Heart Rate Reactivity to Acute Mental Stress is Associated With Parasympathetic Withdrawal and Adiposity in Firefighters

Abstract Background Firefighters are regularly exposed to stress and have a high incidence of cardiovascular events. Investigating cardiovascular and autonomic reactivity to acute mental stress (AMS) and its association with adiposity may contribute to explaining the increased cardiovascular risk in these professionals. Objectives To evaluate cardiovascular and autonomic reactivity to AMS in firefighters while considering adiposity parameters. Methods This study recorded the blood pressure and heart rate (HR) of twenty-five firefighters (38±8 years) at rest, while performing the Stroop color-word test to induce AMS, and recovery. Cardiac autonomic modulation (HR variability), baroreflex sensitivity (BRS — sequential method), and adiposity (electrical bioimpedance) were assessed. One-way or two-way analysis of variance followed by Tukey's post hoc test and multiple linear regression were performed. The significance level was P<0.05. Results The AMS increased mean arterial pressure (MAP — Δ16±13 mmHg) and HR (Δ14±7 bpm) ( P <0.05). These responses were associated with parasympathetic modulation withdrawal (RMSSD: baseline: 29.8±18 vs. AMS: 21.5±14 ms; High-frequency: baseline: 5.2±1.4 vs. AMS: 4.5±1.3 Ln ms 2 ; P <0.05) and decreased in the Up gain of the baroreflex (baseline: 8.9±5.1 vs. AMS: 6.3±3.0 mmHg/ms; P <0.05). Groups divided by HR reactivity peak showed parasympathetic modulation withdrawal only in firefighters with lower adiposity (RMSSD: baseline: 27.8±17.6 vs. AMS: 14.4±9.2 ms; High-Frequency: baseline: 5.3±1.2 vs. AMS: 3.8±1.4 Ln ms 2 ; P <0.05). Fat percentage (β = -0.499), BRS (β = 0.486), and sympathetic/parasympathetic balance (β = -0.351) were predictors of HR reactivity ( P <0.05). Conclusion Our results demonstrated that HR reactivity to AMS modulated by cardiac vagal withdrawal seems to be influenced by body composition in this group of firefighters.

Core curriculum in cariology for dentistry degrees in the Republic of Argentina / Contenidos Mínimos de Cariología en el Currículo de las Carreras de Odontología en la República Argentina

ABSTRACT Aim To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools Materials and Method Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W) Results Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved Conclusion Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

RESUMEN Objetivo Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado Materiales y Método El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W) Resultados Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas Conclusión En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

Impacto del padre en el desarrollo de la conducta prosocial de niños y niñas durante la primera infancia: una revisión sistemática

Los bebés exhiben una amplia gama de comportamientos prosociales, que incluyen ayudar, compartir, consolar y cooperar. En la infancia, estos comportamientos se vuelven más sofisticados y socialmente apropiados. El objetivo de esta investigación es identificar y revisar sistemáticamente la literatura que ha incorporado el estudio de la figura paterna y su impacto en el desarrollo de la conducta prosocial en los niños/as entre los 0 y 5 años. Método, utilizando la metodología PRISMA, se realiza una búsqueda y análisis de artículos científicos en las bases de datos Scopus y Web of Science, considerando criterios de inclusión y exclusión establecidos. Resultados, se seleccionaron 28 artículos y el análisis de sus resultados indica que el padre tiene un impacto en el desarrollo de la conducta prosocial de los niños entre los 0 y 5 años. El ejercicio del rol paterno y el apoyo entregado por el padre, favorece que el niño/a manifieste conductas prosociales desde la infancia temprana, en la relación con sus figuras significativas y con terceros, de forma directa e indirecta, en los distintos contextos de socialización.

Infants exhibit a wide range of prosocial behaviors, including helping, sharing, comforting, and cooperating. In infancy, these behaviors become more sophisticated and socially appropriate. The aim of this research is to systematically identify and review the literature that has incorporated the study of the father figure and its impact on the development of prosocial behavior in children aged 0-5 years. Method, using the PRISMA methodology, a search and analysis of scientific articles in the Scopus and Web of Science databases was carried out, considering established inclusion and exclusion criteria. Results, 28 articles were selected and the analysis of their results indicates that fathers have an impact on the development of prosocial behavior in children between 0 and 5 years of age. The exercise of the paternal role and the support provided by the father, favors the child to manifest prosocial behaviors from early childhood, in the relationship with their significant figures and with third parties, directly and indirectly, in the different socialization contexts.

¿Cómo Intervenir el Proceso de Caries en Personas Mayores? Adaptación del Consenso de ORCA/EFCD/DGZ

Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.

Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.

Rotura espontánea de vena ilíaca: una causa infrecuente de abdomen agudo hemorrágico / Spontaneous rupture of the iliac vein: a rare cause of intra-abdominal hemorrhage

RESUMEN La rotura espontánea de la vena ilíaca es una causa poco frecuente de hemorragia retroperitoneal exanguinante. Generalmente está asociada con un traumatismo y las lesiones iatrogénicas durante la cirugía de hemiabdomen inferior o pelviana. Ocurre con frecuencia del lado izquierdo y afecta indistintamente a la vena ilíaca común como a la externa. Con el objetivo de destacar las características clínicas e imagenológicas de esta infrecuente entidad, presentamos un caso fatal de rotura espontánea de la vena ilíaca externa izquierda. El tratamiento se basa en la reparación quirúrgica abierta o, en casos seleccionados, en la colocación de prótesis por vía endovascular. Es necesario un alto índice de sospecha, ya que el diagnóstico y el tratamiento tempranos son fundamentales para mejorar las altas tasas de morbimortalidad que conlleva esta entidad.

ABSTRACT Spontaneous rupture of the iliac vein is a rare cause of fatal retroperitoneal hemorrhage that is generally associated with trauma and iatrogenic injury during lower abdominal or pelvic surgery. It usually occurs in the left common and external iliac veins. We report a fatal case of spontaneous rupture of the left external iliac vein to emphasize the clinical and imaging characteristics of this rare condition. Treatment is based on open surgical repair or endovascular stenting in selected cases. High level of suspicion is essential for early diagnosis and treatment to improve the associated morbidity and mortality.

Estenosis traqueal posintubación asociada a COVID-19. Estudio prospectivo sobre su tratamiento quirúrgico / COVID-19-Related Post-Intubation Tracheal Stenosis. Prospective Study of its Surgical Treatment

RESUMEN Introducción: La enfermedad por SARS-CoV-2 se convirtió en un importante problema de salud pública. El 5 % de los pacientes requirió intubación endotraqueal por insuficien cia respiratoria aguda hipoxémica, y se generó un aumento de consulta por estenosis traqueal. Se realizó el trabajo con el objetivo de expresar los resultados de la cirugía de resección traqueal en pacientes con estenosis post COVID 19. Material y métodos: Estudio prospectivo, observacional, analítico. Se incluyeron 11 pacientes. La evaluación prequirúrgica y postquirúrgica fue la misma en todos los pacientes. Se valoró en el postquirúrgico la ventilación y la fonación hasta los 30 días. Se utilizó la clasificación de Clavien y Dindo para calificar a las complicaciones post-quirúrgicas, con seguimiento hasta los 60 días postquirúrgicos. Análisis estadístico: se aplicó prueba de Wilcoxon para comparar los resultados. Resultados: El 27.2 % de los pacientes tuvieron complicaciones postquirúrgicas. Fue estadísticamente significativa la comparación de la ventilación entre el prequirúrgico y el postquirúrgico (p<0.05) con mejoría en el postquirúrgico. Al comparar la fibrobron coscopía prequirúrgica con la postquirúrgica (diámetro de la luz traqueal) también el resultado fue estadísticamente significativo (p <0.05). Conclusión: Los resultados obtenidos son similares a los expresados en la literatura. La cirugía de resección traqueal es un procedimiento seguro y efectivo y debe ser considerada como tratamiento de primera línea para la estenosis traqueal.

ABSTRACT Introduction: The disease caused by SARS-CoV-2 has become a significant public health issue. 5 % of the patients required endotracheal intubation due to acute hypox emic respiratory failure, leading to an increased number of consultations for tracheal stenosis. This work was done with the aim of presenting the results of tracheal resection in patients with post-COVID-19 stenosis. Material and methods: Analytical, prospective, observational study. 11 patients were included. The preoperative and postoperative evaluation was the same for all patients. Post-surgical ventilation and phonation were assessed up to 30 days. The Clavien and Dindo classification was used to grade post-surgical complications, with follow-up extended up to 60 post-surgical days. Statistical analysis: the Wilcoxon test was used to compare the results. Results: 27.2 % of the patients had postoperative complications. The comparison of pre- and postoperative ventilation (p < 0.05) was statistically significant, with improve ment in the postoperative period. When comparing pre- and postoperative fiberoptic bronchoscopy (tracheal lumen diameter), the result was also statistically significant (p < 0.05). Conclusion: The results obtained are similar to those expressed in the literature. Tra cheal resection is a safe and effective procedure and should be considered as first-line treatment for tracheal stenosis.

