitapida versus Estatinas en pacientes con diagnóstico de hipercolesterolemia fa-miliar. Protocolo de revisión sistemática / Reduction of cardiovascular events of Lomitapida versus Statins in patients with a diagnosis of familial hypercholesterolemia: A systematic review protocol

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.

Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.

Reducción de eventos cardiovasculares de Lomitapida versus Estatinas en pacientes con diagnóstico de hipercolesterolemia fa-miliar. Protocolo de revisión sistemática / Reduction of cardiovascular events of Lomitapida versus Statins in patients with a diagnosis of familial hypercholesterolemia: A systematic review protocol

Introducción: La hipercolesterolemia familiar (HF) un trastorno genético autosómico domi-nante que produce un desarrollo prematuro de enfermedades cardiovasculares. Las estati-nas han sido el medicamento de elección en estos pacientes, sin embargo, un buen por-centaje de pacientes no pueden alcanzar sus objetivos terapéuticas con las dosis máximas por lo que la Lomitapida se podría establecer como una nueva alternativa de tratamiento. Objetivo: El objetivo de esta revisión sistemática es determinar si la Lomitapida reduce los eventos cardiovasculares en pacientes con diagnóstico de Hipercolesterolemia familiar comparado con estatinas. Métodos: Se incluirán ensayos controlados aleatorios (ECA) y cuasialeatorios de pacientes con diagnóstico de HF. Las medidas de resultado los niveles de LDL, HDL pos tratamiento y eventos cardiovasculares. Las búsquedas electrónicas se realizarán en PUBMED, The Coch-rane Central Register of Controlled Trials (CENTRAL), EMBASE y Scientific electronic library (Scielo). En la evaluación del riesgo de sesgo se utilizará la herramienta de Cochrane. Las medidas del efecto del tratamiento serán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95%. La evaluación de heterogeneidad se realizará mediante la inspec-ción visual del diagrama de embudo. La evaluación de la calidad de la evidencia se reali-zará usando la evaluación GRADE.

Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disor-der that produces hypercholesterolemia and premature development of cardiovascular diseas-es. Statins are the drug of choice in these patients; however, a high percentage of patients cannot achieve their therapeutic goals with the maximum recommended doses, so Lo-mitapide may prove to be useful as a new treatment alternative to traditional statins. Objective: The objective of this systematic review is to determine if Lomitapide is better than statins at reducing cardiovascular events in patients with a diagnosis of FH. Methods: Randomized controlled trials (RCTs) and quasi-randomized trials of patients di-agnosed with FH will be included. Primary outcome measures included several parameters: 1. Post-treatment low- and high-density lipoprotein (LDL and HDL, respectively) levels and 2. Presence of cardiovascular events. Electronic searches will be conducted in PUBMED, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the scientific elec-tronic library (Scielo). The assessment of the risk of bias will be used by the Cochrane tool. The measures of the treatment effect will be considered the mean differences (MD) and the 95% confidence intervals (CI). The evaluation of heterogeneity will be done by visual inspec-tion of the funnel diagram. The evaluation of the quality of the evidence will be done using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ap-proach.

Neuropatía periférica como manifestación unica de poliangeítis microscópica en la altura. Reporte de caso / Peripheral neuropathy as a unique manifestation of microscopic polyangetis in high altitude. Case report

Resumen La poliangeítis microscópica, es una vasculitis de vasos pequeños cuya incidencia es de 4 por 1 000 000 de habitantes y que frecuentemente se presenta asociada a manifestaciones de glomerulonefrítis rápidamente progresiva y capilaritis pulmonar. Las manifestaciones neurológicas son menos frecuentes. El diagnostico se confirma con serología positiva para Anticuerpos Anticitoplasma de neutrófilos (ANCA) y especificidad para patrón de fluorescencia perinuclear (P-ANCA) y Mieloperoxidasa (MPO). El tratamiento idóneo son los glucocorticoides e inmunosupresores. Se presenta el caso de un paciente de 69 años con poliangeitis microscópica que debuta con neuropatía periférica como única manifestación clínica, presentación que se considera atípica. Se plantea que ante la presencia de una neuropatía periférica aislada, deben efectuarse estudios para confirmar o descartar la presencia de Poliangeitis Microscópica en base a la gran variabilidad de su sintomatología clínica y potenciales formas de tratamiento.

