Hábitos bucales no fisiológicos y maloclusión en niños que asisten a la consulta de odontopediatría / Nonphysiological oral habits and malocclusion in children attending dentistry consultation

Un hábito bucal no fisiológico puede interferir con el desarrollo de la oclusión. El objetivo de este estudio fue describir los hábitos bucales no fisiológicos y maloclusión en niños con dentición mixta que asisten a la consulta de Odontopediatría II área de Pregrado de la Facultad de Odontología de la Universidad de Carabobo en el periodo 2012-2013. El estudio fue epidemiológico descriptivo no experimental transversal, población 190 historias clínicas, muestra no probabilística 110 historias clínicas. La detección de los diferentes hábitos bucales no fisiológicos se realizó en 2 etapas: 1) llenado de la historia clínica de la FOUC y 2) Aplicación de una lista de cotejo con los datos obtenidos en la Historia Clínica. El total de pacientes sanos fue de 29, los pacientes con maloclusión dieron un valor de 81; el hábito bucal de mayor frecuencia fue la onicofagia con un valor de 40 pacientes, con respecto a las maloclusiones se observó mayor frecuencia el apiñamiento con 22 pacientes, clase II subdivisión 2 con 21 pacientes, mordida abierta con 14 pacientes, por último, los pacientes que presentaron hábitos bucales no fisiológicos y maloclusión fue de 51. Se encontró evidencia significativa con respecto a la influencia de los hábitos bucales no fisiológicos sobre la maloclusión, es necesaria la identificación oportuna de estos hábitos, si es posible disminuir o erradicarlos durante el crecimiento y desarrollo de los maxilares, por otra parte, tratar de no anticipar el uso de dispositivos antes de los primeros 6 meses de vida.

A nonphysiological oral habit may interfere with the development of the occlusion. The objective of this study was to describe the non-physiologic oral habits and malocclusion in children with mixed dentition attending the consultation area of the Undergraduate Dentistry II, Faculty of Dentistry, University of Carabobo in the period 2012-2013. The study was non-experimental descriptive epidemiological cross-sectional, population 190 medical records, non-probability sample 110 clinical records. The detection of different non- physiological oral habits was conducted in 2 stages: 1) filled by the medical history of FOUC and 2) Implementation of a checklist with the data obtained in the clinical history. A total of 29 patients were healthy, patients with malocclusion gave a value of 81, the most frequent oral habit was nail biting with a value of 40 patients, with regarding crowding malocclusions more frequently observed with 22 patients, class II branch 2 with 21 patients, 14 patients with open bite, finally, patients who had no oral habits and malocclusion physiological was 51. Significant evidence was found regarding the influence of non- physiological oral habits on malocclusion, it is necessary to identify these habits in a timely manner, if possible reduce or eradicate during growth and development of the jaws , on the other hand, try not to anticipate the use of devices before the first 6 months of life.

Microbiological assessment of house and imported bottled water by comparison of bacterial endotoxin concentration, heterotrophic plate count, and fecal coliform count

Consumers increasingly use bottled water and home water treatment systems to avoid direct tap water. According to the International Bottled Water Association (IBWA), an industry trade group, 5 billion gallons of bottled water were consumed by North Americans in 2001. The principal aim of this study was to assess the microbial quality of in-house and imported bottled water for human consumption, by measurement and comparison of the concentration of bacterial endotoxin and standard cultivable methods of indicator microorganisms, specifically, heterotrophic and fecal coliform plate counts. A total of 21 brands of commercial bottled water, consisting of 10 imported and 11 in-house brands, selected at random from 96 brands that are consumed in Puerto Rico, were tested at three different time intervals. The Standard Limulus Amebocyte Lysate test, gel clot method, was used to measure the endotoxin concentrations. The minimum endotoxin concentration in 63 water samples was less than 0.0625 EU/mL, while the maximum was 32 EU/mL. The minimum bacterial count showed no growth, while the maximum was 7,500 CFU/mL. Bacterial isolates like P. fluorescens, Corynebacterium sp. J-K, S. paucimobilis, P. versicularis, A. baumannii, P. chlororaphis, F. indologenes, A. faecalis and P. cepacia were identified. Repeated measures analysis of variance demonstrated that endotoxin concentration did not change over time, while there was a statistically significant (p < 0.05) decrease in bacterial count over time. In addition, multiple linear regression analysis demonstrated that a unit change in the concentration of endotoxin across time was associated with a significant (p < 0.05) reduction in the bacteriological cell count. This analysis evidenced a significant time effect in the average log bacteriological cell count. Although bacterial growth was not detected in some water samples, endotoxin was present. Measurement of Gram-negative bacterial endotoxins is one of the methods that have...

