Diagnosis and treatment strategies for patients with refractory recurrent aphthous ulcer and systemic diseases / 口腔疾病防治

@#Recurrent aphthous ulcer (RAU) is one of the most common diseases of the oral mucosa. At present, no effective method is available for RAU treatment, especially for refractory RAU, which significantly affects patients’ oral health and quality of life. Research shows that combination with systemic diseases greatly increases the difficulty of curing refractory RAU, making conventional oral ulcer treatment harder to perform effectively. This is probably because dentists commonly only focus on handling oral ulcers but neglect to think about the etiology of oral ulcers from a holistic perspective. Thus, we summarized some conditions of refractory RAU accompanied by systemic diseases, including inflammatory bowel disease, iron deficiency anemia, diabetes mellitus, Behçet’s disease, Reiter’s syndrome, sprue syndrome, Sutton syndrome, and acquired immunodeficiency syndrome. We also outlined the treatment principles of these patients. To be specific, on the one hand, dentists should cooperate with the relevant specialists to treat the systemic diseases, while on the other hand they should take measures including topical/general use of medicine, local physical therapy, Traditional Chinese medicine treatment, and psychotherapy for RAU management. This paper aims to provide clinicians with a more comprehensive understanding of the diagnosis and treatment of refractory RAU, in order to make personalized treatment plans for patients and improve the clinical efficacy of refractory RAU.

Vacunación contra SARS-CoV-2 en pacientes con esclerosis sistémica en Argentina: preferencias, acceso y adherencia al plan de vacunación / Vaccination against SARS-CoV-2 in patients with systemic sclerosis in Argentina: preferences, access and adherence to the vaccination plan

Introducción: en pacientes con enfermedades reumatológicas autoinmunes se recomienda la aplicación sistemática y secuencial de una serie de vacunas para la prevención de enfermedades transmisibles. El objetivo de este estudio fue estimar la proporción de pacientes con esclerosis sistémica (ES) que recibieron vacunación contra el coronavirus (SARS-CoV-2). Materiales y métodos: se envió una encuesta anónima por correo electrónico o contacto por WhatsApp desde mayo a septiembre de 2021, con preguntas para evaluar la adherencia al esquema de vacunación recomendado en pacientes con enfermedades reumatológicas, así como temores, preferencias y adherencia al esquema de vacunación contra el SARS-CoV-2. Resultados: se incluyeron 295 pacientes con ES. El 68,81% estaba vacunado contra el SARS-CoV-2 con al menos una dosis, de los cuales el 48,7% tenía dos dosis. El 84,75% refirió conversar con su médico sobre su esquema de vacunación general. Solo el 5,4% tenía las cuatro vacunas. El 93,56% manifestó voluntad de vacunarse contra el SARS-CoV-2; el 56,27% prefirió la vacuna Sputnik V. El 7,46% manifestó su voluntad de no vacunarse. Los factores que influyeron en la adherencia a la vacunación, con mayor frecuencia, fueron el miedo a contraer la infección por SARS-CoV-2 (86,1%) y las reacciones adversas (23,05%). Conclusiones: destacamos el hecho de que solo 6 meses después de que se dispusiera la vacunación contra el SARS-CoV-2, la mitad de los pacientes con ES tenía el esquema recomendado completo.

Introduction: in patients with autoimmune rheumatic diseases, the systematic and sequential application of a series of vaccines is recommended for the prevention of communicable diseases. The objective was to estimate the proportion of patients with systemic sclerosis (SSc) who received vaccination against coronavirus (SARS-CoV-2). Materials and methods: since may to september 2021, an anonymous survey was sent by email or messaging app, containing questions to assess adherence to the recommended vaccination schedule in patients with rheumatic diseases, as well as fears, preferences and adherence to vaccination schedule against SARS-CoV-2. Results: 295 patients with SSc were included. 68.81% were vaccinated for SARS-CoV-2 with at least one dose, 48.7% of this group had two doses. 84.75% reported talking to their doctor about their general vaccination schedule. Only 5.4% had all four vaccines. 93.56% expressed willingness to be vaccinated against SARS-CoV-2, 56.27% preferred the Sputnik V vaccine. 7.46% expressed their willingness to not be vaccinated. The factors that most frequently influenced adherence to vaccination were fear of contracting SARS-CoV-2 infection (86.1%) and adverse reactions (23.05%). Conclusions: we highlight the fact that only 6 months after vaccination against SARS-CoV-2 became available, half of the patients with SSc had the full recommended schedule.

