Microfiltración coronal según materiales de restauración temporal empleados en endodoncia / Coronal microleakage according to the temporary restorative materials used in endodontic treatment

RESUMEN Introducción: La microfiltración coronal causada por los materiales de restauración temporal es considerada una de las causas del fracaso de los tratamientos endodónticos. A raíz de ello, en los últimos años se ha buscado crear un material de restauración temporal que sea capaz de evitar este problema. Objetivo: Comparar in vitro la microfiltración coronal de un cemento experimental y cuatro materiales de restauración temporal usados en endodoncia. Métodos: Se realizaron cavidades clase I en 90 premolares, divididos en 10 grupos (n= 9) y evaluados en dos periodos de tiempo (1 y 2 semanas). Se realizó la elaboración del cemento experimental, posteriormente se llevó a cabo el sellado coronal de las piezas dentales con el cemento experimental, Clip F (VOCO), Eugenato (MOYCO), Ketac™ Molar Easymix 3M (ESPE) y Coltosol® F. Los especímenes fueron sumergidos en tinta china (Pelikan) durante 1 y 2 semanas. Se evaluó la microfiltración en la interfase pared dentinaria-restauración temporal utilizando un esteromicroscopio (Leica Microsystems LAS EZ versión 2.0.0). La medición se realizó en milímetros en el programa LAS EZ versión 2.0.0. Resultados: Se encontró diferencias estadísticamente significativas (p < 0,05) al comparar la microfiltración coronal de los cinco materiales de restauración temporal, según el tiempo de exposición en tinta (1 y 2 semanas). Conclusiones: El cemento experimental presentó menor microfiltración que el Coltosol® F y Ketac™ Molar EasyMix 3M (ESPE); sin embargo, ninguno de los cuatro materiales fue capaz de prevenir la microfiltración en su totalidad(AU)

ABSTRACT Introduction: Coronal microleakage caused by temporary restorative materials is viewed as one of the reasons for endodontic failure. Efforts have been made in recent years to create a temporary restorative material capable of preventing that problem. Objective: Compare in vitro coronal microleakage of an "experimental cement" and four temporary restorative materials used in endodontics. Methods: Class I cavities were made in 90 premolar teeth divided into 10 groups (n= 9) and evaluated at two time periods (1 and 2 weeks). The "experimental cement" was prepared and then coronal sealing of the teeth was performed with the experimental Cement, F (VOCO), Eugenato (MOYCO), Ketac™ Molar Easymix 3M (ESPE) and Coltosol® F. The pieces were submerged in India ink (Pelikan)for 1 and 2 weeks. Microleakage was evaluated on the interface dentin wall / temporary restoration using a stereo microscope (Leica Microsystems LAS EZ version 2.0.0). Measurement was made in millimeters using the software LAS EZ version 2.0.0. Results: Statistically significant differences were found (p < 0.05) when comparing coronal microleakage in the five temporary restorative materials according to exposure time in ink (1 and 2 weeks). Conclusions: The experimental cement had less microleakage than Coltosol® F and Ketac™ Molar EasyMix 3M (ESPE). However, none of the four materials was capable of completely preventing microleakage(AU)

Rol de la cirugía bariátrica/metabólica en el manejo de la diabetes mellitus 2. Consenso SOCHED/SCCBM / Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

Expression of miR-155, miR-146a, and miR-326 in T1D patients from Chile: relationship with autoimmunity and inflammatory markers

ABSTRACT Objective The aim of this research was to analyze the expression profile of miR-155, miR-146a, and miR-326 in peripheral blood mononuclear cells (PBMC) of 47 patients with type 1 diabetes mellitus (T1D) and 39 control subjects, as well as the possible association with autoimmune or inflammatory markers. Subjects and methods Expression profile of miRs by means of qPCR using TaqMan probes. Autoantibodies and inflammatory markers by ELISA. Statistical analysis using bivariate correlation. Results The analysis of the results shows an increase in the expression of miR-155 in T1D patients in basal conditions compared to the controls (p < 0.001) and a decreased expression level of miR-326 (p < 0.01) and miR-146a (p < 0.05) compared T1D patients to the controls. miR-155 was the only miRs associated with autoinmmunity (ZnT8) and inflammatory status (vCAM). Conclusion Our data show a possible role of miR-155 related to autoimmunity and inflammation in Chilean patients with T1D.

