[Subclinical atherosclerosis among Chilean subjects classified as having a low cardiovascular Framingham risk]. / Ateroesclerosis subclínica en población de riesgo cardiovascular bajo y moderado por Framingham chileno.

BACKGROUND: Framingham risk score (FRS) has limitations and can underestimate risk. Carotid ultrasound to measure intima media thickness or plaques is recommended for cardiovascular risk assessment. AIM: To determine the prevalence of subclinical atherosclerosis in asymptomatic subjects classified as low and intermediate risk. MATERIAL AND METHODS: Cross-sectional study performed in subjects without cardiovascular disease. Cardiovascular risk was estimated using the Chilean FRS and the General Cardiovascular Disease FRS. Carotid ultrasound was performed in all subjects. We defined subclinical atherosclerosis as the presence of carotid plaque or intima media thickness greater than 75th percentile by gender and age. RESULTS: We studied 203 subjects aged 47.2 ± 9.6 years (54% males). Mean intima media thickness was 0.62 ± 0.1 mm. An abnormal value was detected in 68 subjects (33%) and carotid plaques in 32 subjects (15.7%). Based on Chilean FRS, 96% were considered at low risk, 4% at intermediate, and none at high risk. In the low risk group the prevalence of abnormal intima media thickness and plaques was 40 and 14% respectively. Presence of plaques was more common in women than men (23 and 7% respectively, p < 0.01). According to the General Cardiovascular Disease FRS, 23% were at low, 39% at low intermediate and 28% at high intermediate risk. In the low risk group the prevalence of an abnormal intima media thickness was 34% and no subject had plaques. CONCLUSIONS: Carotid plaques were detected in Chilean subjects classified as having a low FRS risk. The underestimation of risk was higher in Chilean women.

Ateroesclerosis subclínica en población de riesgo cardiovascular bajo y moderado por Framingham chileno / Subclinical atherosclerosis among Chilean subjects classified as having a low cardiovascular Framingham risk

Background: Framingham risk score (FRS) has limitations and can underestimate risk. Carotid ultrasound to measure intima media thickness or plaques is recommended for cardiovascular risk assessment. Aim: To determine the prevalence of subclinical atherosclerosis in asymptomatic subjects classified as low and intermediate risk. Material and Methods: Cross-sectional study performed in subjects without cardiovascular disease. Cardiovascular risk was estimated using the Chilean FRS and the General Cardiovascular Disease FRS. Carotid ultrasound was performed in all subjects. We defined subclinical atherosclerosis as the presence of carotid plaque or intima media thickness greater than 75th percentile by gender and age. Results: We studied 203 subjects aged 47.2 ± 9.6 years (54% males). Mean intima media thickness was 0.62 ± 0.1 mm. An abnormal value was detected in 68 subjects (33%) and carotid plaques in 32 subjects (15.7%). Based on Chilean FRS, 96% were considered at low risk, 4% at intermediate, and none at high risk. In the low risk group the prevalence of abnormal intima media thickness and plaques was 40 and 14% respectively. Presence of plaques was more common in women than men (23 and 7% respectively, p < 0.01). According to the General Cardiovascular Disease FRS, 23% were at low, 39% at low intermediate and 28% at high intermediate risk. In the low risk group the prevalence of an abnormal intima media thickness was 34% and no subject had plaques. Conclusions: Carotid plaques were detected in Chilean subjects classified as having a low FRS risk. The underestimation of risk was higher in Chilean women.

I Workshop ibérico sobre la asociación entre diabetes y enfermedades periodontales. Documento de consenso / 1st Iberian Workshop on the relationship between diabetes and periodontal diseases. Consensus Document

Este consenso se ha realizado por expertos de las Fundaciones de las Sociedades Españolas de Diabetes y de Periodoncia. La evidencia revisada presenta datos relevantes que avalan la importancia tanto de la diabetes como de las enfermedades periodontales, así como de la relación bidireccional entre las mismas:- La diabetes tiene una alta prevalencia en las poblaciones de España y Portugal con elevada prevalencia de diabetes no conocida y con cifras en continuo incremento. Además, es muy relevante la importancia, frecuencia y severidad de sus complicaciones.- Las enfermedades periodontales tienen una alta prevalencia, cercana al 90% de la población adulta. La capacidad destructiva de la periodontitis conduce a la pérdida de dientes, lo que provoca importantes alteraciones para el paciente. También la periodontitis se ha asociado a un incremento en el riesgo de enfermedades cardiovasculares, de resultados adversos del embarazo, y de enfermedades pulmonares, entre otras.- Numerosos estudios han señalado que la diabetes es un importante factor de riesgo para sufrir periodontitis, especialmente si el control de la glucemia no es adecuado.- Las enfermedades periodontales han demostrado un efecto negativo sobre el control de la glucemia, tanto en pacientes con diabetes como en sujetos sanos, y se ha demostrado que las complicaciones de la diabetes son más frecuentes en pacientes con periodontitis.- El tratamiento periodontal es capaz de mejorar el control de la glucemia, con un valor de reducción de la hemoglobina glucosilada de 0.4%.Basados en estas evidencias, se proponen distintas implicaciones para los profesionales sanitarios involucrados en el cuidado de estos pacientes

