Guía de práctica clínica para la atención a niños y adolescentes con enfermedad renal crónica / Clinical practice guide for the care to children and adolescents with chronic renal disease

La enfermedad renal crónica constituye un problema de salud por su impacto sobre los individuos, la sociedad y la economía. Teniendo en cuenta lo anterior, y luego de una amplia búsqueda bibliográfica, se diseñó una guía de práctica clínica en el Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río, dirigida a los profesionales de la atención primaria de salud, con el objetivo de mejorar la calidad de vida de niños y adolescentes con dicha enfermedad. Esta fue elaborada por los métodos de la medicina basada en la evidencia, según el consenso y la opinión de los expertos. Se logró generalizar esta herramienta, emitir recomendaciones y actualizarla acorde con las nuevas evidencias médicas. Finalmente, resultó evaluada por los expertos como muy recomendada.

Chronic renal disease constitutes a health problem due to its impact on individuals, society and economy. Taking into account the above-mentioned, and after a wide literature search, a clinical practice guide was designed in Luis Augusto Turcios Lima Polyclinic from Pinar del Río province, directed to primary health care professionals, aimed at improving the life quality of children and adolescents with this disease. It was elaborated by medicine methods based on the evidence, according to the consent and opinion of experts. It was possible to generalize this tool, give recommendations and up to date according to the new medical evidences. Finally, it was evaluated by experts as very recommended.

Utilization of dental services by preschool children: prevalence and associated factors

Abstract Dental associations worldwide recommend that the first dental visit should take place before 12 months of age; however, preschoolers' utilization of dental services remains low. The aim of this study was to assess the prevalence of, and factors associated with, dental services utilization among children aged 1 to 3 years. This was a cross-sectional study carried out in the city of Diamantina, MG, Brazil, and involved a sample of 308 child-mother pairs. Mothers completed a questionnaire addressing sociodemographic and economic aspects of the family and characteristics pertaining to their child's oral health. The clinical assessment of the children included dental caries, trauma, malocclusion, and mucosal changes. Analysis of the data comprised statistical description, application of the chi-square test, and Poisson's regression analysis. Among the children studied, 39.6% had attended at least one dental visit in their lifetime. Children whose families had a greater number of members relying on the family's income (PR = 1.40, 95%CI:1.04 -1.89, p = 0.028) and those with moderate/extensive dental caries (Codes 3-6 of the ICDAS; PR = 1.44, 95%CI: 1.08 -1.93, p = 0.014) exhibited a higher prevalence of dental services utilization. In conclusion, the prevalence of dental services utilization among children aged 1 to 3 years was low, and was associated with a greater number of family members relying on the family's income, and with the occurrence of moderate/extensive dental caries.

The 100 most cited articles about orofacial trauma in children and adolescents: bibliometric analysis

Abstract This bibliometric study aimed to identify and analyze the 100 most cited articles about orofacial trauma in children and adolescents. The search was conducted in the Web of Science Core Collection (WoS-CC) using a combined search strategy. Two researchers collected the following data from each article: year of publication, country, journal, number and density of citations, author, institutions, study design, type of trauma, and keywords. The VOSviewer and SPSS version 22.0 softwares were used for data analyses. The articles were published from 1968 to 2012 and the number of citations ranged from 49 to 176. Europe was the continent with most articles (40 articles; 3,408 citations). Brazil was the country that made the largest contribution (20 articles; 1,741 citations) and the Universidade do Sul de Santa Catarina (Brazil) was the institution with most articles (5 articles; 492 citations). Marcenes W was the most productive author (8 articles; 968 citations). The cross-sectional study design was the most common (50 articles; 3,978 citations). The most frequent field was epidemiology (73 articles; 5,971 citations). The most widely used criteria for trauma diagnosis were the Andreasen (18 articles; 1,505 citations) and Le Fort (3 articles; 260 citations). Strong positive correlations were found in the number of citations between WoS-CC and Google Scholar (r = 0.929; p < 0.001), WoS-CC and Scopus (r = 0.976; p < 0.001), and Google Scholar and Scopus (r = 0.903; p < 0.001). The 100 most cited articles about orofacial trauma in children and adolescents were mainly cross-sectional studies published by Brazilian authors in epidemiology using Andreasen criteria. Dental Traumatology was the journal with the largest contribution.

Estrategias metodológicas interactivas de la educación virtual en medicina: una revisión sistemática

Introducción: La pandemia ocasionada por la COVID - 19, ha provocado un cambio radical en la educación, siendo una de las más afectadas la educación médica. Los programas de esta carrera han realizado cambios para mantener el plan de estudios, surgiendo la necesidad de implementar nuevas estrategias metodológicas que permitan el mejor desempeño del estudiante. Objetivo: Describir estrategias metodológicas interactivas para la mejora de la práctica docente en el programa de medicina humana, teniendo en cuenta el contexto actual, a partir de evidencia publicada como resultado de investigaciones. Métodos: Esta revisión sistemática está basada en evidencia publicada como resultado de investigaciones en las bases de datos SCOPUS, Scielo, Latindex y DOAJ. Se eligieron artículos que hayan sido publicados entre los años 2017 y 2021 de acceso gratuito y que estén escritos en inglés o español. El estudio permitirá de manera importante mejorar la práctica docente en los programas de medicina humana. Desarrollo: En las tablas 1 y 2, son mostradas algunas estrategias metodológicas interactivas de la educación virtual (29,8%), que satisface las exigentes necesidades de la industria de la educación y con ayuda de la tecnología han transformado el sistema educativo en un modo en línea. De los resultados encontrados en la revisión de los artículos (tabla 3), se puede inferir que aplicar estrategias metodológicas donde exista una interacción activa entre el docente y alumno resultan beneficiosas en el aprendizaje. Conclusiones: Se determinó que implementar las estrategias metodológicas interactivas como la simulación virtual, trabajo colaborativo, aula invertida y ambientes virtuales de aprendizaje en la formación del programa de medicina colabora de manera importante en el aprendizaje y estimulación del estudiante.