Registro de datos sobre riesgo quirúrgico en historias clínicas de Estomatología General Integral / Recording surgical risk data in comprehensive dental care medical records

Introducción: La atención estomatológica integral al paciente de riesgo quirúrgico resulta un reto en la actualidad. El profesional de la estomatología necesita herramientas que permita profundizar en los riesgos quirúrgicos, entre esas herramientas puede contarse la correcta confección de historia clínica. Objetivo: Describir el comportamiento de la confección de historia clínica en los pacientes de riesgo quirúrgico en la Clínica Estomatológica "Salvador Allende". Métodos: Se revisaron 108 historias clínicas de todos los pacientes de riesgo quirúrgico ingresados en la consulta de estomatología general integral en el archivo de la Clínica "Salvador Allende" del municipio Cerro, La Habana, correspondientes a un periodo de tres meses. Resultados: Un 41,6 por ciento de pacientes presentó hipertensión arterial, seguidos de pacientes con dos o más enfermedades (37,0 por ciento). El 56,4 por ciento de las historias clínicas abordó sobre el uso de medicamentos para la enfermedad de base, los restantes acápites tuvieron bajos porcentajes en relación con el completamiento de la información. El 79,6 por ciento de los pacientes de riesgo recibieron tratamiento quirúrgico. Conclusiones: La enfermedad de riesgo más frecuente es la hipertensión arterial seguida por los pacientes con dos o más enfermedades. No se recogen los datos necesarios en la atención del paciente de riesgo quirúrgico y las propuestas plasmadas permitirán realizar cualquier ejercicio de la profesión de manera más eficaz y con menor riesgo(AU)

Introduction: Comprehensive dental care of surgical risk patients is a current challenge. Dental care professionals should have access to tools allowing them to expand their knowledge about possible surgical risks. Appropriately developed medical records are an example of such tools. Objective: To describe the process of development of medical records of surgical risk patients at Salvador Allende dental clinic. Methods: A total 108 medical records were reviewed, corresponding to all the surgical risk patients admitted to the general comprehensive dental care service of Salvador Allende dental clinic in the municipality of Cerro, Havana, in a three months' period. Results: Of the patients studied, 41.6 percent had arterial hypertension, followed by patients with two or more conditions (37.0 percent). It was found that 56.4 percent of the medical records contained information about the use of drugs for the underlying condition. The remaining items exhibited low percentages of data completion. 79.6 percent of the risk patients received surgical treatment. Conclusions: The most common risk condition is arterial hypertension, followed by patients with two or more diseases. The data required for the care of surgical risk patients are not recorded. The proposals put forth will make it possible to perform any professional practice in a more effective manner and with a lower level of risk(AU)

Haematological manifestations in primary hyperparathyroidism

Background & objectives: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the haematological manifestations of PHPT in patients with normal renal functions who were treated surgically for parathyroid adenomas. Methods: In this retrospective cross-sectional study, 134 patients with normal renal functions who underwent parathyroidectomies for PHPT were included. The haematological manifestations were evaluated in the total study cohort and in the two groups of different calcium (Ca) levels (Group 1 ?11.2 mg/dl and Group 2 ?11.2 mg/dl). Results: The overall prevalence of anaemia, leucopenia and thrombocytopenia was 20.1, 6.7 and 6.0 per cent, respectively. Normocytic anaemia was present in 19 (14.2%) patients. There were no significant differences in the prevalence of anaemia, leucopenia and thrombocytopenia between the two groups. There were no correlations between the PTH levels and the leukocyte, haemoglobin or platelet values. Six to 12 months after the parathyroidectomy (PTX), 35.7 per cent of the patients with anaemia, 85.7 per cent of the patients with leucopenia and 100 per cent of the patients with thrombocytopenia had recovered. Interpretation & conclusions: In the present study, anaemia was seen with a variable frequency in PHPT, but there was no relationship between anaemia and high PTH or Ca levels. The development of anaemia can be seen regardless of the PTH levels in PHPT patients with normal renal functions. High-resolution rates after PTX indicate a possible association between PHPT and thrombocytopenia or leucopenia, although their prevalence is low in PHPT.

The oral microbiota: a literature review for updating profesional s in dentistry-Part II / La microbiota oral: una revisión de literatura para la actualización de profesionales en odontología-Parte II

ABSTRACT: In the first part of this literature review, published in October 2019 in this journal, we summarized the conceptual background of the oral microbiota, and the main methods used in microbiology to characterize oral organisms. We also presented the most studied bacteria species in the oral microbiota. In this second part, we will discuss the evidence regarding the biological plausibility linking the oral microbiota dysbiosis and systemic diseases, as well as the main factors and mechanisms suspected in this association.

RESUMEN: En la primera parte de esta revisión de literatura, publicada en esta revista en octubre de 2019, se resumieron los antecedentes conceptuales de la microbiota oral y describieron los principales métodos utilizados en microbiología para caracterizar los microorganismos orales. Asimismo, se presentaron las especies bacterianas mejor estudiadas de la microbiota oral. En esta segunda parte, se explorará la plausibilidad biológica que vincularía la disbiosis de la microbiota oral y las enfermedades sistémicas, así como las características que podrían influenciar la composición de la microbiota oral.