This consensus report has been prepared by a group of experts from the Spanish Foundations of Diabetes and of Periodontology. The reviewed evidence shows relevant data that strongly support the importance of diabetes and periodontal diseases, as well as their bi-directional relationship: - Diabetes has a high prevalence in Spain and Portugal, with a high prevalence of un-diagnosed diabetes, and with continuously increasing rates. In addition, the frequency and severity of their complications is also very important. - Periodontal diseases have high prevalence, close to 90% in adult populations. The destructive capacity of periodontitis leads to tooth loss, which is associated with a profound impact on the patients. Periodontitis have also been related to an increased risk of cardiovascular diseases, adverse pregnancy outcomes, and pulmonary infections, as well as other conditions. - Numerous studies have concluded that diabetes is a significant risk factor for periodontitis, especially in subjects with poor glycemic control. - Periodontal diseases have been shown to have a deleterious effect on glycemic control, both in diabetic patients and healthy subjects, and it has been demonstrated that diabetes complications are more frequent in diabetic patients with periodontitis. - Periodontal treatment has been associated with improvements in glycemic control, with a mean reduction in glycosylated haemoglobin of 0.4%. Based on the above evidence, different challenges are proposed for health professionals involved in diabetic and periodontitis patient care

[Association of carotid intima-media thickness with traditional cardiovascular risk and metabolic factors]. / Grosor íntima media carotídeo y asociación con factores de riesgo cardiovascular tradicionales y metabólicos.

BACKGROUND: Carotid intima-media thickness (IMT) is a surrogate marker of subclinical atherosclerosis and is associated with cardiovascular risk factors (CVRF) AIM: To analyze the association of CVRF and metabolic factors (MF) with IMT, and if the clustering of these factors modify IMT. MATERIAL AND METHODS: Cross sectional study in 187 participants aged 46±10 years (53% male) without CV disease. Weight, height, waist circumference (WC), blood pressure, fasting plasma glucose and lipid profile were measured. Abdominal obesity (AOb) was defined by ATP III criteria. Mean carotid IMT was measured at the far wall of the common carotid artery. The cutoff point for an abnormally high IMT was set at the 75th IMT percentile of the sample. RESULTS: The 75th IMT percentile of the sample was 0.67 mm. In a multivariate analysis four factors were significantly related with a high IMT: age (odds ratio (OR): 5.3, confidence intervals (CI): 2.2-12.9), dyslipidemia (OR: 6.4 CI: 2.3-17.9), systolic blood pressure (OR: 2.9, CI: 1.2-7.1) and AOb (OR: 2.9 (IC: 1.1-7.2). The presence of Oto 4 of these factors was associated with an IMT increment from 0.54 to 0.71 mm (p < 0,001). CONCLUSIONS: In this sample dyslipidemia, systolic blood pressure and abdominal obesity were the main predictors of a high IMT.

Grosor íntima media carotídeo y asociación con factores de riesgo cardiovascular tradicionales y metabólicos / Association of carotid intima-media thickness with traditional cardiovascular risk and metabolic factors

Background: Carotid intima-media thickness (IMT) is a surrogate marker of subclinical atherosderosis and is associated with cardiovascular risk factors (CVRF) Aim: To analyze the association of CVRF and metabolic factors (MF) with IMT, and if the clustering of these factors modify IMT. Material and Methods: Cross sectional study in 187 participants aged 46±10years (53% male) without CV disease. Weight, height, waist circumference (WC), blood pressure, fasting plasma glucose and lipid profile were measured. Abdominal obesity (AOb) was defined by ATP III criteria. Mean carotid IMT was measured at the far watt of the common carotid artery. The cutoff point for an abnormally high IMT was set at the 75th IMT percentile of the sample. Results: The 75th IMT percentile of the sample was 0.67 mm. In a multivariate analysis four factors were significantly related with a high IMT: age (odds ratio (OR): 5.3, confidence intervals (CI): 2.2-12.9), dyslipidemia (OR: 6.4 CI: 2.3-17.9), systolic blood pressure (OR: 2.9, CI: 1.2-7.1) and AOb (OR: 2.9 (IC: 1.1-7.2). The presence of Oto 4 of these factors was associated with an IMT increment from 0.54 to 0.71 mm (p < 0,001). Conclusions: In this sample dyslipidemia, systolic blood pressure and abdominal obesity were the main predictors of a high IMT.