Introduction: The pandemic caused by COVID - 19 has caused a radical change in education, one of the most affected being medical education. The programs of this career have made changes to maintain the study plan, arising the need to implement new methodological strategies that allow the best performance of the student. Objective: Describe interactive methodological strategies for the improvement of teaching practice in the human medicine program, taking into account the current context, based on evidence published as a result of research. Methods: This systematic review is based on evidence published as a result of research in the SCOPUS, Scielo, Latindex and DOAJ databases. Articles that have been published between the years 2017 and 2021 with free access and that are written in English or Spanish were chosen. The study will significantly improve teaching practice in human medicine programs. Development: In tables 1,2, some interactive methodological strategies of virtual education (29.8%) are shown, which satisfy the demanding needs of the education industry and with the help of technology have transformed the educational system into a mode in line. From the results found in the review of the articles (table 3), it can be inferred that applying methodological strategies where there is an active interaction between the teacher and student are beneficial in learning. Conclusions: It was determined that implementing interactive methodological strategies such as virtual simulation, collaborative work, flipped classroom and virtual learning environments in the training of the medicine program contributes significantly to student learning and stimulation.

Factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños / Risk factors related to postcovid­19 syndrome in residents from Pinar del Río i: en

Introducción: Las posibilidades de padecer el síndrome poscovid-19 crecen en la medida en que se expande la pandemia. Objetivo: Identificar los factores de riesgo relacionados con el síndrome poscovid-19 en pobladores pinareños. Métodos: Se realizó un estudio de casos y controles, que incluyó a convalecientes de covid-19, atendidos en la consulta multidisciplinaria del Policlínico Luis Augusto Turcios Lima de la provincia de Pinar del Río durante el 2022, quienes fueron incluidos de forma aleatoria en 2 grupos, a razón de 1:2 (100 casos y 200 controles). El análisis estadístico se basó en una estrategia univariada, que consistió en la determinación del odds ratio para cada factor de riesgo, así como en la estimación de los intervalos de confianza al 95 % y la prueba de la Χ2, con un nivel de significación de p<0,05. Resultados: En el estudio predominaron el sexo femenino, la diabetes mellitus, el tratamiento farmacológico, el soporte ventilatorio, la presencia de secuelas establecidas y las complicaciones. Conclusiones: A pesar de identificar los factores de riesgo más frecuentes relacionados con el síndrome poscovid-19, este continúa siendo un desafío para los profesionales de la salud.

Introduction: The possibilities to suffer from the postcovid-19 syndrome grow as the pandemic expands. Objective: To identify the risk factors related to the postcovid-19 syndrome in residents from Pinar del Río. Methods: A cases and controls study that included covid-19 convalescents was carried out. They were assisted in the multidisciplinary service of Luis Augusto Turcios Lima Polyclinic of Pinar del Rio province during 2022 that were included in 2 groups at random, at a ratio of 1:2 (100 cases and 200 controls). The statistical analysis was based on an univaried strategy, for which the odds ratio was determined for each risk factor and the confidence intervals were considered at 95 %, as well as the chi-square test, with a significance level of p<0,05. Results: In the study there was a prevalence of the female sex, diabetes mellitus, pharmacological treatment, ventilation support, the presence of established sequels and complications. Conclusions: In spite of identifying the most frequent risk factors related to the postcovid-19 syndrome, it is still a challenge for health professionals.

Caracterización clínico quirúrgica de la colecistitis aguda en pacientes tratados en el Servicio de Cirugía General. Cienfuegos, 2017- 2019

Fundamento la colecistitis aguda es una enfermedad inflamatoria, caracterizada por alteraciones agudas de la pared vesicular que pueden ir desde el edema y la congestión hasta la gangrena y perforación. Es una enfermedad con alta incidencia en urgencia quirúrgica. Objetivo: caracterizar clínica y quirúrgicamente la colecistitis aguda en pacientes del Servicio de Cirugía General. Métodos: se realizó un estudio descriptivo y prospectivo de pacientes atendidos por colecistitis aguda en el Servicio de Cirugía durante el período del primero de enero de 2017 al treinta y uno de diciembre de 2019. Los datos se obtuvieron de las historias clínicas y los informes operatorios, utilizando un modelo de recolección de datos. Se analizaron las variables edad, sexo, enfermedades asociadas, manifestaciones clínicas, confirmación diagnóstica, tipo de tratamiento, modalidad de tratamiento quirúrgico, evolución, complicaciones, uso de antibiótico, lugar de ingreso y estadía hospitalaria Resultados: predominaron los pacientes de 60 años y más del sexo femenino; el dolor abdominal prevaleció en la mayoría de los pacientes, acompañado de vómitos y taquicardia; el diagnóstico se confirmó mediante la clínica; predominó el tratamiento quirúrgico, la colecistectomía convencional abierta fue la técnica de elección; la mayoría evolucionó de forma satisfactoria. La sepsis de la herida quirúrgica fue la complicación más frecuente. Conclusiones: la colecistitis aguda es más frecuente en ancianos, el diagnóstico precoz y tratamiento oportuno pueden disminuir el porcentaje de complicaciones; el tratamiento quirúrgico es el de elección, combinado con antibióticoterapia.