Desarrollo de la habilidad "diagnóstico" de manifestaciones oftalmológicas en la carrera de Medicina

RESUMEN Introducción: El creciente aumento en el índice de enfermedades sistémicas y su relación con algunas manifestaciones oftalmológicas, impone un reto al ejercicio de la Medicina en la Atención Primaria de Salud y a la Educación Médica Superior cubana en la actualidad. Objetivo: Elevar la preparación metodológica del colectivo docente de la asignatura Oftalmología para el desarrollo de la habilidad "diagnóstico" de manifestaciones oftalmológicas presentes en algunas enfermedades sistémicas. Método: Se utilizó un muestro censal, en el departamento de Oftalmología del Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, realizado durante el curso académico 2019- 2020, constituido por los 21 docentes de ese colectivo docente. En correspondencia, se utilizaron métodos teóricos y empíricos. Resultados: Se identificó que los profesores del colectivo de la asignatura Oftalmología fueron capaces de significar el valor de la relación entre los profesores, los estudiantes y el grupo, como componentes personales del proceso de enseñanza-aprendizaje y comprender que el marco de relaciones interpersonales entre ellos, se establece sobre la base de las categorías, actividad y comunicación. En cuanto a los componentes didácticos no personales, los docentes manifestaron, tanto en entrevistas en profundidad como en las grupales, que este tipo de preparación metodológica, fue muy útil para su desempeño docente-asistencial. Conclusiones: La preparación metodológica realizada es pertinente y se contextualiza a las potencialidades e insuficiencias didácticas-metodológicas identificadas en dicho colectivo docente para el desarrollo de la habilidad "diagnóstico" de manifestaciones oftalmológicas presentes en algunas enfermedades sistémicas: cerebrovasculares, cardiovasculares, neoplasias y respiratorias.

ABSTRACT Introduction: The growing increase in the rate of systemic diseases and their relationship with some ophthalmologic manifestations, imposes a challenge to the practice of medicine in Primary Health Care and to Cuban Higher Medical Education at present. Objective: To increase the methodological preparation for the teaching staff of Ophthalmology subject in order to develop the skill "diagnosis" of ophthalmologic manifestations present in some systemic diseases. Method: A census sample was applied in the Ophthalmology department at the Hospital General Docente "Dr. Agostinho Neto", in Guantánamo. This census was carried out during the academic year 2019-2020, constituted by the 21 professors of that teaching group. Correspondingly, theoretical and empirical methods were used. Results: It was identified that the professors of the Ophthalmology subject group were able to understand the value of the relationship between professors, students and the group, as personal components of the teaching-learning process and to understand that the framework of interpersonal relationships among them it´s established on the basis of categories, activity and communication. As for the non-personal didactic components, professors stated, both in in-depth and group interviews, that this type of methodological preparation was very useful for their teaching-assistance performance. Conclusions: The methodological preparation carried out was appropriate and it is contextualized to the didactic-methodological potentialities and insufficiencies identified in this teaching group for the development of the skill "diagnosis" of ophthalmologic manifestations present in some systemic diseases: cerebrovascular, cardiovascular, neoplasias and respiratory diseases.

RESUMO Introdução: O crescente aumento do índice de doenças sistêmicas e sua relação com algumas manifestações oftalmológicas, impõe um desafio à prática da Medicina na Atenção Primária à Saúde e à Educação Médica Superior cubana na atualidade. Objetivo: Levantar a preparação metodológica do grupo de ensino da disciplina de Oftalmologia para o desenvolvimento da capacidade "diagnóstico" das manifestações oftalmológicas presentes em algumas doenças sistêmicas. Método: Foi utilizada uma amostra censitária no serviço de Oftalmologia do Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, realizada durante o ano letivo 2019-2020, composta por 21 professores deste grupo de ensino. Correspondentemente, métodos teóricos e empíricos foram usados. Resultados: Identificou-se que os professores do grupo disciplinar de Oftalmologia conseguiram significar o valor da relação entre professores, alunos e grupo, como componentes pessoais do processo ensino-aprendizagem e compreender que o arcabouço das relações interpessoais entre eles, é estabelecido com base em categorias, atividade e comunicação. Quanto aos componentes didáticos não pessoais, os professores afirmaram, tanto em entrevistas em profundidade como em entrevistas em grupo, que este tipo de preparação metodológica foi muito útil para a sua atuação docente-assistencial. Conclusões: O preparo metodológico realizado é pertinente e contextualizado às potencialidades e insuficiências didático-metodológicas identificadas no referido grupo de ensino para o desenvolvimento da capacidade "diagnóstico" de manifestações oftalmológicas presentes em algumas doenças sistêmicas: cerebrovasculares, cardiovasculares, neoplasias e respiratórias.

