Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico / Prognostic value of granular pattern of growth hormone secreting tumors

Background: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. Aim: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. Material and Methods: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Results: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. Conclusions: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

Biomarcadores Salivales en Pacientes Diagnosticados con Fibrosis Quística, Concepción, 2016 / Salivary Biomarkers in Patients Diagnosed with Cystic Fibrosis, Concepción, 2016

RESUMEN: El odontólogo como profesional integral del área de la salud, debe tener conocimiento acerca de distintas manifestaciones bioquímicas que pueden tener repercusión en la cavidad oral. El objetivo del trabajo fue determinar las manifestaciones bioquímicas y alteraciones en biomarcadores salivales en la cavidad oral producto de la fibrosis quística o del consumo crónico de medicamentos para el tratamiento de la FQ. Se seleccionó un total de cinco personas con fibrosis quística y cuatro personas sanas, pertenecientes a la ciudad de Concepción en la Octava Región de Chile. Se midió pH salival, capacidad buffer, concentración de proteínas totales, tasa de flujo salival estimulado y se determinó presencia de ciertas enzimas salivales en pacientes que padecen la enfermedad. Se pudo evidenciar que el pH salival en sujetos con fibrosis quística tiende a ser mayor a los valores de referencia, la tasa de flujo salival es mucho menor al igual que la capacidad buffer, la concentración de proteínas totales en saliva se encuentra igual a los valores de referencia y se determinó la presencia biomarcadores salivales a través de la técnica de electroforesis. La fibrosis quística afecta de muchas formas a las personas que la padecen, genera cambios a nivel de los biomarcadores salivales como también en la cavidad oral, por lo que el odontólogo debe estar capacitado para identificar estos cambios y poder tratar de la mejor manera a todo tipo de paciente.

ABSTRACT: The dentist as an integral health professional must have knowledge of various biochemical manifestations that may have repercussions on the oral cavity. The objective of the study was to determine the biochemical manifestations and salivary biomarker alterations in the oral cavity resulting from cystic fibrosis or chronic consumption of drugs for the treatment of CF. We selected a total of five people with cystic fibrosis and four healthy people, from the city of Concepcion in the eighth region of Chile. Salivary pH, buffer capacity, total protein concentration, stimulated salivary flow rate and the presence of certain salivary enzymes were measured in patients suffering from the disease. It was observed that the salivary pH in subjects with cystic fibrosis tends to be higher than the reference values, the salivary flow rate and buffer capacity are less than normal, the total protein concentration in saliva is equal to the reference values and the presence of salivary biomarkers was determined through the electrophoresis technique. Cystic fibrosis affects those who suffer the disease in many ways, it generates changes at the salivary biomarker level, as well as in the oral cavity. The dentist must therefore, be able to identify these changes in order to treat them in the best possible approach for all types of patients.

Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal / Selective use of glucocorticoids during the perioperative period of transsphenoidal surgery for pituitary tumors

Background: There is consensus in promoting the selective use of glucocorticoids (GC) in the peri-operative period of transsphenoidal surgery (TE) for pituitary adenomas (PA). Aim: To evaluate the safety of a selective glucocorticoid administration protocol and the usefulness of immediate postoperative cortisol levels as a predictor of final eucortisolism. Patients and Methods: Clinical and biochemical data from 40 patients aged 27 to 78 years (65% males) were prospectively collected. Exclusion criteria were previous use of GC, apoplexy and Cushing disease. Patients with pre-operative short synthetic ACTH test (SST) > 18 µg/dl or basal cortisol > 15 µg/dl did not receive GC. A morning serum cortisol (SC) threshold of 10 µg/dl in postoperative days one to three was used to decide a discharge without GC. Hypotension, dizziness or nausea, requirement of increased dose of corticosteroids, hospitalizations and emergency service visits were investigated, as well as surgical and endocrinological complications. Corticotropic status was evaluated three months after surgery. Results: Macroadenomas were present in 87% of patients. Median hospital stay was 4 days and follow up lasted 9 months. No differences were found in gender, age or tumor size between patients who received or not GC (35 and 65% respectively). Eighty five percent of patients were discharged without GC and all of them had normal corticotropic function three months after surgery. A SC ≥ 15 µg/dl had 100% specificity to predict eucortisolism. Conclusions: Selective glucocorticoid administration is safe. A normal corticotropic function before surgery and in the immediate postoperative period are useful to identify patients who do not need GC.

Effect of xylitol chewing gum on dental plaque, saliva flow and saliva buffer capacity in Chilean youngsters / Efecto de chicles con xilitol sobre placa bacteriana, flujo salival y capacidad buffer de la saliva en adolescentes chilenos

Prevention is the area of dentistry that should be given more emphasis to reduce further consequences on the oral cavity. The aim of this study was to assess the use of xylitol chewing gum on dental plaque, saliva flow and saliva buffer capacity in youngster. Fifteen dental students were randomly assigned to a study and control group, the first received a xylitol chewing gum while the second a placebo chewing gum, provided 4 times per day for 21 days. Dental plaque, saliva flow and saliva ph were measures at day 0, 7, 14 and 21st. Dental plaque concentration decreased in both groups (p >0,05), saliva flow increased (p>0,05) and saliva ph was incremented but no significant differences were found among groups (p>0,05). The use of xylitol chewing gum helps to reduce dental plaque, increase saliva flow and ph, like the placebo chewing gum, but a larger study is needed to properly assess if xylitol has an additional benefit on the studied variables.