Background: acute cholecystitis is an inflammatory disease, characterized by acute changes in the gallbladder wall that can range from edema and congestion to gangrene and perforation. It is a disease with a high incidence in surgical urgency. Objective: to clinically and surgically characterize acute cholecystitis in patients of the General Surgery Service. Methods: a descriptive and prospective study of patients treated for acute cholecystitis in the Surgery Service was carried out from January the 1st, 2017 to December the 31st, 2019. Data were obtained from medical records and operative reports, using a data collection model. The variables age, sex, associated diseases, clinical manifestations, diagnostic confirmation, type of treatment, modality of surgical treatment, evolution, complications, use of antibiotics, place of admission and hospital stay were analyzed. Results: female patients aged 60 years and over predominated; abdominal pain prevailed in most of the patients, accompanied by vomiting and tachycardia; the diagnosis was confirmed through the clinic; surgical treatment predominated, conventional open cholecystectomy was the technique of choice; most progress satisfactorily. Surgical wound sepsis was the most frequent complication. Conclusions: acute cholecystitis is more frequent in the elderly, early diagnosis and timely treatment can reduce the percentage of complications; surgical treatment is the treatment of choice, combined with antibiotic therapy.

Factores de riesgo relacionados con la COVID-19. Policlínico Turcios Lima. Pinar del Río, 2020-2021

Fundamento el reconocimiento oportuno de determinados factores de riesgo contribuye a identificar la infección por COVID-19 en una etapa temprana, lo cual, unido a la participación interdisciplinaria e intersectorial, permite implementar mejores estrategias y reducir la morbimortalidad. Objetivo determinar los factores de riesgo relacionados con la aparición de COVID-19. Métodos se realizó un estudio de casos y controles, que incluyó a pacientes atendidos en el Policlínico Comunitario Turcios Lima, de Pinar del Río, en los años 2020 y 2021. La selección de la muestra fue aleatoria 3:6 (3000 casos positivos de COVID-19/6000 controles sin la enfermedad), pareados por edad y sexo. El análisis estadístico se basó en una estrategia multivariada, cálculo de Odds Ratio (OR) con intervalos de confianza al 95 % (IC 95 %), y la prueba de Chi Cuadrado, con nivel de significación estadística de p<0,05. Resultados los factores de riesgo más frecuentes fueron: el sexo masculino (X2=8,5900; p<0,001), la residencia urbana (X2=509,03; p<0,001) y la ocupación como estudiante o trabajador (X2=199,93; p<0,001); así como los antecedentes patológicos personales de diabetes mellitus, hipertensión arterial, cardiopatía isquémica, asma bronquial, insuficiencia cardiaca y enfermedad pulmonar obstructiva crónica. Conclusiones aunque se identificaron el sexo, el lugar de residencia, la ocupación y los antecedentes patológicos personales, como factores de riesgo relacionados con la COVID-19, la información acerca del impacto de otros factores es todavía limitada y requiere de estudio.

Background timely recognition of certain risk factors helps to identify COVID-19 infection at an early stage, which, together with interdisciplinary and intersectoral participation, allows for the implementation of better strategies and reduction of morbidity and mortality. Objective to determine the risk factors related to the appearance of COVID-19. Methods: a case-control study was carried out, which included patients treated at the Turcios Lima Community Polyclinic, in Pinar del Río, from 2020 to 2021. The sample selection was random 3:6 (3000 positive cases of COVID-19/6000 controls without the disease), matched by age and sex. Statistical analysis was based on a multivariate strategy, calculation of the Odds Ratio (OR) with 95% confidence intervals (95% CI), and the Chi Square test, with a statistical significance level of p<0.05. Results the most frequent risk factors were: male sex (X2=8.5900; p<0.001), urban residence (X2=509.03; p<0.001) and occupation as a student or worker (X2=199 .93, p<0.001); as well as personal medical history of diabetes mellitus, arterial hypertension, ischemic heart disease, bronchial asthma, heart failure, and chronic obstructive pulmonary disease. Conclusions although sex, place of residence, occupation, and personal medical history were identified as risk factors related to COVID-19, information about the impact of other factors is still limited and requires further study.

Propuesta de guía de práctica clínica corta para el manejo de la enfermedad renal crónica

La enfermedad renal crónica constituye un problema de salud debido su impacto sobre los individuos, la sociedad y la economía. Se propone una guía de práctica clínica para atención de la enfermedad renal crónica en la Atención Primaria de Salud. Se realizó una investigación clínica epidemiológica entre los años 2017-2019, en el Policlínico Luis Augusto Turcios Lima, del municipio de Pinar del Río. La guía fue elaborada siguiendo criterios de la medicina basada en la evidencia, por consenso y por opinión de expertos. La evaluación de calidad se realizó con el Instrumento Appraisal of Guidelines, Research and Evaluation for Europe. Se elaboraron recomendaciones, se generalizó y actualizó permanentemente con las nuevas evidencias médicas. Se sistematizaron las prácticas preventivas y de detección precoz de la enfermedad. La guía propuesta provee a los profesionales que laboran en la Atención Primaria de Salud, las herramientas apropiadas para la detección y manejo de la enfermedad renal crónica; además de facilitar la coordinación entre los ámbitos de los niveles primario y secundario de Salud. Se concluye que permite mejorar la atención de los pacientes con esta enfermedad, particularmente en la Atención Primaria de Salud.