Curso optativo de riesgo quirúrgico para estudiantes de pregrado de la carrera de estomatología / Elective course on surgical risk for undergraduate dental medicine students

Introducción: Los pacientes de riesgo quirúrgico presentan enfermedades asociadas que deben considerarse durante el tratamiento estomatológico. Investigaciones realizadas revelan la existencia de deficiencias durante la atención estomatológica a este tipo de paciente y que el tema debe ser reforzado durante el pregrado. Objetivos: Exponer las generalidades del curso optativo de atención estomatológica integral al paciente de riesgo quirúrgico y los criterios emitidos por sus participantes. Métodos: Se realizó una investigación descriptiva de corte pedagógico para exponer las características más importantes del curso. Se tuvieron en cuenta las siguientes variables: temas, objetivos, sistema de conocimientos y de habilidades. Se aplicó la técnica de Positivo, Negativo, Interesante a todos los participantes del curso. Resultados: El curso implementado contó con cinco temas: el primero dedicado a las generalidades y las características particulares en la confección de historia clínica; el segundo y tercero, a las enfermedades de riesgo quirúrgico y los tratamientos estomatológicos; el cuarto, al uso de medicamentos para la enfermedad sistémica y las posibles interacciones; y el quinto, a experiencias clínicas. Los estudiantes aportaron criterios positivos, negativos e interesantes. Conclusiones: El curso diseñado ofrece conocimientos y habilidades al estudiante que no se proporcionan en las asignaturas de pregrado, lo cual permite una mejor atención estomatológica integral a los pacientes de riesgo quirúrgico. Los estudiantes participantes del curso optativo aportaron criterios favorables sobre su estructura, pertinencia y valor científico(AU)

Introduction: Surgical risk patients have associated diseases that must be considered during dental treatment. Some research carried out have revealed the existence of deficiencies during dental care for this type of patients, a reason why the issue must be strengthened during undergraduate studies. Objective: To present the generalities of an elective course of comprehensive dental care for patients at surgical risk and the criteria issued by its participants. Methods: A descriptive research with a pedagogical nature was carried out to expose the most important characteristics of the course. The following variables were taken into account: topics, objectives, knowledge system and skills system. The positive-negative-interesting technique was applied to all the course participants. Results: The implemented course had five topics: the first was dedicated to generalities and particular characteristics in the preparation of a clinical record; the second and third courses, to surgical risk diseases and dental treatments; the fourth course, to the use of drugs for systemic diseases and possible interactions; and the fifth, to clinical experiences. The students provided positive, negative and interesting criteria. Conclusions: The designed course offers knowledge and skills to the student that are not provided in undergraduate subjects, which allows better comprehensive dental care to patients at surgical risk. The students participating in the elective course provided favorable criteria about the course's structure, relevance and scientific value(AU)

El glaucoma y las enfermedades sistémicas con compromiso vascular / Glaucoma and systemic diseases of vascular involvement

La presión intraocular es considerada el único factor causal potencialmente modificable con el propósito de prevenir la ceguera por glaucoma. Esta es una enfermedad multifactorial y, aunque es el factor de riesgo más importante en su desarrollo, la reducción de sus valores no garantiza el cese de la progresión del daño glaucomatoso. El glaucoma primario de ángulo abierto y el glaucoma de presión normal comparten factores de riesgo similares en la patogénesis y se pueden clasificar en categorías mecánicas y vasculares. La evidencia científica actual ha logrado demostrar que existe una importante asociación entre las enfermedades sistémicas con compromiso vascular, como la migraña, la apnea obstructiva del sueño, la hipotensión arterial de diferentes causas, la hipertensión arterial, la enfermedad cerebrovascular, la cardiopatía isquémica y la diabetes mellitus con los hallazgos a nivel ocular en pacientes con neuropatía óptica glaucomatosa. Esta correlación orienta a considerar estas enfermedades en conjunto para que cada profesional dedicado a la salud visual considere siempre imprescindible la evaluación de los aspectos que vinculan estas enfermedades para actuar en consecuencia. Se realiza una búsqueda sobre el glaucoma y las enfermedades sistémicas con compromiso vascular(AU)

Intraocular pressure is considered to be the only potentially modifiable causative factor to prevent glaucoma blindness. However, glaucoma is a multifactorial disease, and true as it is that its main risk factor is intraocular pressure, its reduction does not ensure cessation of the progress of glaucomatous damage. Primary open angle glaucoma and normal pressure glaucoma share similar pathogenetic risk factors, and may be classified as mechanical or vascular. According to current scientific evidence, an important association exists between systemic diseases with vascular involvement, such as migraine, obstructive sleep apnea, arterial hypotension of various causes, arterial hypertension, cerebrovascular disease, ischemic heart disease and diabetes mellitus, and ocular findings in patients with glaucomatous optic neuropathy. In view of this correlation, these diseases should be considered jointly, so that visual health professionals always bear in mind the evaluation of their common characteristics and act in consequence. A search was carried out on glaucoma and systemic diseases with vascular compromise(AU)

Pseudoexfoliación ocular: un signo de alerta temprana de enfermedades sistémicas / Ocular pseudoexfoliation: an early warning signal in systemic diseases