Evaluation and comparison of á priori alignment techniques for transtibial prostheses in the developing world - field trial in Nicaragua.

PURPOSE: The purpose of this study was to transfer three simplified alignment techniques to prosthetic technicians in a developing country through training materials and a hands-on training workshop, and to subsequently evaluate the efficacy of the alignment systems in producing acceptably aligned monolimb prostheses. METHOD: Prosthetists utilized the anatomically-based-alignment (ABA)-standing, ABA-supine and vertical alignment axis (VAA) alignment systems to produce three monolimbs for each of 30 healthy and active transtibial amputees. Prosthetists assessed all three monolimbs for each subject in both static and gait conditions to determine which monolimb had the best alignment and produced the best functional gait. Subjects also selected the monolimb which they believed had the best alignment; subjects utilized each monolimb for a 1-month home assessment. RESULTS: Twenty-eight subjects completed the study. Eighty-four monolimbs were evaluated by the prosthetists and the subjects. A few monolimbs had minor socket fitting and alignment issues, but none prevented evaluation in the laboratory or during the 1-month home assessment. Only three monolimbs had poor alignment and could not be worn by the subjects. CONCLUSIONS: All three systems captured acceptable alignments, although the two systems that incorporate weight bearing, the ABA-standing and VAA alignment systems, produced slightly better outcomes. The alignment ratings between these two systems were statistically insignificant.

Plastic soda bottles: a reusable material for making transradial sockets.

This paper describes a new fabrication process for making low-cost transradial sockets using recyclable plastic soda bottles. Easy, fast, and inexpensive to fabricate, the resulting socket can be used as a temporary device for stump care. Multiple sockets can be made and individually incorporated with various terminal devices for light-duty self-care or functional activities, such as feeding, showering, typing, swimming, or gardening. The formed socket is lightweight and also suitable for use with a cosmetic passive hand prosthesis. This process has been developed as a potential cost-effective assistive technology appropriate for individuals with transradial amputation in resource-limited countries.

CIR Casting System for making transtibial sockets.

This paper describes a new casting system for transtibial socket fabrication. Like the earlier CIR Sand Casting System, the CIR Casting System is based on the 'dilatancy' principle that is similar to the packaging process for coffee beans by which loose beans become a solid mass when a vacuum is applied. The main difference from the CIR Sand Casting System is that the CIR Casting System uses light-weight, polystyrene beads in place of silica sand as the primary material for casting the negative mold. The formed negative mold can be converted into a positive sand model for modification and socket formation. With the new plaster-less casting system, the prosthetist can fabricate a transtibial prosthesis in about one hour. It reduces the set-up cost, overall weight and size of the casting system, and increases portability for service in remote areas. The System also creates minimal waste and is energy-conserving and environmentally-friendly.

Comparison of á priori alignment techniques for transtibial prostheses in the developing world - pilot study.

PURPOSE: The purpose of this study was to evaluate three alignment systems based on two alignment theories that can be utilized in the fabrication of monolimb prostheses that have acceptable alignment. A second goal was to assess the feasibility of technology transfer for providing prosthetic services to remote areas of landmine-affected countries. METHOD: Five prosthetists and five healthy transtibial amputees participated in the study. Each prosthetist was trained and then used each of the three systems to capture alignment measurements for one subject. Three monolimbs identified as X, Y and Z were fabricated for each subject and assessed during clinical static and dynamic gait conditions. Training materials and methods were also evaluated. RESULTS: All three systems captured acceptable alignments fairly well, although the two systems that incorporated weight-bearing into the alignment process had slightly better outcomes. Each system has its own advantages in terms of ease of use, required equipment, and ease of technology transfer. CONCLUSION: All three systems have the potential for application in outreach prosthetic services and warrant continued evaluation. Minor changes need to be incorporated into the alignment systems and procedures to make them easier to use and more effective.