Chronic kidney disease constitutes a health problem due to its impact on individuals, society and the economy. A clinical practice guide for chronic kidney disease care in Primary Health Care is proposed. A clinical epidemiological investigation was carried out from 2017 to 2019, at the Luis Augusto Turcios Lima Polyclinic, in the Pinar del Río municipality. The guideline was prepared following evidence-based medicine criteria, by consensus and by expert opinion. The quality evaluation was carried out with the Appraisal of Guidelines, Research and Evaluation for Europe Instrument. Recommendations were elaborated; it was generalized and permanently updated with the new medical evidence. Preventive practices and early detection of the disease were systematized. The proposed guide provides professionals working in Primary Health Care with the appropriate tools for the detection and management of chronic kidney disease; also facilitating coordination between the primary and secondary levels of Health. It is concluded that it allows improving the care of patients with this disease, especially in Primary Health Care.

Mothers' sense of coherence and oral health-related quality of life of preschoolers: a 3-year cohort study

Abstract The aim of the present study was to assess whether mothers' sense of coherence (SOC) was a predictor of decline in oral health-related quality of life (OHRQoL) of preschoolers. A 3-year cohort study was conducted in Diamantina, Brazil. At baseline, 162 preschoolers aged one to three years were randomly selected from among children registered in local Primary Healthcare Units. In the first stage, mothers completed a sociodemographic questionnaire, the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian short version of the Sense of Coherence Scale (SOC-13). The total score obtained from the SOC-13 was used to select exposed and unexposed children. Clinical examinations were performed to detect the presence of dental caries, traumatic dental injury, and malocclusion. At follow-up, mothers completed the sociodemographic questionnaire and the B-ECOHIS again. The incidence of severe dental caries and adherence to the proposed treatment at baseline were evaluated. A decline in OHRQoL was considered if there was an increase in the B-ECOHIS score of at least one unit. The chi-square test and Poisson regression were performed. A total of 151 preschoolers participated in the study, among whom 37.7% showed a decline in OHRQoL. Mothers' SOC was not associated with a negative impact on OHRQoL (RR = 1.24; 95%CI = 0.81-1.88), while the incidence of severe dental caries had a greater impact on the decline in OHRQoL (RR = 2.02; 95%CI = 1.29-3.16). Mothers' low SOC was not a predictor of decline in the OHRQoL of preschoolers after a 3-year follow-up period.

Psychometric assessment of oral health-related quality of life questionnaires cross-culturally adapted for use in Brazilian adults - a systematic review / Avaliação psicométrica de questionários de qualidade de vida relacionada à saúde bucal adaptados culturalmente para uso em adultos brasileiros - uma revisão sistemática

ABSTRACT Objective: This study aimed to review the psychometric properties of oral health-related quality of life (OHRQoL) questionnaires for the Brazilian adult population. Methods: A systematic review was performed based on the COSMIN guidelines (PROSPERO CRD42022300018). The studies were obtained through electronic searches in the PubMed/MEDLINE, Web of Science, Lilacs, VHL (BIREME), SciELO, and Embase databases. Results: The search was performed in December 2022. Articles on OHRQoL that reported the cross-cultural adaptation of instruments into Portuguese (Brazil) and evaluated the psychometric properties of measuring instruments in adult patients were included. Those about the development of a novel instrument and participants under 18 years of age were excluded. Information was collected on the country, type of instrument validated, psychometric tests, and adaptation process. The certainty of the evidence was assessed using GRADEpro program. The search returned 6,556 articles, and 14 were considered for this review. However, two studies did not report the cross-cultural adaptation process. Content validity, internal consistency, criterion validity, construct validity, reliability, general discriminant validity, Cronbach's alpha value, and general intraclass correlation coefficient value were confirmed in 12 studies. Cronbach's alpha ranged from 0.69 to 0.96. The certainty of the evidence was considered moderate and low. This study has some limitations, such as the lack of information in some reviewed studies, the unavailability of Brazilian instruments, and absence of longitudinal validation of some instruments. Conclusions: In conclusion, there are 14 OHRQoL instruments adapted for Brazilian adults that can be used with caution by researchers and clinicians, since they presented moderate to low certainty of the evidence.

RESUMO Objetivo: Este estudo teve como objetivo revisar as propriedades psicométricas dos questionários de qualidade de vida relacionada à saúde bucal (OHRQoL) para a população adulta brasileira. Métodos: Foi realizada uma revisão sistemática com base nas diretrizes Consensus-based standards for the selection of health measurement instruments - COSMIN (International Prospective Register of Systematic Reviews - PROSPERO CRD42022300018). Os estudos foram obtidos por meio de buscas eletrônicas nas bases de dados United States National Library of Medicine (PubMed)/ Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Virtual em Saúde - BVS (Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde - BIREME), Scientific Electronic Library Online (SciELO) e Embase. A busca foi realizada em dezembro de 2022. Foram incluídos artigos que relatavam a adaptação transcultural de instrumentos (QVRSB) para o português (Brasil) e que avaliavam as propriedades psicométricas de mensuração de instrumentos (QVRSB) em pacientes adultos. Foram excluídos aqueles sobre o desenvolvimento de um novo instrumento e com participantes menores de 18 anos. Foram coletadas informações sobre país, tipo de instrumento validado, testes psicométricos e processo de adaptação. A certeza da evidência foi avaliada usando GRADE. Resultados: A pesquisa retornou 6556 artigos, e 14 foram incluídos nesta revisão. Dois estudos não relataram o processo de adaptação transcultural. A validade de conteúdo, consistência interna, validade de critério, validade de constructo, confiabilidade, validade discriminante geral, valor alfa de Cronbach e valor geral do coeficiente de correlação intraclasse foram confirmadas em 12 estudos. O alfa de Cronbach variou de 0,69 a 0,96. A certeza da evidência foi considerada moderada e baixa. Esta pesquisa apresenta algumas limitações, como falta de informação em alguns estudos revisados; indisponibilidade de instrumentos brasileiros; ausência de validação longitudinal de alguns instrumentos. Conclusões: Em conclusão, existem 14 instrumentos de QVRSB adaptados para adultos brasileiros que podem ser utilizados com cautela por pesquisadores e clínicos, uma vez que apresentam moderada a baixa certeza de evidência.