El síndrome pseudoexfoliativo es una enfermedad relacionada con la edad, que afecta a la población mayor de 60 años y tiene una distribución mundial. Se caracteriza por la producción y la acumulación progresiva de un material fibrilar extracelular a nivel de las distintas estructuras del ojo, con repercusiones significativas sobre la salud ocular de los pacientes y, además, conduce a complicaciones quirúrgicas. El material pseudoexfoliativo no solo se encuentra en el globo ocular, sino en distintas partes del organismo, como el corazón, los pulmones, el cerebro y los vasos sanguíneos, por lo que algunos estudios sugieren la relación de este síndrome con ciertas afecciones cardíacas. Se presenta un paciente de 74 años de edad, negro, con antecedentes de hipertensión arterial, que se ingresa por pérdida brusca de la visión de ambos ojos, acompañado de dolor. Al examen oftalmológico, después del tratamiento hipotensor, se constató material pseudoexfolitivo y cristalino subluxado a cámara vítrea. Se diagnosticó glaucoma pseudoexfoliativo, disfunción asintomática del miocardio, hiperlipidemia, ateroma en la aorta abdominal e hipoacusia neurosensorial severa. Existen estudios que sugieren relación del síndrome pseudoexfoliativo con ciertas enfermedades y factores de riegos vasculares con alto impacto en la morbimortalidad a nivel mundial(AU)

Pseudoexfoliation syndrome is an aging-related disease of worldwide distribution affecting people aged over 60 years. It is characterized by progressive production and accumulation of extracellular fibrillar material in the different structures of the eye, with significant impacts on the patients' ocular health. It may also lead to surgical complications. Pseudoexfoliative material is not only found in the eyeball, but also in various parts of the body, such as the heart, the lungs, the brain and blood vessels, this being the reason why some studies suggest a relationship to certain heart conditions. A case is presented of a male black 74-year-old patient with a history of arterial hypertension, admitted due to sudden vision loss in both eyes, accompanied by pain. The ophthalmological examination performed after hypotensive treatment confirmed the presence of pseudoexfoliative material and crystalline subluxated to the vitreous chamber. The diagnosis was pseudoexfoliation glaucoma, asymptomatic myocardial dysfunction, hyperlipidemia, abdominal aorta atheroma and severe neurosensory hypoacusis. Some studies suggest a relationship between pseudoexfoliation syndrome and certain vascular diseases and risk factors with a high impact on worldwide morbidity and mortality(AU)

Emergencias médicas en la atención odontológica: pacientes "de riesgo" y/o "en riesgo" / Medical emergencies in dental care: 'risk' and/or 'at risk' patients

En medicina, los pacientes de riesgo son aquellos que, al momento de la consulta, presentan antecedentes y/o pa- decimientos que implican una mayor probabilidad de sufrir complicaciones, como personas inmunodeprimidas o con en- fermedades crónicas, ya sean cardíacas, pulmonares, renales, hepáticas, sanguíneas o metabólicas (por ejemplo, diabetes). Estos pacientes se encuentran en riesgo en el caso de prác- ticas que puedan exacerbar o provocar reacciones adversas a raíz de su padecimiento. En la actualidad, el grupo poblacional vulnerable ha au- mentado a partir de nuevos tratamientos médicos que han per- mitido mejorar padecimientos sistémicos severos y prolongar la esperanza de vida. Ante pacientes "de riesgo" o "en riesgo", el odontólogo debe estar alerta y actualizado, a fin de evitar provocar alteraciones sistémicas y de reaccionar pronta y eficazmente, en caso de ser necesario, ante las urgencias médicas que se presenten (AU)

In medicine, risk patients are those who at the consulta- tion have a history and/or conditions that could cause a great- er possibility of a complication; such as immunosuppressed, chronic heart, pulmonary, kidney, liver, blood or metabolic diseases (for example, diabetes).These patients are at risk during procedures that could in- crease or cause inadequate reactions due to their conditions. Currently, the vulnerable population group has increased since newest medical treatments have emerged; allowing se- vere systemic ailments to improve and prolong life expectancy. With risk or at-risk patients, the dentist must be alert and up-to-date to avoid systemic alterations and react promptly and efficiently if necessary in any medical emergency that might take place (AU)

Oral implant treatment for elderly patients / 华西口腔医学杂志

With the advance of materials and technologies, modern oral implantology developed rapidly. Dental implant has become the first choice to restore the missing teeth. Although it achieves a high success rate among healthy adults, for elderly patients, with the decline of physical function and other systemic diseases, the risks of implant treatment increase accordingly. Doctors should pay more attention to the factors that may affect the implant treatment of the elderly and ways of preventing possible risks and complications. Here we discuss the specificity, success rate, effect of systemic diseases and drug considerations of implant treatments in elderly patients.