Hepatitis C in Puerto Rico: a time for public health action

Studies investigating the seroprevalence of HCV infection have been carried out in diverse populations, showing an estimated worldwide prevalence of 3%. A seroprevalence survey conducted among randomly selected non-institutionalized adults aged 21-64 years in San Juan, Puerto Rico in 2001-2002 revealed that 6.3% were positive for HCV antibodies. These data suggest that Puerto Ricans are burdened with a significantly greater prevalence of HCV infection compared to the general United States population aged 20-69 years (0.9%-4.3%). This article illustrates data from different sources that taken together establish the need to start addressing HCV infection in Puerto Rico with prompt and decisive public health actions. Some of these include (1) establish hepatitis C prevention as a priority for state and municipal public health authorities, (2) raise awareness and educate target populations about HCV transmission and prevention, (3) increase clinician awareness of the HCV reporting system and the epidemiology and management of hepatitis C, (4) increase availability of diagnosis and treatment facilities, (5) increase access to effective drug treatment services, and (6) develop appropriate control measures to help reduce continued transmission in correctional settings.

Review of clinical characteristics and management of patients with ST segment elevation myocardial infarction at atertiary care center

BACKGROUND: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective and strategic management, leading to a revision of the 1999 ACC/AHA practice guidelines for that condition. OBJECTIVE: Analyze the clinical characteristics, management strategies, the timing of therapeutic interventions and outcome of patients with STEMI referred to the Cardiovascular Center of Puerto Rico (CVCPR). METHODS: Retrospective review of medical records of all patients admitted to the CVCPR with a diagnosis of STEMI from January 1, 2003 to December 31, 2003. RESULTS: A total of 184 medical records were reviewed. Seventy-six percent of patients were men, mean age was 62.1 +/- 11.8 years. A high prevalence of coronary risk factors was present: systemic hypertension (64), diabetes mellitus (40), dyslipidemia (35), smoking (33) and previous CAD (32). Less than 1/4 of referral forms contained data indicative of whether patients had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty percent of patients arrived to the CVCPR more than 48 hours after diagnosis. Only forty-two patients (23) arrived within 12 hours. Thrombolytic therapy had been used in 27of them. 179 (97) patients underwent coronary angiography, 69.2of which had multivessel disease. 114 (62) patients underwent percutaneous coronary interventions (PCI) with stenting. Patients submitted to PCI and stenting of the culprit lesion had a better outcome and survival than the ones not exposed to those procedures (p = 0.02). Approximately two-third of patients received secondary prevention medications upon discharge. CONCLUSIONS: Relevant findings of this review were that in spite of high prevalence of CAD major risk factors, the use of medications of proven benefit for prevention and treatment of CAD at referral centers was less than that recommended by current guidelines, a significant delay in the transfer of patients to the tertiary care facility (in most cases that period exceeded more than 48 hours after diagnosis) and a reduced utilization of thrombolytic therapy. Intensification of the education of physicians throughout the island regarding these matters is to be encouraged. Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fib

Early postoperative complications after coronary artery bypass grafting at the San Juan Veterans Affairs Medical Center

OBJECTIVES: Describe the perioperative characteristics of the patients undergoing coronary artery bypass grafting (CABG) in San Juan, Veterans Affairs Medical Center (SJ-VAMC). Determine the in-hospital and 30-day morbidity and mortality following CABG and identify adverse predictors for postoperative complications. BACKGROUND: Preoperative risk factors for complications post-CABG have been identified; however limited data is available regarding the value of these predictors in the Puerto Rican Population. METHODS: Perioperative characteristics and 30-day complications were gathered from all patients undergoing CABG (n = 252) at the SJ-VAMC (2001-2003). Logistic regression analysis was performed to determine factors associated with the occurrence of complications. RESULTS: The population's mean age was 66.9 +/- 8.1 years. Associated illnesses included: hypertension (95.6), diabetes (57), past smoking (61), COPD (26), chronic renal insufficiency (CRI-11.5), cerebrovascular disease (CVD-20.6), disabling angina (78), 3-vessel coronary disease (75.8), significant left main stenosis (20), and non-elective surgical intervention (54). The most frequent primary complications were postoperative myocardial infarction (MI-4.8) and congestive heart failure (4.8). The 30-day mortality was 1.2. Upon multivariate analysis PRBC transfusions > 3 units was associated to increased risks of primary complications, in patients with prior history of CVD. CRI and LVEF < or = 40were independently associated to development of primary complications, in patients with prior MI and CVD. CONCLUSION: The preoperative characteristics are suggestive of an older and sicker patient that is undergoing CABG at the SJ-VAMC. Despite this, the death rate was low and the frequency of other complications comparable to the Society of Thoracic Surgeons (STS) National Adult Cardiac Database.