DNA sequencing in the classroom: complete genome sequence of two earwig (Dermaptera; Insecta) species

BACKGROUND: Despite representing the largest fraction of animal life, the number of insect species whose genome has been sequenced is barely in the hundreds. The order Dermaptera (the earwigs) suffers from a lack of genomic information despite its unique position as one of the basally derived insect groups and its importance in agroecosystems. As part of a national educational and outreach program in genomics, a plan was formulated to engage the participation of high school students in a genome sequencing project. Students from twelve schools across Chile were instructed to capture earwig specimens in their geographical area, to identify them and to provide material for genome sequencing to be carried out by themselves in their schools. RESULTS: The school students collected specimens from two cosmopolitan earwig species: Euborellia annulipes (Fam. Anisolabididae) and Forficula auricularia (Fam. Forficulidae). Genomic DNA was extracted and, with the help of scientific teams that traveled to the schools, was sequenced using nanopore sequencers. The sequence data obtained for both species was assembled and annotated. We obtained genome sizes of 1.18 Gb (F. auricularia) and 0.94 Gb (E. annulipes) with the number of predicted protein coding genes being 31,800 and 40,000, respectively. Our analysis showed that we were able to capture a high percentage (≥ 93%) of conserved proteins indicating genomes that are useful for comparative and functional analysis. We were also able to characterize structural elements such as repetitive sequences and non-coding RNA genes. Finally, functional categories of genes that are overrepresented in each species suggest important differences in the process underlying the formation of germ cells, and modes of reproduction between them, features that are one of the distinguishing biological properties that characterize these two distant families of Dermaptera. CONCLUSIONS: This work represents an unprecedented instance where the scientific and lay community have come together to collaborate in a genome sequencing project. The versatility and accessibility of nanopore sequencers was key to the success of the initiative. We were able to obtain full genome sequences of two important and widely distributed species of insects which had not been analyzed at this level previously. The data made available by the project should illuminate future studies on the Dermaptera.

Inteligencia emocional en residentes de Cirugía General: análisis de una encuesta nacional / Emotional intelligence among residents in general surgery: analysis of a national survey

RESUMEN Antecedentes: la inteligencia emocional (IE) es la capacidad de reconocer nuestros propios sentimientos y los de los demás, de motivarnos y de manejar adecuadamente las relaciones interpersonales. La IE se ha relacionado con muchas competencias no técnicas necesarias entre los médicos en formación. Objetivo: describir las características psicométricas de la IE en médicos residentes de Cirugía General de la Argentina y analizar los efectos que ejercen sobre ella la edad, el sexo, el ámbito de desempeño y el año de residencia. Material y métodos: estudio prospectivo, analítico de corte transversal; se utilizó la encuesta anónima y autogestionada Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF v1.5) respondida en línea durante el mes de marzo de 2020. Se aplicó la prueba de Kolmogorov-Smirnov para variables cuantitativas, pruebas T y la prueba ANOVA (IC 95%, p estadística α 0,05). Resultados: fueron respondidas 156 encuestas, de las cuales 105 (67,3%) corresponden a mujeres y 51 (32,7%) a hombres. Edad promedio: 29,02 ± 3,69 años. El promedio global de la prueba fue de 4,58 ± 0,89. El análisis ANOVA demostró que existen diferencias estadísticamente significativas de la dimensión bienestar entre los diferentes años de residencia (p = 0,002) así como en puntajes globales de IE (p = 0,0001). Conclusión: la IE es un modelo atractivo y eficaz para definir y capacitar a los futuros cirujanos generales en competencias no técnicas. Estos hallazgos son importantes para generar nuevas propuestas de formación.

ABSTRACT Background: Emotional intelligence (EI) is the ability to recognize our own feelings and those of others, to motivate us and properly manage relationships. EI encompasses many non-technical skills that are important for physicians in training. Objective: The aim of this study was to describe the psychometric characteristics of EI among residents in general surgery in Argentina and to analyze the effects of age, sex, scope of practice and postgraduate year level on it. Material and methods: We conducted a prospective, cross-sectional analytic study using the Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF v1.5), a self-report and anonymous survey that was answered on-line during March 2020. The statistical analysis was performed by using the Kolmogorov-Smirnov test for quantitative variables, Student's t-test and ANOVA (95% CI, p statistic α 0.05). Results: The survey was responded by 156 physicians; 105 (67.3%) were women and 51 (32.7%) were men (mean age: 29.02 ± 3.69 years). Mean global score was 4.58 ± 0.89. ANOVA showed statistically significant differences in the well-being dimension and global scores of EI across the different postgraduate year levels (p = 0.002 and p = 0.0001, respectively). Conclusion: EI is an attractive and effective model for defining and training future general surgeons in non-technical skills. These findings are important for generating new proposals for training.

Bicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo? / Intravenous sodium bicarbonate. When, how and why to use it?

Severe metabolic acidosis is defined by a pH < 7.2 with HCO3− < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be "adapted" and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.

Evaluación teórica de la exposición dietaria a la bacteriocina nisina como conservante natural para aderezos de tipo mayonesa vegetal en Chile

Actualmente, existe una necesidad en la industria alimentaria de buscar preservantes de origen natural que tengan una mejor aceptación por el consumidor. Una alternativa interesante que ha emergido en los últimos años es el uso de antimicrobianos naturales, los cuales además de ser efectivos en el control de microorganismos, son inocuos para la salud. La nisina es una bacteriocina producida por bacterias ácido lácticas que se utiliza actualmente como preservante en varios productos alimenticios. En Chile, el uso de la nisina como aditivo está restringido a quesos y cremas naturales o nata cuajada, pero existen otros alimentos que podrían beneficiarse del uso de este preservante, como es el caso de los aderezos tipo mayonesa vegetal. En el presente trabajo, se analiza de manera teórica, como el uso de nisina en estos aderezos impactaría el consumo máximo permitido para este aditivo en la población chilena. Para esto, se analizó cuál es el consumo teórico actual de nisina en Chile, y cómo este se vería afectado si se utilizara nisina como preservante en aderezos tipo mayonesa vegetal. Finalmente, los datos obtenidos se compararon con el valor de ingesta diaria admisible (IDA) para la nisina, evidenciándose que existe una ventana de oportunidad para el uso de nisina en otros productos alimenticios.

Currently, there is a need in the food industry for natural preservatives that have good consumers acceptance. Natural antimicrobials are a novel alternative, effective in controlling microbial growth, and safe to consume. Nisin is a bacteriocin produced by lactic acid bacteria that is currently used as a preservative in several food products. In Chile, nisin is regulated and restricted as an additive to cheeses and natural creams or curds. However, other food products could benefit from using nisin as a preservative, such as plant-based mayonnaise, where the consumer expects to find natural preservatives. In this review, we make a theoretical analysis of how adding nisin to plant-based mayonnaise would impact the daily intake of this additive in the Chilean population. Finally, we compare this data with the acceptable daily intake for nisin to conclude that there is an opportunity for using nisin as a preservative in plant-based mayonnaise without affecting consumers´ health.

Adolescent depression and resting-state fMRI brain networks: a scoping review of longitudinal studies

The neurobiological factors associated with the emergence of major depressive disorder (MDD) in adolescence are still unclear. Previous cross-sectional studies have documented aberrant connectivity in resting-state functional magnetic resonance imaging (rs-fMRI) networks. However, whether these findings precede MDD onset has not been established. This scoping review mapped key methodological aspects and main findings of longitudinal rs-fMRI studies of MDD in adolescence. Three sets of neuroimaging methods to analyze rs-fMRI data were identified: seed-based analysis, independent component analysis, and network-based approaches. Main findings involved aberrant connectivity within and between the default mode network (DMN), the cognitive control network (CCN), and the salience network (SN). Accordingly, we utilized Menon's (2011) triple-network model for neuropsychiatric disorders to summarize key results. Adolescent MDD was associated with hyperconnectivity within the SN and between DMN and SN, as well as hypoconnectivity within the CCN. These findings suggested that dysfunctional connectivity among the three main large-scale brain networks preceded MDD onset. However, there was high heterogeneity in neuroimaging methods and sampling procedures, which may limit comparisons between studies. Future studies should consider some level of harmonization for clinical instruments and neuroimaging methods.