Summary Microscopic polyangiitis is a small vessel vasculitis whose incidence is 4 per 1 000 000 inhabitants, frequently associated with manifestations of rapidly progressive glomerulonephritis and pulmonary capilaritis, and a less frequent neurological involvement. The diagnosis is confirmed with a positive serology for antineutrophil cytoplasmic antibodies (ANCA) and specificity for fluorescence pattern perinuclear (P-ANCA) and myeloperoxidase (MPO). The ideal treatment is a combination of glucocorticoids and immunosuppressants. The case is presented of a 69-year-old patient with microscopic polyangiitis who debuts with peripheral neuropathy as the only manifestation, an atypical feature. The suggestion is made that in the presence of an isolated peripheral neuropathy, studies should be done to rule out the presence of Microscopic Polyangiitis, given its great variability in clinical presentation and potential treatments.

Impacto del bypass gástrico en pacientes con índice de masa corporal > 35 kg/m2 y diabetes mellitus tipo 2 / Impact of gastric bypass in patients with body mass index > 35 kg/m2 and type 2 diabetes mellitus

La cirugía bariátrica ha demostrado que, además de producir pérdida de peso importante y mantenida, puede en la mayoría de casos mejorar el control de la glicemia e incluso la remisión de la diabetes en algunos pacientes. Objetivo: Analizar los efectos del bypass gástrico laparoscópico en pacientes con índice de masa corporal (IMC) ≥ 35 kg/m2 y diabetes mellitus tipo 2 (DMT2) intervenidos en el programa de cirugía bariátrica del Hospital Dr. Miguel Pérez Carreño. Método: La investigación es de tipo descriptiva, longitudinal y retrospectiva. La muestra fue de 20 pacientes de la consulta del programa de cirugía bariátrica a los cuales se les realizó bypass gástrico en Y de Roux (BPGYR) entre 2011 y 2015, con diagnóstico de DMT2. Resultados: Posterior al BPGYR, en el periodo de 1 año se observó una disminución significativa de los valores de glicemia, hemoglobina glicosilada (HbA1c) e IMC. Se observó remisión completa de la DMT2 en 75 % de los pacientes, remisión parcial en 10 % y mejoría metabólica en 15 %. Conclusiones: El BPGYR es efectivo en pacientes con DMT2, logrando una remisión del 75% de los pacientes tratados(AU)

Bariatric surgery has demonstrated that, besides producing significant and sustained weight loss, it can in most cases improve glycemic control and even produce diabetes remission in some patients. Objective: To analyze the effects of Roux-en-Y gastric bypass (RYGBP) in patients with BMI ≥ 35 kg/m2 and type 2 diabetes operated in the bariatric surgery program of Dr. Miguel Pérez Carreño Hospital. Method: The investigation was descriptive, longitudinal and retrospective. The sample consisted of 20 patients attending the bariatric surgery program and underwent laparoscopic Roux-en-Y gastric bypass between 2011 and 2015, with diagnosis of type 2 diabetes (T2DM). Results: After 1 year following RYGBP, significant decrease in glycaemia, glycosylated hemoglobin (HbA1c) and BMI was observed. Complete remission was observed in 75 % of patients, partial remission in 10 % and metabolic improvement in 15 %. Conclusions: RYGBP is effective in patients with T2DM, achieving a remission of 75% of treated patients(AU)