Estrategia educativa sobre enfermedad renal crónica en el Policlínico Turcios Lima de Pinar del Río / Educational strategy on chronic kidney disease at the Turcios Lima Polyclinic in Pinar del Río

RESUMEN Fundamento la enfermedad renal crónica se reconoce cada vez más como un problema de salud pública, debido al gran impacto económico y social que genera en la población. El conocimiento de aspectos relacionados con el autocuidado y factores de riesgo por los pacientes puede contribuir a una mejor calidad de vida de estos. Objetivo exponer los resultados de una estrategia de intervención educativa sobre la enfermedad renal crónica. Métodos: se realizó un estudio descriptivo, de antes y después, en pacientes con enfermedad renal crónica de 16 consultorios urbanos (N=60) pertenecientes al Policlínico Luis A. Turcios Lima, durante 2019. Se aplicaron encuestas a los pacientes antes y después de la intervención, la cual estuvo orientada a elevar el nivel de conocimientos acerca de aspectos de interés relacionados con la enfermedad. Se utilizó la prueba de McNemar al 95 % de certeza para comparar los resultados. Resultados antes de la intervención cerca del 70 % de los pacientes no identificaron adecuadamente la enfermedad; luego de ella, más del 93 % de los pacientes refirieron haber adquirido esos conocimientos. Lo mismo sucedió con los factores de riesgo, las manifestaciones clínicas, complicaciones, diagnóstico, la prevención y el tratamiento, con diferencia estadísticamente significativa en todos los casos. Conclusión proporcionar educación a los pacientes sobre la enfermedad renal crónica y sus opciones de tratamiento, incrementa su nivel de conocimientos, su capacidad de comprender, razonar y realizar acciones favorables a su estado de salud.

ABSTRACT Background Chronic kidney disease is increasingly recognized as a public health problem, due to the great economic and social impact it generates in the population. Knowledge of aspects related to self-care and risk factors by patients can contribute to a better quality of life for them. Objective to present the results of an educational intervention strategy on chronic kidney disease. Methods a descriptive study was carried out, before and after, in patients with chronic kidney disease from 16 urban clinics (N=60) belonging to the Luis A. Turcios Lima Polyclinic, during 2019. Surveys were applied to patients before and after the intervention, which was aimed at raising the knowledge level about aspects of interest related to the disease. McNemarˈs test at 95% certainty was used to compare the results. Results before the intervention about 70% of the patients did not properly identify the disease; after it, more than 93% of the patients reported having acquired this knowledge. The same happened with risk factors, clinical manifestations, complications, diagnosis, prevention and treatment, with a statistically significant difference in all cases. Conclusion providing education to patients about chronic kidney disease and its treatment options increases their level of knowledge, their ability to understand reason and take actions favorable to their health status.

Congenital atresia of the submandibular gland duct: report of two clinical cases with spontaneous regression and literature review / Atresia congênita do ducto da glândula submandibular: relato de dois casos clínicos com regressão espontânea e revisão da literatura

Background:Congenital atresia of the submandibular gland duct is a rare condition, originated during the embryogenic process, characterized by swelling in the region of the oral floor. A few cases of congenital atresia of the submandibular gland duct have appeared inthe literature and only one reports no surgical intervention to date. Case series:In the present study reports two cases of babies with clinical findings demonstrating swelling well-defined in the region of the oral floor, slightly translucent bluish color, painless to palpation, without finding stones or salivary drainage and apparently with no perforation of the submandibular gland duct. Both patients were kept under observation, later presenting spontaneous regression. Conclusion:This study highlights the importance of conducting a thorough clinical examination in addition to showing that the use of complementary exams may not be essential

Introdução:A atresia congênita do ducto da glândula submandibular é uma condição rara, originada durante o processo embriogênico, caracterizada por edema na região do assoalho bucal. Alguns casos de atresia congênita do ducto da glândula submandibular têm aparecido na literatura e apenas um relata nenhuma intervenção cirúrgica até o momento. Série de casos:No presente estudo relata-se dois casos de bebês com quadro clínico demonstrando aumento de volume bem definido na região doassoalho bucal, cor azulada levemente translúcida, indolor à palpação, sem encontrar cálculos ou drenagem salivar e aparentemente sem perfuração do ducto da glândula submandibular. Ambos os pacientes foram mantidos em observação, apresentando posteriormente regressão espontânea. Conclusão:Este estudo destaca a importância da realização de um exame clínico minucioso, além de mostrar que a utilização de exames complementares pode não ser imprescindível.