Effect of liners on composite resin microleakage after selective carious lesion removal: an experimental study / Efecto de los recubrimiento en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas: un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Objetivo: Evaluar la microfiltración de resinas compuestas (RC) colocadas sobre diferentes liners cavitarios después del manejo de lesiones de caries profundas mediante la remoción selectiva de tejido cariado blando hasta dentina blanda (SRCT-S). Material y Métodos: Se recolectaron 54 dientes humanos para pruebas de microfiltración. Cada ensayo comprendía lesiones cariosas ICDAS 5 o ICDAS 6 y dientes sanos para los controles. Se prepararon dientes sanos con cavidades que reflejaban las cavidades de los dientes cariados, que se prepararon con SRCT-S. Los dientes sanos y cariados se asignaron al azar a uno de los tres grupos experimentales: Grupo A: adhesivo universal (AU) + RC, Grupo B: revestimiento de cemento de ionómero de vidrio + AU + RC, y Grupo C: hidróxido de calcio + AU+ RC. La microfiltración oclusal (MO) y la microfiltración cervical (MC) se clasificaron dentro de una de las 5 categorías de profundidad. Se calcularon las pruebas ANOVA y Chi-cuadrado (p<0,05). Resultados: La MO y MC se distribuyeron de manera similar en los subgrupos (p> 0,05). Todas las muestras del Grupo C con lesiones cariosas presentaron algún grado de microfiltración. Sin embargo, no se observaron diferencias estadísticamente significativas entre grupos y dentro de cada grupo (p>0,05). Conclusión: Los dientes restaurados con RC después de SRCT-S usando hidróxido de calcio como material de revestimiento parecen exhibir una mayor microfiltración que aquellos restaurados usando ionómero de vidrio o AU solo. Se necesita más investigación clínica para profundizar estos hallazgos. Relevancia clínica: la aplicación de hidróxido de calcio como revestimiento debajo de una resina compuesta puede reducir la longevidad de una restauración después de realizar la eliminación selectiva o parcial de los tejidos cariados. Los médicos deberían reconsiderar la necesidad de usar hidróxido de calcio para esta aplicación, aunque no haya evidencia clínica.

Alcalosis respiratoria grave, la transformación de un cuadro funcional en orgánico. Caso clínico / Severe respiratory alkalosis due to psychogenic hyperventilation. Report of one case

Severe respiratory alkalosis is a life-threatening condition, as it induces hypo- calcaemia and extreme adrenergic sensitivity leading to cerebral and myocardial vasoconstriction. We report a 37-year-old woman with previous consultations for a conversion disorder. While she was infected with SARS-CoV-2 (without pulmonary involvement), she consulted in the emergency room due to panic attacks. On admission, she developed a new conversion crisis with progressive clinical deterioration, hyperventilation, and severe respiratory alkalosis (pH 7.68, Bicarbonate 11.8 mEq/L and PaCO2 10 mmHg). Clinically, she was in a coma, with respiratory and heart rates 55 and 180 per min, a blood pressure of 140/90 mmHg, impaired perfusion (generalized lividity, distal coldness, and severe skin mottling) and tetany. She also had electrocardiographic changes and high troponin levels suggestive of ischemia, and hyperlactatemia. She was managed in the hospital with intravenous benzodiazepines. The clinical and laboratory manifestations resolved quickly, without the need for invasive measures and without systemic repercussions.

Sinopsis de la Situación de Salud Oral en Chile - Parte IV: Traumatismo Dentoalveolar

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

Offspring of mothers with bipolar disorder: a systematic review considering personality features

Objective: To examine personality/temperament features and mental health vulnerability in offspring of mothers with bipolar disorders (BD), including dimensions which may impact psychological characteristics or therapeutic measures. Methods: A systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, was conducted to search for original articles that investigated personality/temperament features of offspring of women with BD and emotional factors involved in the mother-child relationship. The electronic search was performed in the PubMed, Web of Science, and PsycINFO databases from February 2010 to February 2017. Results: Ten quantitative studies were included in the analysis: seven from the United States, two from Brazil, and one from Canada. The narrative synthesis was categorized into three dimensions: 1) reliability of instruments for prediction of future psychopathology in offspring; 2) environmental risk factors for offspring; and 3) early interventions. The findings showed impairments in the offspring's lives, high rates of behavior and temperament problems, and psychiatric disorders. Conclusion: BD is a frequent psychiatric disorder, and the offspring of mothers with this condition are exposed to complex family relationships and psychosocial difficulties. If they are to ensure a good provision of mental health and psychosocial care to this unique population, early interventions must not neglect their contextual specificities. Systematic review registration: PROSPERO CRD-42017039010

Trastorno grave del medio interno por fístula enterovesical, a propósito de un caso clínico / Severe metabolic disorder associated with an enterovesical fistula: report of one case

Enterovesical fistula (EVF) is a fistulous communication between the intestine and the bladder. It is uncommon and its classic clinical manifestations are the presence of pneumaturia, fecaluria, suprapubic pain and recurrent urinary infections. Surgical repair of EVF leads to rapid correction of both diarrhea and metabolic abnormalities. We report a 73-year-old diabetic woman with a neurogenic bladder secondary to a spine meningioma. She presented with diarrhea, vomiting, impaired consciousness and metabolic acidosis. She developed hypernatremia, hypokalemia, hypocalcemia, and hypophosphatemia, which were successfully corrected.