Efeito da contaminação por saliva humana na interface adesiva: resistência de união, análise de camada híbrida e conversão de sistemas adesivos / Effect of human saliva contamination on adhesive interface: bond strength, hybrid layer analysis and conversion of adhesive systems

Este estudo teve como objetivo analisar o efeito da contaminação por saliva humana na resistência de união (RU) da interface adesiva em dentina por microtração, nas características morfológicas da camada híbrida (CH) em microscopia confocal e no grau de conversão (GC) de 2 sistemas adesivos: Adper Single bond 2 (SB) e Single Bond® Universal (SU). Cento e oitenta dentes terceiros humanos hígidos foram divididos em 12 grupos (n=10), de acordo com o sistema adesivo utilizado, a presença de saliva e o tempo de armazenagem. Após o procedimento adesivo e aplicação da resina composta Filtek Z250, os dentes foram mantidos em água destilada em estufa a 37°C por 48 horas, 6 meses ou 12 meses antes de serem seccionados em palitos (0,8mm x 0,8mm, aproximadamente) para serem levados à máquina de ensaios universal Instron para os testes de microtração. Para à análise da interface adesiva em microscopia confocal de varredura a laser para verificação e mensuração de alterações internas na interface foram utilizados 60 dentes divididos em 6 grupos (n=10) de acordo com os tempos de 48 horas, 6 meses, e 12 meses respectivamente, empregando os sistemas adesivos (SB) e (SU). O efeito da presença de saliva também foi avaliado pelo grau de conversão dos adesivos, empregando-se espectroscopia de infravermelho transformada de Fourier empregando os sistema adesivos (SB) e (SU) com incorporação de saliva humana na sua composição (n=5) com concentrações 10%, 25% e 50% em vol. Para a comparação das variáveis: RU, (GC), espessura da CH, na presença de saliva e tempo de armazenamento foram utilizados os testes de Análise de Variância a três critérios e de comparações múltiplas de Tukey (p<0,05). Os valores de RU (MPa±dp: 48horas/6meses/1ano) foram: SB (43,53 ±6,0; 40,10±3,4; 38,59±5,4); SalSB (43,09±6,2; 39,86±6,6; 37,255,8); SU (42,98±4,3; 39,30±3,6; 40,44±5,7); Sal SU (44,39±4,2; 42,26±2,5; 38,26±5,7). Os Valores médios da CH (MPa±dp: 48horas/6meses/1ano) foram: SalSB (3,59±0,8; 3,59±1,0; 2,08±1,5). SalSU (1,26±0,5; 1,73±0,8; 1,07±0,3). Os valores de GC (MPa±dp: 10%/25%/50%vol) foram: SB (85,59±3,4; 49,68±12,8; 38,56±11,8); SU (85,52±3,3; 86,27±3,5; 57,82±11,1).Conclui-se, portanto, que a contaminação por saliva humana não interferiu na RU da interface dentina/resina composta após 48 horas, 6 meses e 12 meses. A morfologia da camada hibrida foi alterada pela presença da saliva nos períodos 6 e 12 meses,. O GC dos sistemas adesivos foi afetado pela presença de saliva após a polimerização imediata. Entretanto o fator tempo foi determinante para a deformação da interface dentina/resina para ambos os sistemas adesivos.(AU)