Factores de riesgo relacionados con enfermedad renal crónica. Policlínico Luis A. Turcios Lima, Pinar del Río, 2019

RESUMEN Fundamento La enfermedad renal crónica presenta una prevalencia elevada en Pinar del Río, Cuba, y constituye una de las principales causas de muerte; por ello se requiere obtener información de interés y que contribuya a su conocimiento. Objetivo determinar los factores de riesgo relacionados con la enfermedad renal crónica. Métodos se realizó un estudio de casos y controles, con pacientes pertenecientes a 16 consultorios del Policlínico Luis A. Turcios Lima, de Pinar del Río, en el periodo enero-diciembre de 2019. La selección de los participantes se realizó de forma aleatoria 1:2 (30 casos y 60 controles). El análisis estadístico se basó en una estrategia multivariada, la determinación del Odds Ratio, con intervalos de confianza al 95 %, y la prueba de Chi Cuadrado con un nivel de significación estadística de P<0,05. Se analizaron variables sociodemográficas, hábitos tóxicos, antecedentes familiares de enfermedad renal crónica y antecedentes patológicos personales, entre otras. Resultados los factores de riesgo identificados como de mayor incidencia fueron la edad por encima de 60 años, la obesidad, la hipercolesterolemia, los antecedentes patológicos personales de hipertensión arterial y la diabetes mellitus, así como la cardiopatía isquémica, las uropatías obstructivas y tener familiares con enfermedad renal crónica. Conclusión Los principales factores de riesgo fueron la presencia de antecedentes de la enfermedad en la familia, así como padecer hipertensión arterial y diabetes mellitus. Otras de las variables analizadas también se mostraron como tal, pero en menor medida.

ABSTRACT Background Chronic kidney disease has a high prevalence in Pinar del Río, Cuba, and is one of the main causes of death; so, it is necessary to obtain information of interest that contributes to its knowledge. Objective to determine the risk factors related to chronic kidney disease. Methods a case-control study was carried out, with patients belonging to the Luis A. Turcios Lima Polyclinic 16 doctor's office, in Pinar del Río, from January-December 2019. The selection of participants was carried out randomly 1:2 (30 cases and 60 controls). The statistical analysis was based on a multivariate strategy, the determination of the Odds Ratio, with 95% confidence intervals, and the Chi Square test with a level of statistical significance of P <0.05. Sociodemographic variables, toxic habits, family history of chronic kidney disease and personal pathological history, among others, were analyzed. Results the risk factors identified as having the highest incidence were age over 60 years old, obesity, hypercholesterolemia, personal pathological history of arterial hypertension and diabetes mellitus, as well as ischemic heart disease, obstructive uropathies and having relatives with chronic kidney disease. Conclusion The main risk factors were the presence of the disease family history, as well as suffering from high blood pressure and diabetes mellitus. Other variables analyzed were also shown as such, but to a lesser extent.

Risk indicators of untreated dental caries incidence among preschoolers: a prospective longitudinal study

Abstract: The aim of the present study was to evaluate the influence of socioeconomic factors, oral conditions and the impact of OHRQoL as possible risk indicators related to the incidence of untreated dental caries in preschool children two years after an initial examination. A prospective longitudinal study was performed with a sample of 288 preschool children allocated to two groups at baseline (T0): caries free (n = 144) and with untreated dental caries (n = 144). Untreated dental caries was determined through clinical examinations performed by a calibrated dentist at T0 (Kappa > 0,89) and T1 (two years after the baseline) (Kappa > 0,91) using the dmft criteria. Parents/caregivers answered a socioeconomic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at T0 and T1. Mann-Whitney test and hierarchically adjusted Poisson regression models were used (95%CI, p < 0,05). The incidence of untreated dental caries was 41.3%. Low (RR = 1.63; 95%CI:1.18-2.26; p < 0.001) and high severity of untreated dental caries (RR = 1.92; 95%CI:1.36-2.72; p < 0.001), monthly household income less than two times the Brazilian minimum salary (RR = 1.79; 95%CI:1.04-3.25; p = 0.042) and overall B-ECOHIS score (RR = 1.03; 95%CI:1.02-1.05; p < 0.001) at T0 were risk indicators for the incidence of untreated dental caries among the preschool children. In conclusion, the incidence of untreated dental caries was high and the higher severity of untreated dental caries, the lower monthly income and the higher the B-ECOHIS score (indicating a negative impact on quality of life) were risk indicators to the developing of new lesions of untreated dental caries after 2 years.

Association between different stages of dental caries in preschoolers and familial socioeconomic factors

Abstract: This study evaluated the association between socioeconomic factors and stages of dental caries in children one to five years of age. A cross-sectional study was conducted involving 759 children enrolled in preschools in Diamantina, Brazil. The parents/caregivers filled out a form addressing socioeconomic factors. Add to the end of this sentence: and categorized in caries free (code 0 and 1), no obvious decay (code 2 and 3) and obvious decay (code 4, 5 and 6). Statistical analysis was performed using the Mann-Whitney test and multinomial regression. The prevalence of "no obvious decay" was higher among children from families with a larger number of income-dependent individuals (OR: 2.47; 95%CI: 1.41-4.31). The higher prevalence of "obvious decay" was associated with the child's age (OR: 1.36; 95%CI: 1.16-1.58), attending a public preschool (OR: 2.38; 95%CI: 1.31-4.34), a larger number of income-dependent individuals (four to five individuals: OR: 1.71; 95%CI: 1.09-2.74; more than five individuals: OR: 3.41; 95%CI: 1.95-5.94), no access to a dentist (OR: 2.14; 95%CI: 1.48-3.09), and lower income (OR: 1.72; 95%CI: 1.19--2.49). It was concluded that the variable of a larger number of income-dependent individuals was associated with both no obvious decay and obvious decay. Child's age, type of preschool, access to a dentist, and income were associated with obvious decay.