Prevalence of pericardial effusion in systemic diseases / Prevalencia de derrame pericárdico en enfermedades sistémicas

Abstract Introduction: The presence of 50 ml of fluid or more in the pericardial sac is known as pericardial effusion. Objective: To determine the prevalence of pericardial effusion in patients with systemic diseases. Method: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. Results: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). Conclusions: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

Medicamentos en pacientes con riesgo quirúrgico y su repercusión en Estomatología / Medicine use in surgery risk patients and repercussion in Dentistry

RESUMEN • Introducción: Con el envejecimiento creciente de la población, la práctica estomatológica exige la utilización del conocimiento para identificar y tratar pacientes con enfermedades sistémicas cada vez más frecuentes, lo cual puede requerir el uso de medicamentos capaces de interactuar con el tratamiento farmacológico de su enfermedad de base. La literatura refleja esta relación de manera fragmentada y carente de un enfoque sistémico. Objetivo: Identificar en la literatura el uso de medicamentos en pacientes con riesgo quirúrgico y describir su repercusión durante el tratamiento estomatológico. Material y Métodos: Se realizó una revisión bibliográfica y se consultaron artículos científicos, tesis de titulación de especialistas, maestrías y doctorales entre otras referencias principalmente de los últimos 5 años mediante Google. Desarrollo: Se abordan las generalidades, manejo estomatológico y las interacciones medicamentosas de cada una de las enfermedades a estudiar (Diabetes Mellitus, hipertensión arterial y cardiopatía), así como las situaciones que requieren profilaxis antibiótica. Conclusiones: Los pacientes con riesgo quirúrgico utilizan medicamentos que producen interacciones importantes con fármacos como AINES, anestésicos locales y glucocorticoides que habitualmente se emplean en los tratamientos estomatológicos; existen además enfermedades sistémicas en las cuales hay que tener en cuenta la profilaxis antibiótica antes de realizar determinados procederes estomatológicos.

ABSTRACT • Introduction: With the growing of population aging, the dental practice requires the adequate knowledge to identify and treat patients with increasingly frequent systemic diseases, which may require the use of drugs capable of interacting with the pharmacological treatment of their underlying diseases. The literature reflects this relationship in a fragmented manner and lacking a systemic approach. Objective: To identify the drugs used in risk patients undergoing surgery and describe their repercussion during dental treatment. Material and Method: A bibliographic review was carried out. Scientific articles, specialists´ theses, Master´s and PhD degrees among other references were consulted, mainly the ones obtained from the search carried out in Google during the last 5 years. Results: The generalities, dental management and drug interactions between the diseases studied (diabetes mellitus, arterial hypertension and heart disease) were addressed, as well as the situations that require antibiotic prophylaxis. Conclusions: The surgical risk patients studied use drugs that produce important interactions with drugs such as NSAIDs, local anesthetics and glucocorticoids that are usually used in dental treatments. There are also systemic diseases in which antibiotic prophylaxis must be taken into account before performing certain dental procedures.

Confocal microscopy observation of corneal nerve plexus and Langerhans cells in patients with systemic diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Corneal confocal microscope(CCM)is a non-invasive instrument for the study of living cornea and is increasingly being used to evaluate corneal nerve plexus and Langerhans cell lesions. This paper reviews the recent advances in corneal nerve plexus and Langerhans cell lesions from the perspective of the use of CCM in the study of systemic diseases such as diabetes mellitus, Sjogren's syndrome, multiple sclerosis, thyroid-associated ophthalmopathy, fibromyalgia, chronic migraine and Parkinson's disease.

Radiological findings of breast involvement in benign and malignant systemic diseases / Aspectos radiológicos do envolvimento mamário em doenças sistêmicas benignas e malignas

Abstract Although the primary purpose of periodic mammograms in screening programs is to identify lesions suspected of being carcinomas, the findings are often related to systemic (benign or malignant) diseases, rather than breast cancer. Although the involvement of breast structures in systemic diseases is unusual, it can be included in the differential diagnosis of masses, skin changes, calcifications, asymmetry, and axillary lymphadenopathy. The main diagnostic entities that can be associated with such involvement are diabetes, chronic kidney disease, heart diseases, connective tissue diseases, HIV infection, lymphoma, leukemia, and metastases from primary tumors at other sites. In many cases, information related to knowledge and treatment of chronic diseases is not available to the radiologist at the time of evaluation of the mammography findings. The purpose of this essay is to offer relevant pictorial information to the general radiologist about systemic diseases involving the breast, expanding the range of differential diagnoses in order to avoid unnecessary invasive procedures.

Resumo Embora o objetivo primário da realização periódica da mamografia nos programas de rastreamento seja a identificação de lesões suspeitas para carcinoma mamário, muitas vezes as alterações encontradas não estão relacionadas ao câncer de mama, e sim, a doenças sistêmicas benignas e malignas secundárias de outros sítios. O envolvimento das estruturas mamárias nas doenças sistêmicas é incomum, mas pode ser incluído no diagnóstico diferencial de nódulos, alterações cutâneas, calcificações, assimetrias e linfonodomegalias axilares. As principais entidades diagnósticas que podem estar associadas ao acometimento mamário são o diabetes, a nefropatia crônica, as cardiopatias, as colagenoses, as infecções pelo vírus HIV ou parasitas, o linfoma, a leucemia e as metástases de tumores primários de outros órgãos. Muitas vezes as informações relacionadas ao conhecimento e/ou tratamento de doenças crônicas não estão disponíveis para o radiologista no momento da avaliação da mamografia. O objetivo deste ensaio é oferecer informações iconográficas relevantes a respeito de doenças sistêmicas com envolvimento mamário, permitindo ampliar o leque de diagnósticos diferenciais e evitar eventuais procedimentos invasivos desnecessários.

