Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial / Challenges of the Chilean Public Health Care System Network in the Temporomandibular Disorders and Orofacial Pain Specialty

RESUMEN: Los Trastornos Temporomandibulares (TTM) son un conjunto de patologías musculares y articulares que afectan al sistema masticatorio. Según estadísticas nacionales, la prevalencia de al menos un diagnóstico de TTM en la población adulta corresponde al 49,6 %, mientras que el 19,6 % padece de un dolor temporomandibular severo. La atención de pacientes afectados por estos trastornos corresponde al odontólogo especialista en trastornos temporomandibulares y dolor orofacial (TTM y DOF), especialidad reconocida legalmente desde el año 2013 por el decreto 8 del Ministerio de Salud. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y recientemente se han comenzado a establecer protocolos de derivación a la especialidad desde la Atención Primaria Odontológica. En el presente estudio se realiza un análisis de la situación actual de la especialidad de TTM y DOF en la red pública de atención y se plantean posibles soluciones y mejoras a los problemas encontrados.

ABSTRACT: Temporomandibular Disorders (TMD) comprise a heterogenous group of muscle and joint disorders that affect the masticatory system. According to national statistics, the prevalence of at least one diagnosis of TMD in the adult population is 49.6 %, while 19.6 % suffers from severe temporomandibular pain. Care of patients affected by these disorders corresponds to the dentist specialized in temporomandibular disorders and orofacial pain (TMD and OFP); these particular disorders and the specialty were incorporated by the Ministry of Health in 2013.. The pathologies are not incorporated in the Explicit Health Care Guarantees (GES) and only recently protocols for a referral program were established for Primary Dental Care in this area. In this study, the present situation of the specialty of TMD and OFP in the public health care network is analyzed, as well as possible solutions and improvements to the difficulties encountered therein.

Prevalencia de trastornos temporomandibulares en la población adulta beneficiaria de Atención Primaria en Salud del Servicio de Salud Valparaíso, San Antonio / Prevalence of temporomandibular disorders in the beneficiary adult population of Primary Health Care at Servicio de Salud Valparaíso, San Antonio

Los Trastornos Temporomandibulares (TTM) son un conjunto de problemas musculares y articulares que afectan al sistema masticatorio. En Chile, hay pocos estudios epidemiológicos en TTM y no se conoce su distribución, severidad, necesidad de tratamiento y comorbilidad. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y no existen Guías Clínicas Unificadas a nivel nacional para su diagnóstico y derivación desde la Atención Primaria en Salud (APS). El objetivo general de este estudio fue determinar la prevalencia de trastornos temporomandibulares en adultos beneficiarios del Servicio de Salud de Valparaíso y San Antonio (SSVSA). Para lo anterior se propuso un estudio observacional de corte transversal (prevalencia) de TTM, cuya población objetivo correspondió a adultos (mayores de 18 años) beneficiarios del Fondo Nacional de Salud (FONASA) del SSVSA inscritos en consultorios de APS de la comuna de Valparaíso (n= 273.449 según los registros per capita de pacientes válidamente inscritos en 2012). Se examinaron 270 pacientes (168 mujeres, 102 hombres), seleccionados al azar, utilizando las categorías diagnósticas del Research Diagnostic Criteria de Dworkin (Dworkin 1992, adscritas a la Asociación Internacional para la investigación Dental). Los resultados arrojaron una prevalencia de TTM de un 49,6% (al menos un diagnóstico) en la muestra estudiada; y un 19,6% de la población padecía de un TTM severo (dolor muscular y/o articular, asociado a limitación funcional), siendo el sexo femenino el más comprometido (AU)

Temporomandibular Disorders (TMD) are a set of muscle and joint problems affecting the masticatory system. In Chile, there are few epidemiological studies on TMD, and no distribution, severity, and comorbidity need for treatment is known. These conditions are not incorporated into oral health benefits of Explicit Health Guarantees (GES) and there are no clinical guidelines for diagnosis and referral from Primary Health Care (PHC). The overall objective of this study was to determine the prevalence of Temporomandibular Disorders in adults beneficiaries of the Health Service of Valparaiso and San Antonio (SSVSA). For the above observational cross-sectional study (prevalence) TMD, whose target population corresponded to adults (over 18 years) beneficiaries of the National Health Fund (FONASA) of SSVSA enrolled in PHC clinics of the commune of Valparaiso proposed (n= 273,449 according to per capita patients validly registered records in 2012). 270 patients (168 women, 102 men), selected at random, using the diagnostic categories of Research Diagnostic Criteria Dworkin (Dworkin 1992, assigned to the International Association for Dental Research) were examined. The results showed a prevalence of 49.6% TTM (at least one diagnosis) in the sample; and 19.6% of the population suffered from severe TMD (muscle pain and/or joint pain associated with functional limitation), being the most committed female (AU)