The objective of this study was to analyze the effect of human saliva contamination on bond strength of the dentin/adhesive interface, morphology of the hybrid layer by confocal microscopy and SEM analysis and degree of conversion of 2 adhesive systems: Adper Single bond 2 (SB) and Single Bond® Universal ( SU). One hundred and eighty healthy human third teeth were divided into 12 groups (n = 10), according to the adhesive system used, the presence of saliva and the storage time. After the adhesive procedure and placement of resin composite (Filtek Z250), the teeth were stored in distilled waterat 37 ° C for 48 hours, 6 months or 12 months before being cut into sticks (0.8mm x 0.8mm, approximately) to the microtensile strength tests. For the analysis of the adhesive interface in confocal microscopy of laser scanning for verification and measurement of internal interface changes, 60 teeth were used divided into 6 groups (n = 10) according to the storage time: 48 hours, 6 months, and 12 monthsand (SB) and (SU). The effect of the presence of saliva was also evaluated by the degree of conversion of the adhesives using Fourier transform infrared spectroscopy employing adhesive (SB) and (SU) systems incorporating human saliva in its composition (n = 5) with 10%, 25% and 50% vol. For the comparison of the variables: bond strength, degree of conversion, and hybrid layer thickness in the presence of saliva and storage time, the three criteria Variance Analysis and Tukey multiple comparisons tests (p <0.05) were used. The values of bond strength (MPa ± dp: 48hours / 6meses / year) were: SB (43.53 ± 6.0, 40.10 ± 3.4, 38.59 ± 5.4); SalSB (43.09 ± 6.2, 39.86 ± 6.6, 37.255.8); SU (42.98 ± 4.3, 39.30 ± 3.6, 40.44 ± 5.7); SU salt (44.39 ± 4.2, 42.26 ± 2.5, 38.26 ± 5.7). The mean values of hybrid layer thickness (MPa ± dp: 48hours / 6meses / year) were: SalSB (3.59 ± 0.8, 3.59 ± 1.0, 2.08 ± 1.5). SalSU (1.26 ± 0.5, 1.73 ± 0.8, 1.07 ± 0.3). The values of degree of conversion (MPa ± dp: 10% / 25% / 50% vol) were: SB (85.59 ± 3.4, 49.68 ± 12.8, 38.56 ± 11.8); (85.52 ± 3.3, 86.27 ± 3.5, 57.82 ± 11.1). It was therefore concluded that human saliva contamination did not interfere on bond strength of the dentin/adhesive interface after 48 hours, 6 months and 12 months. The morphology of the hybrid layer was altered by the presence of saliva after 6 and 12 months. The degree of conversion of adhesive systems was affected by the presence of saliva immediately after polymerization. However, the time factor was determinant for the dentine/resin interface deformation for both adhesive systems.(AU)

Pancreatectomía córporo-caudal con resección del tronco celíaco por adenocarcinoma de cuerpo pancreático: intervención de Appleby modificada / Distal pancreatectomy with celiac axis resection for adenocarcinoma of the pancreatic body: the modified Appleby procedure

La resección oncológica completa es el único procedimiento que permite la sobrevida a largo plazo en cáncer de páncreas. La afectación de la arteria hepática, tronco celíaco o arteria mesentérica superior constituyen una contraindicación quirúrgica porque se asocia a mal pronóstico y por las dificultades técnicas que implica conseguir la resección oncológica completa. Solo un grupo seleccionado de pacientes con buena respuesta a la quimioterapia y pasibles de resección R0 se benefician de la cirugía de resección del tronco celíaco. A partir de un caso clínico de un adenocarcinoma de páncreas con infiltración de la arteria hepática común y tronco celíaco que tras una buena respuesta a la neoadyuvancia y embolización de la arteria hepática común fue sometido a una esplenopancreatectomía córporo-caudal con resección del tronco celíaco, se realiza una revisión de la literatura sobre el tema y sus aspectos técnicos relevantes. El análisis realizado permite sugerir que en casos debidamente seleccionados la pancreatectomía córporo-caudal con resección del tronco celíaco en bloque es un procedimiento factible, seguro, y con buenos resultados quirúrgicos y oncológicos. En condiciones de respuesta a la quimioterapia neoadyuvante y experiencia del equipo quirúrgico pareciera que esta cirugía podría mejorar el pronóstico y calidad de vida de estos enfermos.