Advances in salivary protein glycosylation and its relationship with systemic and oral diseases / 华西口腔医学杂志

Protein glycosylation is one of the most important protein post-translational modifications that can affect life activities by endowing the protein with various structural and functional features. Saliva is an easy-to-obtain, noninvasive body fluid that contains components originating from serum, gingival crevicular fluid, and oropharyngeal mucosae. In recent years, understanding of saliva has been constantly updated with the developments in related research. Studies have shown that salivary proteins can be used as diagnostic markers for certain diseases, and changes of protein glycosylation in saliva are generally considered to be related to many diseases. In this review, salivary protein glycosylation and its relationship with systemic and oral diseases were discussed.

Implante dental inmediato en paciente diabético / Immediate dental implant post-extraction on systemically compromised patient

RESUMEN: Actualmente el implante dental se considera una buena alternativa para reemplazar los órganos dentarios faltantes. Sin embargo, existen ciertos requerimientos necesarios para la colocación de este y obtener una buena resolución. Estudios actuales demuestran que la colocación inmediata del implante dental posterior a la extracción dental obtiene mejores resultados a largo plazo y preserva el espacio alveolo dental natural por lo cual facilita la inserción y correcto ajuste del implante dental, siempre y cuando la extracción sea atraumática y sin complicaciones. Por ende, en el presente caso se reporta paciente masculino de 73 años con antecedentes de hipertensión arterial y diabetes mellitus tipo II, controlado con su médico especialista, al cual se le realizó extracción dentaría atraumática de OD#46 con inmediata colocación de implante dental NORMON HI e inserción de xenoinjerto óseo BIO-GEN para asegurar correcta oseointegración, cuyo procedimiento se realizó sin complicaciones y con correcta posición y paralelismo.

ABSTRACT: Nowadays, a dental implant is considered a good alternative to replace the missing teeth. However, there are several requirements needed for the implant placements and for a good resolution. Present studies demonstrate that the immediate implant placement posterior to the extraction of the tooth obtains better long-term results and also preserves the natural alveolar socket. This facilitates the placement and correct adjustment of the dental implant, only if the extraction is done atraumatically and without complications. Therefore, the present case reports a 73-year-old male patient with arterial hypertension and type II diabetes mellitus background, controlled by his medical doctor. An atraumatic tooth extraction of OD#46 was carried out on this patient, with immediate dental implant NORMON HI placement and insertion of xenograft bone BIO-GEN in order to ensure correct osseointegration. This procedure was done without complications and with correct position and parallelism.

Enfermedades autoinmunes sistémicas y tuberculosis: una mala asociación / Systemic autoimmune diseases and tuberculosis: a poor association

Resumen: Las enfermedades autoinmunes sistémicas son trastornos caracterizados por la alteración de los mecanismos reguladores de la identificación y tolerancia de las propias estructuras celulares con la resultante producción de autoanticuerpos e inmunocomplejos. Una de las complicaciones más frecuentes vinculadas al tratamiento de estas enfermedades es el riesgo de infecciones, entre ellas la tuberculosis, cuya prevalencia está en aumento en nuestro medio. Presentamos tres casos clínicos de patologías autoinmunes diferentes en los cuales se tuvo como complicación el desarrollo de tuberculosis en dos topografías distintas: meníngo-encefálica y pulmonar.

Abstract Autoimmune systemic diseases are characterized by the alteration of regulatory mechanisms of identification and tolerance of own cellular structures with the resulting production of autoantibodies and immune disorders. One of the most frequent complications related to the treatment of these diseases is the risk of infections, including tuberculosis, whose prevalence is increasing in our environment. We present three different clinical cases of ASD in which we observed as a complication the development of tuberculosis in two different topographies: meningoencephalic and pulmonary.

Relationship between oral and gut microbes / 华西口腔医学杂志

Oral cavity and gut are important parts of the human digestive tract. The structure and pathogenesis of oral and gut microbial communities have been extensively investigated. The interaction and pathogenic effects of oral and gut microbiota have also been widely explored. This review aimed to integrate data from literature and discuss the structures and functions of microbial communities in the oral cavity and gut. The mutual colonization and pathogenesis of oral and gut microbes and the relationship between these phenomena and involved systemic diseases are also described.