Evaluación de los protocolos de aplicación de ácido hialurónico en procesos degenerativos óseos de la articulación temporomandibular: una revisión de la literatura / Application protocol of hyaluronic acid on temporomandibular joint degenerative diseases

Los trastornos temporomandibulares son un grupo heterogéneo de alteraciones funcionales que afectan al aparato masticatorio y reducen la calidad de vida de los pacientes. Dentro de estos trastornos encontramos las alteraciones del complejo cóndilo disco, los cuales son factores de riesgo para la generación de patologías degenerativas articulares de la articulación temporomandibular (ATM). El tratamiento de los procesos degenerativos articulares es controversial ya que se han utilizado a través del tiempo variadas estrategias terapéuticas; desde la utilización de dispositivos ortopédicos mandibulares, pasando por terapias invasivas como la artrocentesis o irrigación y drenaje de los espacios articulares, hasta la infiltración de fármacos dentro del espacio articular. Tradicionalmente la infiltración intra articular de fármacos se ha efectuado con glucocorticoides debido a su efecto antiinflamatorio y analgésico; sin embargo, hace más de dos décadas ha surgido la utilización del ácido hialurónico, cuyo efecto antiinflamatorio y de viscosuplementación ha demostrado poseer gran utilidad terapéutica en procesos degenerativos a nivel articular. Clínicamente, sin embargo, este fármaco carece de un protocolo que forme el esquema terapéutico en cuanto a concentración, dosis, frecuencia y extensión del tratamiento en su uso en patologías degenerativas óseas de la ATM. Por lo tanto, surge la necesidad de revisar la evidencia existente al respecto en estudios experimentales realizados en humanos o animales. Se realizó una revisión de la evidencia disponible online, la que luego de un proceso de análisis y selección obtuvo 11 estudios en humanos y 4 en animales, los autores no encontraron pruebas científicas suficientes para establecer un protocolo de infiltración de ácido hialurónico en patologías degenerativas de la articulación temporomandibular

Temporomandibular disorders are a heterogeneous group of functional disorders affecting the masticatory system, reducing the quality of life of patients. Within these disorders find the disc condyle complex disorders, which are risk factors for the generation of degenerative joint diseases of the temporomandibular joint (TMJ). The treatment of joint degenerative processes is controversial, and have been used over time varied therapeutic strategies, since the use of mandibular orthopedic devices, through invasive therapies such as arthrocentesis or irrigation and drainage of the joint spaces; drugs to infiltration into the joint space. Traditionally the intra infiltration articular drug was performed with glucocorticoids due to its anti-inflammatory and analgesic effect, however more than two decades ago has emerged using the hyaluronic acid, the inflammatory and viscosupplementation effect has demonstrated great therapeutic usefulness in degenerative processes articular level. Clinically this drug however lacks a protocol that regulates the therapeutic regimen in strength, dosage, frequency and extent of treatment in use in bone degenerative diseases of the TMJ. Thus arises the need to review the existing evidence on this in experimental studies in humans or animals. A review of the evidence was made available online, which after a process of analysis and selection scored 11 studies in humans and 4 in animals, the authors found insufficient evidence to establish a protocol infiltration of hyaluronic acid in degenerative pathologies temporo mandibular joint

Induced posterior vitreous detachment by intravitreal sulfur hexafluoride (SF6) injection in patients with nonproliferative diabetic retinopathy.

PURPOSE: To induce posterior vitreous detachment (PVD) in patients with nonproliferative diabetic retinopathy (NPDR) by injecting an intravitreal gas bubble of SF6 and to compare the evolution of the diabetic retinopathy between eyes with gas induced PVD and non-injected eyes without PVD. METHODS: An intravitreal gas bubble of SF6 was injected via the pars plana in twelve eyes of twelve patients with NPDR and no previous PVD. Subsequent clinical, ultrasonographic and angiographic controls were performed to evaluate the development of PVD and progression of the disease. RESULTS: All gas-injected eyes developed PVD. All eyes with induced PVD (treatment group) remained stable without progression of the retinopathy after 2 years of follow up. In the control group (contralateral eyes without PVD), two eyes (16.6%) progressed to proliferative diabetic retinopathy (PDR) (p= 0.23); five (41.6%) showed progression to more severe stages of NPDR (p= 0.01) and another 41.6% of such eyes remained stable. CONCLUSIONS: Intravitreal SF6 injection induced PVD in all eyes of our study without undesirable side effects. Further studies are necessary to make conclusions regarding the correlation between the presence of induced PVD and the progression of diabetic retinopathy.

Use of microwave digestion and atomic absorption spectrophotometry to determine chromic oxide as a digestibility marker in feed, feces, and ileal content.