Prevalence of unsatisfactory dental restorations in posterior primary teeth and associated factors

Abstract The aim of this study was to investigate the prevalence of unsatisfactory dental restorations on posterior primary teeth and associated factors in school children aged six to ten years. A cross-sectional study was conducted with children randomly selected from public schools in a small Brazilian town. Questionnaires were sent to the guardians addressing socioeconomic and behavioral aspects of the child. Oral examinations were performed at the schools to determine the quality of dental restorations, visible biofilm, and presence of moderate/extensive untreated caries (scores 3-6 ICDAS). This examination was performed by two previously trained and calibrated examiners. Associations were tested using multilevel logistic regression. Among the 400 children evaluated, 98 had restorations (217 teeth). The prevalence of unsatisfactory restorations was 34.6%. Restorations in amalgam were less likely to fail compared to those in glass ionomer cement (OR = 0.11; 95%CI: 0.02-0.49; p = 0.005). Children with moderate/extensive untreated caries were more likely to have unsatisfactory restorations (OR = 6.79; 95%CI: 2.20-20.93; p = 0.001). Children with a visible plaque index ≥ 20% were also more likely to have unsatisfactory restorations (OR = 2.28 95%CI: 1.05-4.92; p = 0.036). The prevalence of unsatisfactory restorations was high. The occurrence of this outcome was associated with restorative material, presence of caries, and visible plaque.

Costo beneficio de acetaminofén en tableta en establecimientos farmacéuticos de Lima / Cost benefit of acetaminophen in tablet in pharmaceutical establishments of Lima

Introducción: La economía de los medicamentos se puede considerar como el estudio y cálculo económico detallados del medicamento, que ayuda a satisfacer las necesidades del paciente según costo, beneficio y eficacia de dicho medicamento. Objetivo: El objetivo de la investigación fue evaluar si la valoración económica de la tableta de acetaminofén 500 mg. permitirá conocer el beneficio en el costo del fármaco en los establecimientos farmacéuticos de Lima. Métodos: La investigación presenta un diseño no experimental, transversal, descriptivo y analítico. Población: 25 trabajadores de la DIGEMID con conocimientos de farmacoeconomía; muestra: 100 por ciento de la población. Para la evaluación se utilizó un cuestionario de escala Likert, basado en las dos variables cuantitativas: Valoración económica y Coste-beneficio. El tratamiento estadístico se realizó con el programa SPSS v.25. Traducción realizada con la versión gratuita del traductor www.DeepL.com/Translator Resultados: De un total de 44 presentaciones de tabletas de acetaminofén vendidas en 41 distritos de Lima, se obtuvieron siete presentaciones que ofrecen el producto a un precio elevado, siendo estas no beneficiosas en el 15,9 por ciento y se encontraron 37 establecimientos que ofrecen el medicamento a un precio medio beneficioso (84,1 por ciento). Conclusiones: La farmacoeconomía aplicada al medicamento acetaminofén presentación tableta 500 mg permitió conocer que dicho producto tiene un costo de bajo a moderado, por lo que es asequible a la población de bajos recursos. Asimismo, la evaluación económica efectuada permitirá la toma de decisiones del consumidor al momento de la compra(AU)

Introduction: The economics of medicines can be considered as the detailed economic study and calculation of the treatment, which helps to satisfy the needs of the patient according to the cost, benefit, and efficacy of said medicine. Objective: The objective of the research was to evaluate if the economic valuation of the acetaminophen 500 mg. tablet will allow to know the benefit in the cost of the drug in pharmaceutical establishments in Lima. Methods: The research presents a non-experimental, cross-sectional, descriptive, and analytical design. Population: 25 DIGEMID workers with knowledge of pharmacoeconomics; sample: 100 percent of the population. A Likert scale questionnaire was used for the evaluation, based on the two quantitative variables: Economic valuation and Cost-benefit. Statistical processing was carried out using the SPSS v.25 program. Results: From a total of 44 presentations of acetaminophen tablets sold in 41 districts of Lima, seven presentations have been obtained that offer the product at a high price, these being not beneficial and reaching 15.9 percent, 37 establishments were found They offer the drug at a helpful average price reaching 84.1 percent. Conclusions: The pharmacoeconomics applied to the drug acetaminophen 500 mg tablet presentation allowed us to know that this product has a low to moderate cost, making it affordable to the low-income population. Likewise, the economic evaluation carried out will allow decision-making at the time of purchase, which will enable the people to identify the price(AU)

Caracterización clínico- quirúrgica de pacientes con pancreatitis aguda. Cienfuegos, 2018-2020 / Clinical-surgical characterization of patients with acute pancreatitis. Cienfuegos, 2018- 2020

RESUMEN Fundamento la pancreatitis aguda es una entidad nosológica grave con una alta morbimortalidad. Requiere de la actualización sistemática en cuanto a aspectos clínicos y terapéuticos para un manejo adecuado. Objetivo: determinar las características clínico quirúrgicas de pacientes con pancreatitis aguda. Métodos: investigación de serie de casos sobre pacientes con diagnóstico de pancreatitis aguda, desarrollada en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, desde junio de 2018 hasta mayo de 2020. Se analizaron las variables edad, sexo, hábitos tóxicos, comorbilidades, manifestaciones clínicas, variables analíticas (amilasa sérica), hallazgos ultrasonográficos, resultados tomográficos según criterios de Balthazar; índice de severidad, determinado por tomografía axial computarizada; clasificación según la gravedad, lugar de ingreso, estadía hospitalaria, tipo de tratamiento, evolución y complicaciones. Resultados: predominaron los pacientes de 60 años y más, masculinos; el consumo de alcohol y la comorbilidad no asociada a pancreatitis aguda, el dolor abdominal y los vómitos fueron las variables clínicas más observadas. En la mayoría de los pacientes la amilasa sérica resultó patológica; prevaleció la litiasis biliar como hallazgo ultrasonográfico. La mayoría de los pacientes presentó una pancreatitis leve. El tratamiento médico fue el más indicado, la colecistectomía el procedimiento quirúrgico más empleado. La mayoría de los pacientes evolucionó de manera satisfactoria. Conclusiones: la pancreatitis aguda grave es una enfermedad de alta prevalencia. Debe clasificarse tempranamente con escalas de gravedad, para establecer el manejo adecuado que permita un tratamiento integral, desde el soporte avanzado en unidad de cuidado intensivo hasta el tratamiento nutricional y quirúrgico.

