Meta-analysis on efficacy of PCI treatment or conservative treatment among patients with chronic total occlusions / 中华心血管病杂志

Objective: To compare the efficacy between percutaneous coronary intervention (PCI) and conservative medication treatment in chronic total occlusions (CTO) patients. Methods: It was a meta-analysis.Articles on drug therapy and PCI for complete coronary artery occlusion were retrieved from Pubmed, Embase and Web of Science databases. The search time was from the database construction to May 10, 2020, and the following search criteria were used for the search "chronic total occlusion" "percutaneous coronary intervention" and "medical therapy". References from searched literatures were also searched to identify more eligible studies. Randomized controlled trials (RCT) and cohort studies comparing efficacy of PCI versus oral medication as well as medication as initial therapy option for CTO patients with single or multiple lesions were included. The primary endpoints included all-cause death, cardiac death, recurrent myocardial infarction, re-revascularization, major adverse cardiac events (MACE) and stroke. Data were analyzed with ReviewManager5.3.0 software. Pooled effect size RR and 95%CI were calculated by randomization effect model. Heterogeneity was evaluated by I2. Bege test was used to evaluate publication bias. Subgroup analyses were performed for RCT and cohort studies. Results: A total of 1 079 articles were retrieved and 16 studies (RCT=4, cohort study=12) were included with 12 223 patients. Fourteen publications (RCT=4, cohort study=10) reported all-cause death post PCI and/or drug therapy. Results showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group (RR=0.45,95%CI 0.39-0.53,P<0.001);subgroup analysis showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.44,95%CI 0.38-0.52,P<0.001),but comparable in RCT (P=0.27). Thirteen studies (RCT=3, cohort study=10) reported cardiac death post PCI and/or drug therapy. Results showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group (RR=0.44,95%CI 0.35-0.55,P<0.001);subgroup analysis showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.43,95%CI 0.34-0.54,P<0.001),but not in RCT (P=0.25). Fourteen publications (RCT=4, cohort study=10) reported recurrent myocardial infarction post PCI and/or drug therapy. Results showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group (RR=0.62,95%CI 0.44-0.88,P=0.007);subgroup analysis showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.56,95%CI 0.40-0.78,P=0.000 5),but comparable in RCT (P=0.17). Fourteen publications (RCT=4, cohort study=10) reported re-revascularization post PCI and/or drug therapy. Results showed that risk of re-revascularization was comparable between PCI group and drug therapy group (P=0.91);subgroup analysis showed that risk of re-revascularization was comparable between PCI group and drug therapy group both in cohort study and RCT (P=0.60 and 0.41, respectively). Eleven publications (RCT=3, cohort study=8) reported MACE post PCI and/or drug therapy. Results showed that risk of MACE was significantly lower in PCI group than in drug therapy group (RR=0.74,95%CI 0.59-0.93,P=0.03);subgroup analysis showed that risk of MACE was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.72,95%CI 0.56-0.93,P=0.01), but not in RCT (P=0.8). Six publications (RCT=2, cohort study=4) reported stroke post PCI and/or drug therapy. Results showed that risk of stroke was comparable between PCI and drug therapy groups (RR=0.62,95%CI 0.32-1.20, P=0.15);subgroup analysis showed that risk of stroke was comparable between PCI and drug therapy groups both in cohort studies and RCT (P=0.48 and 0.32, respectively). Conclusion: Compared with oral drug therapy, PCI may have better efficacy for CTO patients based on results from this cohort study.

Fracturas de húmero distal en pacientes mayores de 65 años: ¿cuál es la mejor opción terapéutica? / Distal humerus fractures in patients over 65 years: what is the best therapeutic option? / Fraturas do úmero distal em pacientes maiores de 65 anos: qual é a melhor opção terapêutica?

Introducción: Las fracturas del húmero distal corresponden al 2% de todas las fracturas. Son los pacientes más añosos, los que presentan mayor desafío terapéutico. Suelen presentarse con huesos osteoporóticos, lo que conlleva a producir fracturas con mayor conminución articular y metafisaria; así como también dificultar una fijación estable y rígida de las mismas, que permita una movilidad precoz. Estas características generan controversia a la hora de elegir el tratamiento adecuado. El objetivo de este estudio es revisar la bibliografía de la última década, acerca de cuál es la mejor opción terapéutica para las fracturas de húmero distal en pacientes añosos. Materiales y métodos: Se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed y Timbó en agosto 2019. La búsqueda llego a un total de 475 artículos, de los cuales se seleccionaron 24 según criterios de inclusión y exclusión. Discusión: La mayoría de los estudios analizados son estudios de serie de casos retrospectivos. En los trabajos revisados, existen fracturas tanto extra como intra-articulares. Se analizaron los resultados de los distintos tratamientos realizados según parámetros clínicos, scores funcionales y complicaciones. Conclusiones: El tratamiento conservador es una opción válida para aquellos pacientes en los que el terreno no permita una intervención quirúrgica. Para las fracturas tipo extra-articulares y parcialmente articulares, la reducción abierta y fijación interna es el tratamiento de elección. Para las fracturas articulares completas, no hay diferencias significativas en cuanto a scores utilizados entre la reducción abierta y fijación interna con la artroplastia de codo. Faltan estudios prospectivos que comparen ambos tratamientos.