Most conventional digestion procedures, such as dry ashing and wet ashing, are tedious and labor intensive. Microwave digestion is a good alternative, because microwave dissolution is faster, safer, and simpler, and provides more controlled reproducible conditions than conventional methods. The purpose of this study was to develop a microwave digestion method for mineralizing meat and bone meal diets, feces, and ileal contents. Each sample was heated on a hot plate for 10 min, dry ashed at 65 degrees C for 4 h, and transferred into microwave vessels. Then, 10 mL 70% HNO3 was added. Samples were digested for 7, 10, and 20 min at 95, 90, and 85% power, respectively. After the heating cycle, 6 mL 30% H2O2 was added, and samples were returned to the microwave for a second heating cycle of 1 and 7 min at 95% and 90% power, respectively. Finally, chromium concentration was determined by flame atomic absorption spectrophotometry. The digestion method was validated by using a standard reference material, SRM domestic sludge 2781, with a certified chromium value of 195 +/- 9 micrograms/g. The value obtained in this study was 178 +/- 11 micrograms/g, for a difference of 17 micrograms/g. Spike recovery experiments resulted in 103.16 and 100.35% recoveries of chromium from diet and feces samples, respectively. Coefficients of variation were 10.8 and 7.8%, respectively.

Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections.

No published reports have stratified pediatric patients with systemic infections according to the new sepsis terminology guidelines. In addition little is known about the outcome of sepsis in developing countries. This large 12-year retrospective study evaluated the outcome of 815 infants and children with sepsis managed in a Latin American pediatric intensive care unit. Of these children 171 (21%) had sepsis, 497 (61%) had severe sepsis and 147 (18%) had septic shock. Multiorgan dysfunction was present in 120 (24%) and 77 (52%) patients with severe sepsis and septic shock, respectively. Infection was bacteriologically proved in 212 (26%) cases, with Staphylococcus aureus and Neisseria meningitidis being the most frequent responsible organisms. Three hundred nineteen (39%) patients died. Case-fatality rates were higher in patients with septic shock, multiorgan dysfunction, sepsis caused by Pseudomonas aeruginosa and meningococcemia than in those without these conditions. Although no difference in mortality was detected between culture-proved and culture-negative sepsis, more patients receiving an inappropriate antimicrobial agent died than those treated with an appropriate drug (53% vs. 34%, P = 0.012). We believe that with the use of the new terminology system a more reliable comparison of data from pediatric sepsis studies and of emerging immunomodulating therapeutic modalities can be achieved.

Changes in dietary fiber content and its composition as affected by processing of black beans (Phaseolus vulgaris, Tamazulapa variety).

This paper presents the effect that the traditional cooking process of black beans (Phaseolus vulgaris, Tamazulapa variety) has on the quantity and composition of soluble (SDF) and insoluble (IDF) dietary fiber of beans, as well as on its protein digestibility and protein quality. There was an increase of IDF from 18.1% in cooked beans to 22.4% in fried beans, and a decrease in SDF from 8.4% to 6.6%, respectively. Starch content decreased from 34.5% to 31.3%. No change was found in lignin. The xylose content was higher in IDF than in SDF and decreased to some extent from cooked to fried beans. Arabinose content was similar in IDF and SDF with no change caused by processing. The fraction containing glucose, mannose and galactose in IDF was higher than in SDF, the content increasing in IDF and decreasing in SDF, with processing. Protein content in IDF was higher than in SDF, with no major change when processing. About 29.5% of the total protein of beans was bound in DF. Protein digestibility and protein quality decreased from cooked to fried beans and was positively related to IDF.

6-[Fluorine-18]fluorodopamine pharmacokinetics and dosimetry in humans.

UNLABELLED: PET scanning after injection of 6-[18F]fluorodopamine visualizes tissue sympathetic innervation. Organ dosimetric estimates for 6-[18F]fluorodopamine have relied on studies of rats and dogs and on literature about the fate of other radiolabeled catecholamines. This report uses empirical clinical findings in healthy volunteers to refine and extend these estimates. METHODS: Thoracic PET scanning was conducted and arterial blood and urine samples were obtained after intravenous injection of 6-[18F]fluorodopamine into 10 normal volunteers. RESULTS: The main target organs for 6-[18F]fluorodopamine-derived radioactivity were the wall of the urinary bladder (3.3 rem for a 4-mCi dose and 3.31-hr voiding interval) and the kidneys (2.9 rem for a 4-mCi dose) due to urinary excretion of radioactive metabolites of [18F]-6F-DA. The estimates were about one-fourth those predicted from studies of laboratory animals. CONCLUSIONS: At administered doses required to visualize the left ventricular myocardium in humans, a 6-[18F]fluorodopamine injection produces acceptable absorbed radiation doses, with the highest doses to the urinary collecting system.

[The adaptation of Cooper's mile test for students in the city of Mexico]. / Adaptación de la prueba de la milla de Cooper para estudiantes en la ciudad de México.

The Cooper is test (running 1609 m) was applied to 1196 students, 15 to 17 years old, performed the Cooper's test (1609 m race). The scale, designed adequately for this sample of Mexican population, allows to judge the physical fitness by means of an easy and economical procedure.