Conhecimento geral e específico entre médicos, dentistas e enfermeiros da doença periodontal e sua associação a outras doenças / Specific and general knowledge of physicians, dentists and nurses about periodontal disease and its association to other diseases

O objetivo do presente estudo foi avaliar o conhecimento geral e específico entre médicos, dentistas e enfermeiros da doença periodontal (DP) e sua associação à outras doenças. Foi utilizado um questionário estruturado, incluindo questões sobre a DP, sua associação com outras doenças e o grau de comprometimento dos profissionais de saúde com o paciente periodontal. As respostas foram determinadas de acordo com revisões sistemáticas e metanálises consultadas. Duzentos e sessenta e nove profissionais da Polícia Militar do Rio de Janeiro responderam o questionário, sendo 87 dentistas, 123 médicos e 59 enfermeiros, com idade média de 39,5 (±7,2) anos. Cinquenta e seis (20,8%) profissionais eram docentes enquanto 200 (74,3%) eram especialistas. O percentual de acertos para os sinais e sintomas de doenças periodontais variou de 87,7% a 97,4% para sangramento gengival, recessão gengival e mobilidade dentária, enquanto 7,8% dos profissionais acertaram o item perda dentária. Com relação aos fatores de risco, o percentual de acertos variou entre 91,4% e 96,7% para diabetes e fumo. Por outro lado, o percentual de acertos foi de 22,3% e 24,2% para idade e escolaridade. Os profissionais relacionaram DP como fator de risco para doença cardiovascular (81,4%). Os dentistas responderam com mais frequência que DP estava associada a um aumento de risco para diabetes, parto prematuro e bebês com baixo peso. Com relação à associação de DP e pré-eclâmpsia, síndrome metabólica e doença renal crônica, os percentuais de acertos variaram entre 17,1% e 41,2%. O grau de instrução e docência influenciou significativamente a possibilidade de acertar as respostas. Em relação ao tratamento periodontal para as doenças acima citadas, o percentual de acertos variou de 2,6% a 20,8%, e o grau de instrução e docência influenciaram significativamente no percentual de acertos. A frequência de acertos sobre a comprovação científica de que o tratamento periodontal melhorou o controle metabólico de pacientes diabéticos variaram de 40.7% (enfermeiros) a 50,4% (médicos). A frequência de médicos e enfermeiros que quase sempre/sempre diagnostica, examina e orienta seus pacientes sobre os riscos e efeitos da DP na saúde geral variou entre 0% e 20,3%. Apenas 23,6% encaminham os pacientes para avaliação e tratamento periodontal. Concluindo, o conhecimento sobre DP e sobre DP ser fator de risco para outras doenças foi reduzido entre médicos e enfermeiros. As três categorias de profissionais mostraram desconhecimento sobre a ausência de comprovação científica do tratamento periodontal como fator de prevenção para doenças sistêmicas. O grau de instrução e docência aumentava significativamente a possibilidade de acertar as respostas corretas. Médicos e enfermeiros não costumam encaminhar o paciente periodontal ao especialista

The aim of this study was to evaluate among physicians, dentists and nurses the general and specific knowledge of periodontal disease (PD) and its association with other diseases. A structured questionnaire including questions about periodontal disease, its association with other diseases, and the degree of commitment of health professionals with periodontal patient was used. Responses were determined according to systematic reviews and meta-analyzes consulted. Two hundred and sixty-nine health professionals at the Military Police of Rio de Janeiro answered the questionnaire, including 87 dentists, 123 doctors and 59 nurses with a mean age of 39.5 (± 7.2) years. Fifty-six (20.8%) professionals were teachers, while 200 (74.3%) were specialists. The percentage of correct answers for questions regarding the signs and symptoms of PD ranged from 87.7% to 97.4% for gingival bleeding, gingival recession and tooth mobility. However, only 7.8% of the professionals correctly answered questions regarding tooth loss. With regard to questions pertaining risk factors, the percentage of correct answers ranged between 91.4% and 96.7% for diabetes and smoking. On the other hand, the percentages of correct answers to questions regarding age and education as risk factors were 22.3% and 24.2%. Periodontal disease was correctly identified as a risk factor for cardiovascular disease by 81.4% of the professionals. Dentists recognized more often that PD was associated with an increased risk for diabetes, premature birth and low birth weight babies. Regarding the association between PD and pre-eclampsia, metabolic syndrome and chronic kidney disease, the percentage of correct answers ranged between 17.1% and 41.2%. The level of education and teaching of health professionals significantly influenced the percentage of correct answers chosen. In relation to questions regarding periodontal treatment for the aforementioned diseases, the percentage of correct answers ranged from 2.6% to 20.8%. Once again, the educational background significantly influenced the percentage of correct answers. The recognition of scientific evidence that periodontal treatment may improve metabolic control in diabetic patients ranged from 40.7% (nurses) to 50.4% (physicians). The frequency of physicians and nurses who often/always diagnose, examine and advise patients about the risks and effects of PD in general health ranged from 0% to 20.3%. Only 23.6% refer patients for evaluation and periodontal treatment. In conclusion, knowledge about PD and PD as a risk factor for other diseases was reduced between physicians and nurses. All three categories of professionals investigated ­physicians, dentists and nurses- showed reduced knowledge about the lack of scientific evidence of periodontal treatment as prevention factor for other diseases. A high degree of education and teaching significantly increased the likelihood of identifying the correct answers. Physicians and nurses do not usually refer patients to periodontal specialists