Abstract Complete oncologic resection is the only procedure that enables survival in pancreatic cancer. Compromise of the liver artery, the celiac artery or the superior mesenteric artery constitute a surgical contraidication since it is associated to a bad prognosis and it is technically hard to achieve a complete surgical resection. Only a selected group of patients who respond well to chemotherapy and may be subject to resection benefit from celiac artery resection surgery. A clinical case of adenocarcinoma of the pancreas with infiltration of the common liver artery and the celiac artery underwent a corporeo-caudal pancreatosplenectomy with celiac artery resection after a good response to neoadjuvant therapy and hepatic arterial embolization. Based on this, a review of literature on this issue and its relevant technical aspects was conducted. The analysis performed may suggest that in duly selected cases, corporeo-caudal pancreatosplenectomy with bloc celiac artery resection is a feasible and safe procedure with good surgical and oncologic results. Upon good response to neoadjuvant chemotherapy and an experienced surgical team, this surgery seems to improve prognosis and the quality of life of these patients.

Resumo A ressecção oncológica completa é o único procedimento que permite uma sobrevida em longo prazo a pacientes com câncer de pâncreas. O comprometimento da artéria hepática, tronco celíaco ou artéria mesentérica superior é uma contraindicação cirúrgica porque está associado a um prognóstico ruim e, devido às dificuldades técnicas que implica conseguir a ressecção oncológica completa. Somente um grupo selecionado de pacientes com boa resposta à quimioterapia e que possa ser submetido à ressecção R.0 pode se beneficiar da cirurgia de ressecção do tronco celíaco. A partir de um caso clínico de um adenocarcinoma de pâncreas com infiltração da artéria hepática comum e do tronco celíaco, que depois de apresentar boa resposta à quimioterapia e a embolização da artéria hepática comum, foi submetido a uma esplenopancreatectomia corpo-caudal com ressecção do tronco celíaco, realizou-se uma revisão da literatura sobre o tema e seus aspectos técnicos relevantes. A análise realizada permite sugerir que nos casos devidamente selecionados, a pancreatectomia corpo-caudal com ressecção em bloco do tronco celíaco é um procedimento factível, seguro, com bons resultados cirúrgicos e oncológicos. Quando se reúnem as condições de resposta adequada à quimioterapia neoadjuvante e a experiência da equipe de cirurgia, pareceria que esta intervenção poderia melhorar o prognóstico e a qualidade de vida destes pacientes.

Endocrown: a conservative approach / Endocrown: uma abordagem conservadora

The purpose of this clinical case description article was to present the planning sequence, indication, treatment and performance to obtain a crown of the Endocrown type. This clinical case description article illustrates a therapeutic option for functional and esthetic rehabilitation of a devitalized mandibular molar, presenting a small amount of remaining coronal tooth structure, by means of cementing a pure porcelain crown of the Endocrowntype (Adhesive Endodontic Crown). A 39-year-oldwoman presented to the Graduate clinic of the Bauru Dental School (FOB), University of São Paulo (USP),with the complaint that tooth #36 had an extensive and unsatisfactory composite resin restoration. The lithium disilicate-based system of monolithic porcelain was used with the lost wax technique. This therapy promoted the stability and retention of the indirect restoration, without the need for performing reconstruction of the above mentioned tooth, either by means of a cast metal core or reconstruction with intracanal post, there by reducing the treatment time. After the tooth preparation, the provisional restoration was done with acrylic resin to determine if the retention and stability of the remaining tooth was adequate to receive the indirect. The characteristics of the internal and external walls of the dental remnants, cervical termination, impression-taking, laboratory stages and adhesive cementation will be discussed. The major advantage of indicating an endocrown is the use of the dental remnants it self, particularly the pulp chamber, to promote retention and stability in cases without adequate height for performing complete dental and crown reconstruction...