Introduction: Distal humerus fractures account for 2% of all fractures. It is the elderly patients who present the greatest therapeutic challenge. Osteoporotic bones, more common in this population, lead to the production of fractures with greater joint and metaphyseal comminution. As a result, stable and rigid fixation becomes more difficult, hindering early mobility. These characteristics generate controversy when choosing the appropriate treatment. The aim of this study is to review the literature of the last decade regarding the best therapeutic option for distal humerus fractures in elderly patients. Methods: A systematized search was performed through the electronic search engines PubMed and Timbó in august 2019. The search reached a total of 475 articles, of which 24 were selected according to inclusion and exclusion criteria. Discussion: Most of the studies analyzed are retrospective case series studies. In the articles reviewed, there are both extra and intra-articular fractures. The results of the different treatments performed were analyzed according to clinical parameters, functional scores and complications. Conclusions: Conservative treatment is a valid option for those patients where the terrain does not allow surgical intervention. For extra-articular and partial-articular fractures, open reduction and internal fixation is the treatment of choice. For complete articular fractures, there are no significant differences in scores used between open reduction and internal fixation and elbow replacement. There is a lack of prospective studies comparing both treatments.

Introdução: Fraturas do úmero distal correspondem a 2% de todas as fraturas. São os pacientes mais idosos os que apresentam maior desafio terapêutico. Geralmente apresentam-se com ossos osteoporóticos, o que implica produzir fraturas com maior cominuição articular e metafisária; assim como também dificultar uma fixação estável e rígida das mesmas, que permita uma mobilidade precoce. Estas características geram controvérsia na escolha do tratamento adequado. O objetivo deste estudo é rever a bibliografia da última década, sobre qual é a melhor opção terapêutica para fraturas de úmero distal em pacientes idosos. Materiais e métodos: Foi realizada uma pesquisa sistematizada através dos buscadores eletrônicos Pubmed e Timbó em agosto 2019. A pesquisa chegou a um total de 475 artigos, dos quais 24 foram selecionados segundo critérios de inclusão e exclusão. Discussão: A maioria dos estudos analisados são estudos de série de casos retrospectivos. Nos trabalhos revisados, existem fraturas tanto extra como intra-articulares. Foram analisados os resultados dos diferentes tratamentos realizados segundo parâmetros clínicos, scores funcionais e complicações. Conclusões: O tratamento conservador é uma opção válida para os pacientes em que o terreno não permita uma intervenção cirúrgica. Para fraturas tipo extra-articulares e parcialmente articulares, a redução aberta e fixação interna é o tratamento de escolha. Para fracturas articulares completas, não há diferenças significativas em termos de scores utilizados entre a redução aberta e a fixação interna com artroplastia do cotovelo. Faltam estudos prospectivos que comparem os dois tratamentos.

Necesidad de tratamiento estomatológico en niños de la Escuela Especial Jardín de La Alegría, 2016 / Need for stomatological treatment in children of the Special School Jardín de La Alegría, 2016

RESUMEN Introducción: La salud bucal del paciente discapacitado intelectual ha sido una gran preocupación a nivel mundial. Cuba no se escapa de ello, por lo que ha implementado programas que priorizan a este tipo de individuos. Objetivo: Determinar la necesidad de tratamiento estomatológico de los pacientes con discapacidad intelectual según la categoría diagnóstica de la Escuela Especial Jardín de la Alegría. Métodos: Estudio descriptivo transversal realizado en el período comprendido entre 2016-2017. El universo de estudio estuvo constituido por 105 niños que representa la matrícula total de la escuela. El examen clínico de los escolares se realizó en el sillón dental. Para la recolección de la información se confeccionó una planilla encuesta teniendo en cuenta las características del grupo objeto de estudio: edad, sexo, categoría diagnóstica, índice COP-D y ceo-d, índice de necesidad de tratamiento periodontal comunitario, y la higiene bucal mediante el índice de higiene bucal simplificado de Greene y Vermillon. Resultados: La categoría diagnóstica que prevaleció fue el discapacitado intelectual leve con 82,8 por ciento. El 68,6 por ciento de la población estudiada presentó higiene bucal regular. El 67,6 por ciento de los niños presentó enfermedad periodontal, el 59,0 por ciento maloclusión y el 54,2 por ciento caries dental. Según necesidad de tratamiento, el 67,0 por ciento requiere tratamiento periodontal, el 59,0 por ciento tratamiento ortodóncico y el 45,7 por ciento tratamiento conservador. Conclusiones: Existió una alta necesidad de tratamiento periodontal en los individuos con discapacidad intelectual leve(AU)

ABSTRACT Introduction: The oral health of the intellectually disabled patient has been a great concern worldwide. Cuba does not escape this concern by implementing programs that prioritize this type of individuals. Objective: To determine the need for stomatological treatment of patients with intellectual disability according to the diagnostic category of the Jardín de la Alegría Special School. Methods: a cross-sectional descriptive study conducted in the period 2016-2017. The clinical examination of the students was carried out in the dental chair. For the collection of the information a survey form was made taking into account the characteristics of the group under study: age, sex, diagnostic category, COP-D index and ceo-d, index of need for community periodontal treatment, and oral hygiene using the simplified oral hygiene index of Greene and Vermillon. The universe of study was constituted by 105 children that represents the total enrollment of the school. Results: the diagnostic category that prevailed was the mild intellectual disability with 82.8. 68.6 percent of the studied population presented regular oral hygiene. 67.6 percent of the children presented periodontal disease, 59.0 percent malocclusion and 54.2 percent dental caries. According to need of treatment, 67 percent need periodontal treatment, 59.0 percent orthodontic treatment and 45.7 percent need conservative treatment. Conclusions: there was a high need for periodontal treatment in individuals with mild intellectual disability(AU)