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial / From insulin pump and continuous glucose monitoring to the artificial pancreas

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

Síndrome de hipoglicemia autoinmune: Primeros casos en Chile / Insulin autoimmune syndrome: Report of two cases

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.

II Consenso de la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina

Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.

Efecto de metformina sobre la expresión del factor de necrosis tumoral-α, los receptores Toll-like 2/4 y la PCR ultra sensible en sujetos obesos con diabetes tipo 2 / Effect of metformin on the expression of tumor necrosis factor-α, Toll like receptors 2/4 and C reactive protein in obese type-2 diabetic patients

Background: The pharmacological action of metformin goes beyond mere glycemic control, decreasing markers of inflammation and contributing to the reduction of oxidative stress. Aim: To evaluate biochemical, anthropometric and pro-inflammatory markers in obese type 2 diabetic patients treated or not with metformin. Patients and Methods: Obese patients with type 2 diabetes were invited to participate in the study if they were aged more than 40 years, were not receiving insulin, did not have cardiovascular diseases and were not taking anti-inflammatory drugs. A pharmacological history was taken and patients were stratified in two groups whether they were using metformin or not. A fasting blood sample was obtained to measure blood glucose, insulin, lipid levels, C reactive protein (hsCRP) and to isolate peripheral blood mononuclear cells. RNA was isolated from these cells to measure expression of tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), Toll-Like Receptor 2/4 (TLR 2/4) and beta-2-microglobulin (B2M). Results: Thirty participants were studied. Of these, 16 subjects aged 54.4 ± 5.5years were treated with metformin and 14 subjects aged 54.9 ± 6.4 years did not receive the drug. Participants receiving metformin had lower levels of hsCRP and lower mRNA relative abundance of TNF-α and TLR 2/4. There were no differences in glucose levels or lipid profile between both groups. Conclusions: Obese diabetic patients treated with metformin had lower levels of hsCRP expression of TNF-α and TLR 2/4, than their counterparts not receiving the drug.

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna / Glycemic control in diabetic patients hospitalized in a non-critical care hospital setting

Background: During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards. Aim: To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival. Material and Methods: Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) > 126 mg/dl or > 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered. Results: Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG > 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG > 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS). Conclusions: Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay.

Diferencias entre las medidas radiográficas y anatómicas en la preparación para poste de la raíz distal de molares inferiores / Differences between anatomic and radiographic measurements on the preparation for post of distal root of lower molars

Objetivo. Evaluar las diferencias existentes entre las medidas anatómicas y radiográficas del espesor de la dentina residual en la raíz distal del primer molar inferior. Material y método. Treinta primeras molares inferiores fueron decoronadas. Posteriormente se introdujeron las raíces distales en un cubo endodóncico. Las raíces fueron seccionadas horizontalmente a un nivel preestablecido y reensambladas en una mufla de acrílico. Se utilizaron limas manuales para la preparación del conducto radicular y fresas Peeso en la preparación del espacio para poste a una profundidad igual a la longitud de la corona. Para permitir la comparación entre el espesor de la dentina residual radiográfica y anatómica se tomaron radiografías (RVG) paralelas estandarizadas y fotografías digitales en el nivel pre-establecido durante tres etapas: antes de la preparación, después de la preparación y después del ensanchamiento. El espesor de las paredes mesial y distal de cada raíz fue medido y registrado utilizando un software de imagen (ImageTool 3.0). Resultados. Las diferencias fueron analizadas mediante la prueba t de Student para datos pareados, mostrando una diferencia altamente significativa(p<0,05) cuando se comparó las medidas radiográficas y anatómicas de la pared mesial, mas no en la pared distal que no mostró diferencias significativas. Conclusiones. El espesor de la pared del conducto radicular determinado por imágenes radiográficas fue mayor que la medida anatómica en la pared mesial, pero en la pared distal no se encontraron diferencias estadísticamente significativas.