O objetivo deste artigo de descrição de caso clínico foi apresentar a sequência de planejamento, indicação, tratamento e execução de uma coroa do tipo Endocrown (Coroa Endodôntica Adesiva).Este artigo ilustra uma opção terapêutica para reabilitação funcional e estética de um molar inferior desvitalizado, apresentando uma pequena quantidade de remanescente coronário, por meio da cimentação de uma coroa pura de porcelana do tipo Endocrown. Uma mulher de 39 anos de idade, apresentou-se à clínica de Pós-Graduação da Faculdade de Odontologia de Bauru (FOB) da Universidade de São Paulo(USP), com a queixa de uma extensa e insatisfatória restauração de resina composta no dente 36. O sistema monolítico de porcelana à base de dissilicato de lítio foi utilizado com a técnica da cera perdida.Esta técnica promoveu a estabilidade e a retenção da restauração indireta, sem a necessidade de realizara reconstrução do dente 36, quer por meio de um núcleo metálico fundido ou reconstrução com pino intra canal, reduzindo assim o tempo de tratamento.Após o preparo do dente, realizou-se a restauração provisória com resina acrílica e verificou-se se a retenção e estabilidade do remanescente dentário era adequada para receber a restauração do tipo Endocrown. As características das paredes internas e externas do preparo do remanescente dentário,término cervical, moldagem, etapas laboratoriais e de cimentação são discutidas. A principal vantagem da indicação de uma coroa do tipo Endocrown é a utilização do próprio remanescente dentário,particularmente a câmara pulpar, para promover a retenção e estabilidade em casos onde não haja altura adequada para a reconstrução coronária...

Uso y percepciones de las tecnologías de información y comunicación en pacientes con hipertensión arterial, dislipidemia o diabetes de un hospital nacional de Lima, Perú / Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Perú

El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de información y comunicación (TIC), en 206 pacientes portadores de hipertensión arterial, dislipidemia y diabetes, reclutados de la consulta externa en un hospital nacional de Lima, Perú. El 54,4% fueron adultos mayores y 70,4% mujeres. El uso diario de llamadas por celular fue 44,7%; la mayoría nunca había usado una computadora (78,2%), correo electrónico (84%) o Internet (84%). Muchos nunca han enviado (80,6%) o recibido (69,9%) un mensaje de texto. El 70% ha olvidado alguna vez tomar su medicina. Al 72,8% le gustaría que le recuerden tomar sus medicinas y 67,9% tiene algún familiar que podría ayudarlos a acceder a las TIC. Pese al bajo uso de las TIC en esta población, existe predisposición y expectativa por los pacientes a participar en programas que las implementen.

This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them.

Effect of resin-modified glass-ionomer cement lining and composite layering technique on the adhesive interface of lateral wall

Interface integrity can be maintained by setting the composite in a layering technique and using liners. Objective The aim of this in vitro study was to verify the effect of resin-modified glass-ionomer cement (RMGIC) lining and composite layering technique on the bond strength of the dentin/resin adhesive interface of lateral walls of occlusal restorations. Material and Methods Occlusal cavities were prepared in 52 extracted sound human molars, randomly assigned into 4 groups: Group 2H (control) – no lining + two horizontal layers; Group 4O: no lining + four oblique layers; Group V-2H: RMGIC lining (Vitrebond) + two horizontal layers; and Group V-4O: RMGIC lining (Vitrebond) + four oblique layers. Resin composite (Filtek Z250, 3M ESPE) was placed after application of an adhesive system (Adper™ Single Bond 2, 3M ESPE) dyed with a fluorescent reagent (Rhodamine B) to allow confocal microscopy analysis. The teeth were stored in deionized water at 37oC for 24 hours before being sectioned into 0.8 mm slices. One slice of each tooth was randomly selected for Confocal Laser Scanning Microscopy (CLSM) analysis. The other slices were sectioned into 0.8 mm x 0.8 mm sticks to microtensile bond strength test (MPa). Data were analyzed by two-way ANOVA and Fisher's test. Results There was no statistical difference on bond strength among groups (p>0.05). CLSM analysis showed no significant statistical difference regarding the presence of gap at the interface dentin/resin among groups. Conclusions RMGIC lining and composite layering techniques showed no effect on the microtensile bond strength and gap formation at the adhesive interface of lateral walls of high C-factor occlusal restorations. .