Epidemiology of hepatitis C infection and its public health implications in Puerto Rico

Hepatitis C infection is the most common chronic blood-borne pathogen in the United States associated with liver cirrhosis and hepatocellular carcinoma and is the leading reason for liver transplantation. It has been estimated that hepatitis C infection may lead to a substantial health and economic burden over the next 10 to 20 years. The prevalence of hepatitis C virus (HCV) infection varies worldwide, with an estimated overall prevalence of 3%. However, the only available data of hepatitis C in the general population of Puerto Rico suggest an elevated prevalence of hepatitis C infection in the municipality of San Juan (6.3%) in comparison with estimates for the adult population residing in the United States (0.9%-3.9%). Much of the inter-region variability in the prevalence of hepatitis C can be attributable to the frequency and extent to which different risk factors have contributed to the transmission of the virus. Established risk factors for infection include injection drug use, transfusion of blood and solid organ transplantation from infected donors prior to July 1992 and blood clotting products before 1987, occupational injury, vertical transmission, sex with an HCV infected partner, and multiple sexual partners. Other potential exposures for infection that have been investigated in epidemiologic studies include history of intranasal cocaine use, sharing of contaminated equipment and personal care items, tattooing, body piercing, imprisonment, acupuncture, and use of contaminated healthcare instruments. The high incidence of AIDS in Puerto Rico and the large prevalence observed in Puerto Rican inmates and in adults residing in the municipality of San Juan indicate that HCV infection is an emerging public health concern. From a public health perspective, potential targets for intervention to decrease the spread of HCV infection, ongoing surveillance, increased clinician awareness of disease reporting systems and the epidemiology and management...

Headache profile at a medical institution with a specialized center for headache management

OBJECTIVE: To describe the clinical characteristics of headache to determine the distribution of antimigraine medication use by specialty of treating physician and the cost of the treatment of headache, among suffers by type of employee (health professionals vs. others). BACKGROUND: The services of a Headache Center are usually offered to the employees of the hospital in which the Center is localized; however, the number and related outcomes of employees who use the Center services versus those who use primary care facilities remain unknown in Puerto Rico. METHODS: A self-administered questionnaire was completed by 350 out of 415 (84.3) employees of one of the private hospital in San Juan, Puerto Rico regarding their management of headache. The data collected included age, gender, occupation, headache intensity and frequency, type of treating physician and medication use. Contingency tables were used to describe statistical associations among categorical variables. Pearson's chi square test or Fisher's exact test was used to assess significance. RESULTS: Nearly 75 of employees suffers headaches on a regular basis. Among these, 25 classified the headache as severe, 20.3 had 5 or more attacks per month, 62.1 reported that productivity was affected and 85 lost 1-2 days of work per month due to headache attacks. Approximately 20 visit a physician when they suffer a headache, and more than one-third visits a specialist. Only 2.34 of the employees used antimigraine medications (triptans). The use of triptans was more common among those employees attending a specialist for headache treatment than those attending primary care physicians (p < 0.05). A similar finding was observed for employees attending a neurologist versus other physicians (p < 0.05). CONCLUSIONS: These results indicate that headache attacks are prevalent and affect productivity and the cost for this institution was near dollars 4,400.00 per month. Despite the frequency and intensity of headache, less than one-fourth seek medical evaluation. Prescription ofspecific antimigraine medication was more common among specialists suggesting a more aggressive management for headache

Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996

OBJECTIVES: Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS: To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS: Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95 per cent CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95 per cent CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3 per cent) had Crohn's disease and 187 (54.7 per cent) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6 per cent were females, the mean age was 35.2 +/- 18.3 years, and 18.1 per cent had a family history of IBD. More than half (57.8 per cent) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1 per cent had a family history of IBD. CONCLUSIONS: The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.

The association of lead-contaminated house dust and blood lead levels of children living on a former landfill in Puerto Rico

Exposure to lead in children living on a former landfill in Vega Baja-Puerto Rico, a United States Environmental Protection Agency (USEPA) designated Superfund Site, is a major health concern. Direct contact with lead-contaminated soil is considered a major exposure source. However, there is a lack of information regarding the contribution of lead-contaminated house dust to children's blood lead concentrations. This study evaluated the relationship between lead contaminated-house dust and children's blood lead levels. Blood from 42 children, aged 6 years old or less, and dust from 29 houses were analyzed for lead, and face-to-face interviews were performed to gather information on potential risk factors for high blood lead levels. Blood lead levels ranged from 0.97 to 7.79 micrograms/dL. Lead values for floors fluctuated from 0.12 to 98.30 micrograms/ft2, with 17 per cent of houses surpassing the USEPA standard of 40 micrograms/ft2. Multiple regression analysis showed that lead in window sills, toy chewing and soil eating habits were significant predictors of blood lead levels. Further investigations aimed at assessing the long-term effects of constant exposure to environmental lead in these children are warranted.