ABSTRACT Background: acute pancreatitis is a serious nosological entity with high morbidity and mortality. It requires systematic updating in terms of clinical and therapeutic aspects for proper management. Objective: to determine the clinical-surgical characteristics of patients with acute pancreatitis. Methods: case series research on patients admitted with a diagnosis of acute pancreatitis at the Dr. Gustavo Aldereguía Lima University General Hospital, from June the 1st, 2018 to May the 31st, 2020. Age, sex were analyzed , toxic habits, comorbidities, clinical manifestations, laboratory variables (serum amylase), ultrasonographic findings, tomographic results according to Balthazar criteria, severity index determined by computerized axial tomography, classification according to severity, place of admission, hospital stay, type of treatment , evolution and complications. Results: male patients aged 60 years old and over predominated; alcohol consumption and comorbidity not associated with acute pancreatitis, abdominal pain and vomiting were the most observed clinical variables. In most patients, serum amylase was pathological; Gallstones prevailed as an ultrasound finding; most of the patients presented mild pancreatitis. Medical treatment was the most indicated, cholecystectomy the most used surgical procedure. Most of the patients evolved satisfactorily. Conclusions: severe acute pancreatitis is a highly prevalent disease. It should be classified early with severity scales to establish adequate management that allows comprehensive treatment, from advanced support in the intensive care unit to nutritional and surgical treatment.

Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study / Influência da duração da amamentação na incidência de cárie dentária em pré-escolares: um estudo de coorte

Abstract Objectives: investigate the association between breastfeeding duration and the incidence of severe caries in preschoolers. Methods: a cohort study was conducted with 132 pairs of mothers and children in the city of Diamantina, Brazil. Data collection was performed in 2 moments: when the children were between two and three years of age (baseline- 2013/2014) and after three years (T1-2016/2017). In both moments, children were evaluated for dental caries (International Caries Detection and Assessment System - ICDAS) and a questionnaire was administered to the mothers addressing socioeconomic aspects and thee habits of children. The outcome evaluated was the incidence of severe caries (Dentin caries - ICDAS Codes 5 and 6). Data analysis involved descriptive statistics, chi-squared test and Poisson hierarchical regression with robust variance. Results: children who breastfed for more than 24 months (RR = 2.24 CI95%= 1.23-4.08), those whose parents were separated (RR = 1.73 CI95%= 1.11-2.69), and those with estab-lished/severe caries (RR = 2.74 CI95%= 1.37-5.49) at baseline were at greater risk of incidence of severe caries after three years. Conclusion: breastfeeding for more than 24 months is a risk factor for incidence of severe caries. In addition, family structure and established or severe baseline caries were associated.

Resumo Objetivos: investigar a associação entre a duração da amamentação e a incidência de cárie grave em pré-escolares. Métodos: foi realizado um estudo de coorte com 132 pares de mães e crianças de Diamantina, Minas Gerais, Brasil. As crianças foram avaliadas em dois momentos: dois e três anos de idade (baseline-2013/2014) e após três anos (T1- 2016/2017). Dados socioeconómicos e relativos aos hábitos das criançasforam obtidos por meio de entrevistas com as mães e a presença de cárie dentária foi diagnosticada segundo o protocolo "International Caries Detection and Assessment System - ICDAS". O desfecho foi a incidência de cárie grave (cárie em dentina - códigos ICDAS 5 e 6). Para análise dos dados empregou-se regressão hierárquica de Poisson com variância robusta. Resultados: crianças que amamentaram por mais de 24 meses (RR = 2,24 IC95%= 1,234,08), cujos pais viviam separados no baseline (RR = 1,73 IC95%= 1,11-2,69) e aquelas com cárie estabelecida ou grave no baseline (RR = 2, 74 IC950%= 1,37-5,49) estavam em maior risco de incidência de cárie grave após 3 anos. Conclusão: a amamentação por mais de 24 meses foi um fator de risco para a incidência de cárie dentária grave em pré-escolares. Além disso, estrutura familiar e cárie estabelecida ou grave no baseline estiveram associados.

Malocclusion Impact Scale for Early Childhood (MIS-EC): development and validation

Abstract: This study aimed to develop and validate the Malocclusion Impact Scale for Early Childhood (MIS-EC), a malocclusion-specific measure of oral health-related quality of life (OHRQoL) of children aged 3-5 years and their parents/caregivers. A pool of items was analysed to identify those relevant to the assessment of the impact of malocclusion on OHRQoL. Dental professionals and mothers of children with and without malocclusion rated the importance of these items. The final version of the MIS-EC was evaluated in a cross-sectional study comprising 381 parents of children aged 3-5 years to assess construct validity, internal consistency and test-retest reliability. Twenty-two items were identified from item pooling. After item reduction, eight items were chosen to constitute the MIS-EC, in addition to two general questions. The MIS-EC demonstrated good internal consistency (Cronbach's alpha = 0.79 for the Child Impact section and 0.53 for the Family Impact section), and excellent test-retest reliability (ICC = 0.94), floor effect was 55.7% and ceiling effect 0%. MIS-EC scores indicating worse OHRQoL were significantly associated with the presence of malocclusion (p < 0.05). The MIS-EC is reliable and valid for assessing the impact of malocclusion on the OHRQoL of preschool children and their parents/caregivers.