La prevención es el área de la odontología a la que se le debe dar más énfasis para disminuir posteriores consecuencias sobre la cavidad oral. El objetivo de este estudio fue evaluar el efecto del uso de chicles con xilitol sobre placa bacteriana, flujo salival y capacidad buffer de la saliva en jóvenes. Participaron 15 alumnos de quinto año, se asignaron al azar en un grupo de estudio y un grupo control, consumiendo chicles con xilitol y un placebo respectivamente, 4 veces al día por 21 días. Se midió placa bacteriana, flujo salival y capacidad buffer de la saliva al día 0, 7, 14 y 21. La placa bacteriana se redujo en ambos grupos tras 21 días de tratamiento sin obtener valores significativos (p>0,05). Asimismo el flujo salival aumentó tanto en el grupo de estudio como en el grupo de control, pero sin encontrar resultados significativos (p>0,05). El pH salival aumentó en ambos grupos, sin obtener valores significativos (p>0,05). Los resultados sugieren quemasticar chicles con xilitol disminuye la placa bacteriana, aumenta el flujo salival y la capacidad buffer de la saliva, pero estudios con un mayor número de pacientes deberían realizarse para obtener valores significativos.

Actualidad y perspectiva del currículum de Odontología / Present-day and perspective of Odontology curriculum

Las actuales construcciones curriculares de la carrera de Odontología en Chile, evidencian la necesidad de un nuevo enfoque que articule las reales necesidades sociales y del mundo del trabajo con las propuestas académicas en ejecución. El trabajo que se presenta a continuación analiza las características generales de la formación del odontólogo en Chile y presenta una perspectiva de las demandas futuras, más allá de los procesos de acreditación institucional. Se evidencian algunas incongruencias en los proyectos curriculares relacionados con la contextualización y adecuación a las necesidades actuales de salud. Se concluye que debe hacerse un mejor esfuerzo en la estructuración curricular de la carrera de Odontología para adaptarlo al rápido avance del conocimiento curricular según el cambiante perfil epidemiológico. Si bien se hacen esfuerzos por modernizar los currículos, el insumo necesario para la adecuación curricular debe provenir desde los egresados y se insta a profundizar en esta línea de investigación.

The present curricular structuring of dentistry studies in Chile shows the need of a new approach that combines the real social needs and the requirements of the working world with the academic proposals nowadays. This paper analyzes the general characteristics of the dental training in Chile and presents some perspective of the future demands, beyond the institutional and programs accreditation processes. Some inconsistencies were observed in the curricular projects related to the contextualization and adaptation to the current health needs. It was concluded that great effort should be made in restructuring the curricula of dental training, in order to adapt it to the advancing knowledge according to the changes in the epidemiological profile. Although efforts are being made to update the curricula, the necessary input for curricular suitability should come from graduates, therefore this paper encourages deepening such research line.

Efecto in vitro de las bebidas refrescantes sobre la mineralización de la superficie del esmalte dentario de piezas permanentes extraídas / In Vitro Effect of Refreshing Drinks on the Mineralization of Tooth Enamel Surface in Extracted Permanent Dental Pieces

El objetivo de este estudio fue determinar el efecto de las bebidas refrescantes sobre la mineralización de la superficie del esmalte de piezas dentarias permanentes extraídas. Para esto se realizó un estudio experimental donde la muestra correspondió a 50 cortes de premolares permanentes extraídos en estado íntegro, estos fueron distribuidos en tres grupos de estudio mediante asignación aleatoria: bebidas gaseosas, jugos y néctares, y aguas minerales purificadas y saborizadas más un grupo control. Los dientes fueron lavados y almacenados en saliva artificial a 4°C. A todos los cortes dentarios se les midió la mineralización con el equipo Diagnodent 2095 (Kavo®) antes de iniciar la exposición, la cual correspondió a un minuto en el tipo de bebida según grupo, seguido por tres minutos en saliva artificial, ciclo que se repitió cinco veces en un tiempo de 20 minutos. Este procedimiento se realizó una vez al día, por un mes y para cada día se utilizaron nuevas bebidas refrescantes. Una vez finalizado se volvió a medir la mineralización para luego realizar las comparaciones entre grupos. El grupo de bebidas gaseosas provocó una mayor desmineralización en la superficie del esmalte dentario (p=0,000), seguido del grupo de jugos y néctares (p=0,000). El grupo de aguas minerales saborizadas y purificadas no provocaron efectos sobre la mineralización de la superficie del esmalte. Por lo tanto, sólo el grupo de gaseosas y jugos provocaron un efecto desmineralizador en la superficie del esmalte de las piezas dentarias, siendo la Coca-cola la que produjo mayor efecto seguido de la Coca-cola light y luego el Kapo.

The aim of this study was to determine the effect of refreshing drinks on the mineralization of tooth enamel surface in extracted permanent dental pieces. For this an experimental study was conducted where the sample was composed by 50 permanent premolars extracted as an entire piece. These pieces were randomly distributed in three study groups: soft drinks, juices and nectars, and purified and flavored mineral waters, in addition to a control group. The teeth were carefully washed and stored in artificial saliva at 4 C. Before starting the exposure to refreshing drinks, all dental slices were tested in order to measure their baseline mineralization using the Diagnodent 2095 equipment (Kavo®). The exposition consisted in one minute of contact with the drink corresponding to each group, followed of three minutes in artificial saliva. This cycle was repeated 5 times in 20 minutes time. This procedure was carried out once daily, for one month, and every day new refreshing drinks were used. Once the assay finished, the premolar mineralization was measured again, in order to make comparisons between groups. The soft drinks group caused the highest demineralization on the teeth enamel surface (p=0.000), followed by the juices and nectars group (p=0.000). In the purified and flavored mineral waters group, no effects were found on the mineralization of the enamel surface. A demineralizing effect on the enamel surface of dental pieces was observed only in the groups of soft drinks and juices, where Coca-Cola caused the highest effect, followed by Coca-Cola light and then Kapo.