Prevalence of obesity and its association with blood pressure, serum lipids and selected lifestyles in a Puerto Rican population of adolescents 12-16 years of age

OBJECTIVES: To describe the prevalence of obesity and determine its association with blood pressure, serum lipids and lifestyles in adolescents attending a public junior-high school in San Juan, Puerto Rico. METHODS: During the 1999-2000 academic school year, 352 students, ranging in age from 12 years to 16 years, were screened for weight, height, and blood pressure. A sub-sample of voluntary adolescents (n = 26) was screened for serum lipids and lifestyles were assessed using a standardized questionnaire. RESULTS: The prevalence of level I obesity and level II obesity among 12 to 16 years old adolescents were 33.2 per cent and 2 per cent, respectively. The mean systolic and diastolic blood pressures were significantly higher in obese than in non-obese adolescents (p < .001). There were no significant differences in serum lipids between the study groups (p > .05). However, the obese group showed higher median levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study group reported engaging in hazardous lifestyles (alcohol intake, smoking, and unhealthy eating patterns), but no real differences in lifestyles were found between obese and non-obese groups (p > .05). CONCLUSIONS: A high prevalence of level I and level II obesity was found in this population. In addition, significant positive correlations between blood pressure and body mass index were observed. This study underscores the need to assess the burden of obesity in Puerto Rico in order to develop community intervention strategies encouraging early detection and conduct modification towards healthier lifestyles.

Effect of right atrial pacing, intravenous amiodarone and beta blockers for suppression of atrial fibrillation after coronary artery bypass surgery: a pilot study

OBJECTIVE: This pilot study aimed to compare right atrial pacing, intravenous amiodarone and oral beta-blockers in the prevention, time to onset, duration and effect on hospital stay of postoperative atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) at our center. BACKGROUND: AF is the most common arrhythmic complication after CABG and is related to increased morbidity, length of hospital stay and costs. Trials with different drugs and other therapeutic modalities including beta-blockers, intravenous amiodarone and override suppression of automatic atrial foci by atrial pacing have shown partial success as preventive measures. However, a comparison between those three interventions has not been reported. METHODS: Thirty-six consecutive patients that underwent CABG at our institution were randomly assigned to atrial pacing (18 patients) and intravenous amiodarone (18 patients) after baseline clinical, electrocardiographic and hemodynamic assessment. All patients received concomitant oral metoprolol or atenolol right after extubation. Thirty-three patients who had CABG at our center in the previous two months and that only received beta-blockers during their perioperative period served as a control group. RESULTS: The majority of baseline clinical and hemodynamic characteristics were similar in all groups. Only one patient (5.6 per cent) developed AF in the atrial pacing group versus five (27.8 per cent) on amiodarone and six (18.2 per cent) who only received beta-blockers. That finding, however, did not attain statistical significance (p > 0.05). After adjusting for potential confounders, the odds of occurrence of AF was 77 per cent lower in atrial pacing patients (OR = 0.23; 95 per cent CI: 0.02, 2.20; p = 0.09) and 2.36 times higher in those on amiodarone (95 per cent CI: 0.55, 10.24; P = 0.053) when compared to patients which only received beta blockers. Since only one patient on right atrial pacing developed atrial fibrillation, the analysis of the median time to onset and median duration of atrial fibrillation was restricted to those assigned to amiodarone and those who only received beta-blockers showing no statistically significant differences (p > 0.05)...

Estudio comparativo de indinavir versus ritonavir para evaluar el desarrollo de enfermedades oportunistas en pacientes adultos de SIDA / A comparative study of indinavir versus ritonavir for assessing the development of opportunistic diseases in adult AIDS patients

This observational study compared the probability of developing the first opportunistic infection among AIDS adult patients attending the [quot ]Programa SIDA de San Juan[quot ] who received either indinavir plus zidovudine and lamivudine (n = 45) or ritonavir plus zidovudine and lamivudine (n = 16) between August 1, 1996 and July 31, 1997. No significant differences were observed with respect to appearance of an opportunistic infection, increase in CD4 levels and decrease in viral load between both groups during the study period. However, an increased probability of being free of opportunistic infection after 10 months was observed for the indinavir group (p > 0.05). In addition, the probability of changing or interrupting prescribed therapy was 2 times higher for patients under ritonavir (p < 0.05). These results suggest the need to confirm these findings in a larger group of patients in a controlled clinical trial and to assess the short-term and long-term effects of both therapies among Puerto Rican AIDS patients