Mercado de formación y disponibilidad de profesionales de ciencias de la salud en el Perú / Demand for training and availability of health science professionals in Peru

Objetivos. Describir el mercado de formación y la disponibilidad de profesionales de ocho carreras de ciencias de la salud en Perú. Además, examinar los perfiles de los médicos, enfermeros y obstetras que se forman y sus competencias para trabajar en el primer nivel de atención. Materiales y métodos. Estudio transversal utilizando datos de volumen de postulantes, ingresantes y graduados de ocho profesiones durante el periodo de 2007û2011. También se analizaron los planes de estudio de programas de formación de médicos, enfermeros y obstetras de universidades públicas y privadas, y los perfiles de competencias elaborados por los colegios profesionales y el Ministerio de Salud (MINSA). Resultados. Las tasas de ingreso en universidades públicas y privadas varían según la carrera: 4 y 28% respectivamente para Medicina Humana, y 18 y 90% para Enfermería. Además, se estima que se gradúan aproximadamente 43 y 53% de los estudiantes que ingresan a Medicina y Enfermería, respectivamente. El análisis del perfil de los profesionales recientemente graduados en Medicina, Enfermería y Obstetricia, al ser contrastados con el perfil de competencias priorizadas para los profesionales que laboran en el primer nivel de atención elaborado por el MINSA, indican que no están necesariamente ni específicamente formados para trabajar en este nivel de atención. Conclusiones. Existe demanda de formación para profesionales de ciencias de la salud y predomina la oferta por parte de universidades privadas. Los perfiles de competencias desarrollados por el MINSA muestran un claro divorcio con respecto a la oferta actual de profesionales formados.

Objectives. To describe the availability and demand of professional training programs for eight health science professions in Peru. Study the profiles of the physicians, nurses and midwives that these programs train and their competencies to work at the primary health care level. Materials and methods. Cross-sectional study using data on the volume of applicants, students and graduates of these eight professional training programs during the period 2007 - 2011. In addition, the curricula of professional training programs for physicians, nurses and midwives from public and private universities were analyzed, along with competency profiles developed by Professional Colleges and the Ministry of Health. Results. Admission rates in public and private universities vary by program: 4% and 28% respectively for medical schools, and 18% and 90% for nursing. Graduation rates were estimated at approximately 43% and 53% of students entering medicine and nursing training programs respectively. Contrasting the profiles of recently graduated professionals in medicine, nursing and midwifery, with the skills required by the Ministry of Health for professionals working in primary care the first level of care, indicate that these recently graduated professionals are not necessarily or specifically trained to work in primary care. Conclusions. Demand for professional training in health sciences exists and its supply is met predominantly by private universities. Competency profiles developed by the MOH for the basic professional health team in primary care shows a clear disconnect regarding the current supply of trained professionals.