Objective. To evaluate differences between anatomic and radiographic measurements of the thickness on residual dentin in distal roots of mandibular first molars. Material and method. Thirty mandibular first molar were decoronated. Subsequentlely, the distal root were introduced in an endodontic cube. Roots were sectioned horizontally at a pre-established level and reassembled in an acrylic muffle device. Hand files were used for root canal preparation and Peeso reamers were used for the space preparation for a post to a depth equal to the crown length. To allow the comparison between the thicknesses of the residual radiographic dentin, standardized parallel radiographs (RVG) and digital photographs at the pre-established level were taken during three stages before preparation, after preparation and after enlargement. The thickness of the mesial and distal walls of each root was measured and recorded using imaging software (Imagetool 3.0). Results. The differences were analyzed with paired t-test, showing a highly significant difference (p<0.05) when radiographic and anatomical measurement of mesial wall were compared. The comparison of the measurement in the distal wall did not show any statiscally significant difference. Conclusions. The thickness of the wall of the root canal determined by radiographs was greater than theanatomic measurement in mesial wall, but in the distal wall no significant difference were found.

VIPoma pancreático: Caso clínico / Pancreatic VIPoma: Report of one case

Neuroendocrine tumors are uncommon, including VIPoma that produces vasoactive intestinal polypeptide. We report a 45-year-old female presenting with a history of diarrhea lasting three months. An abdominal CAT scan showed a solid tumor in the body of the pancreas. A fine needle aspiration biopsy of the tumor was compatible with a neuroendocrine tumor. The patient was subjected to a partial pancreatectomy, excising a 4 cm diameter tumor. The pathological study was compatible with a neuroendocrine carcinoma. There was no regional lymph node involvement. During the postoperative period the results of serum vasoactive intestinal polypeptide were received. These were 815.9 pg/ml before surgery and normalized after the operation.

Capacidad de permeabilización en retratamiento de conductos subobturados mediante tres cementos selladores / Permeabilization capacity in root canal retreatment underfilling using three sealers

Introducción: En el presente estudio in vitro se evaluó la permeabilidad de los conductos subobturados con tres cementos selladores, los cuales fueron retratados de manera químico - mecánica con el objetivo de alcanzar la longitud de trabajo óptima. Material y método: Fueron utilizados 60 conductos de las raíces mesiales de molares inferiores permanentes, divididos en tres grupos: (G1) Gutapercha - Endofill, (G2) Gutapercha - Roeko seal y (G3) el sistema de obturación Resilon (conos de resina y Epiphany Seal); los cuales fueron retratados mediante el sistema Pro-taper Re tratamiento (D1, D2) y el cloroformo como disolvente. Resultados: Fueron evaluados cualitativamente empleando la prueba de chi cuadrado, encontrándose que fue estadísticamente significativa (p<0,005) entre los grupos (G1) gutapercha-endofill y (G2) gutapercha Roeko seal en comparación con el (G3) sistema Resilon Epiphany seal. Conclusiones: El estudio demostró que los cementos selladores Endofill y Roeko Seal presentaron mayor factibilidad en la permeabilización que el Epiphany en conductos subobturados.

Introduction: In this in vitro study, there was evaluated the permeability of the underfilling root canals with three sealers, which were portrayed in chemical-mechanical way in order to achieve optimal working length. Material and Methods: There were used 60 mesial root canals of permanent lower molars divided (G1) Gutta-percha - Endofill, (G2) Gutta-percha - Roek Seal and (G3) Resilon obturation system (cones and resin Epiphany Seal), which were portrayed by the Pro-taper Re treatment (D1, D2) and chloroform as solvent. Results: There were evaluated qualitatively using the Chi Square test finding that it was statistically significant (p <0.005) among the groups (G1) and gutta-endofill (G2) Roek percha seal compared to the (G3) Epiphany Resilon system seal. Conclusions: The study showed that sealers: Endofill and Roeko seal showed higher permeability than the Epiphany in under filling root canals.