Mexican registry of pediatric cardiac surgery: First report

Background: Currently, there is a spreading worldwide tendency to characterize health issues and to propose alternative solutions via the creation of computerized databases. The aim of this study was to present the results in a computerized database of pediatric cardiac surgeries developed under the auspices of the Mexican Association of Specialists in Congenital Heart Diseases (Asociación Mexicana de Especialistas en Cardiopatías Congénitas A.C) and coordinated by the collegiate group of Pediatric Cardiology and Surgery as petitioned by the National Institutes of Health and High Specialty Hospitals Coordinating Commission. Methods: We analyzed all cases registered in the database during a 1-year observation period (August 1, 2011 to July 31, 2012) by all major Health Ministry-dependent institutes and hospitals offering surgical services related to pediatric cardiopathies to the non-insured population. Results: Seven institutions participated voluntarily in completing the database. During the analyzed period, 943 surgeries in 880 patients with 7% reoperations (n = 63) were registered. Thirty-eight percent of the surgeries were performed in children <1 year of age. The five most common cardiopathies were patent ductus arteriosus (n = 96), ventricular septal defect (n = 86), tetralogy of Fallot (n = 72), atrial septal defect (n = 68), and aortic coarctation (n = 54). Ninety percent of surgeries were elective and extracorporeal circulation was used in 62% of surgeries. Global mortality rate was 7.5% with the following distribution in the RACHS-1 score categories: 1 (n = 4, 2%), 2 (n = 19, 6%), 3 (n = 22, 8%), 4 (n = 12, 19%), 5 (n = 1, 25%), 6 (n = 6, 44%), and non-classifiable (n = 2, 9%). Conclusions: This analysis provides a representative view of the surgical practices in cardiovascular diseases in the pediatric population at the national non-insured population level. However, incorporating other health institutions to the national registry database will render a more accurate panorama of the national reality in surgical practices in the population <18 years of age.

Bone density of defects treated with lyophilized amniotic membrane versus colagen membrane: a tomographic and histomorfogenic study in a rabbit´s femur / Densidad ósea de defectos tratados con membrana amniótica liofilizada versus membrana de colágeno. Un estudio topográfico e histomorfogénico en el fémur de un conejo

The aim of this study was to compare the bone density of bone defects treated with lyophilizated amniotic membrane (LAM) and collagen Membrane (CM), at 3 and 5 weeks. Two bone defects of 4 mm in diameter and 6 mm deep were created in left distal femoral diaphysis of New Zealand rabbits (n = 12). The animals were randomly divided into 2 groups. One of the defects was covered with lyophilized amniotic membrane (Rosa Chambergo Tissue Bank/National Institute of Child Health-IPEN, Lima, Peru) or collagen Membrane (Dentium Co, Seoul, Korea). The second was left uncovered (NC). The rabbits were killed after 3 and 5 weeks (3 rabbits/period). The results showed a high bone density and repair of the defect by new bone. The tomographic study revealed that the bone density of the defects treated with LAM at 3 weeks was equivalent to the density obtained with CM and higher density compared with NC (p <0.05). At 5 weeks, the bone density obtained with LAM was more than density CM and NC (p <0.05). The histomorphometric study showed no significant differences between LAM and CM at 3 and 5 weeks (p> 0.05). The results show that lyophilizated amniotic membrane provides bone density equal or higher to the collagen membrane.

El propósito de este estudio fue comparar la densidad ósea (DO) de defectos óseos tratados con membrana amniótica liofilizada (MAL) y membrana de colágeno (MC), a las 3 y 5 semanas. Se crearon dos defectos óseos, de 4 mm de diámetro y 6 mm de profundidad, en la diáfisis femoral distal izquierda de conejos Nueva Zelanda (n=12). Los animales fueron divididos aleatoriamente en 2 grupos. Uno de los defectos fue cubierto con membrana amniótica liofilizada (Banco de tejidos Rosa Chambergo/INSN-IPEN, Lima, Perú) o membrana de colágeno (Dentium Co, Seoul, Korea). El segundo se dejó sin cubrir (NC). Los conejos fueron sacrificados después de 3 y 5 semanas (3 conejos/periodo). Los resultados mostraron una alta DO y reparación del defecto por hueso neoformado. El estudio tomográfico reveló que la DO de los defectos tratados con MAL a las 3 semanas fue comparable a la densidad obtenida con MC y mayor comparado con la densidad de NC (p<0,05); mientras que a las 5 semanas fue mayor a la densidad de MC y NC (p<0,05). El estudio histomorfométrico no mostró diferencias significativas entre MAL y MC a las 3 y 5 semanas (p>0,05). Los resultados muestran que la membrana amniótica liofilizada brinda densidad ósea comparable o mayor que la membrana de colágeno.