ABSTRACT
ABSTRACT Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child's developing brain. This disorder can significantly affect the pediatric patient's behavior in the dental setting. An uncooperative 9-year- old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist's guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient's oral health and general welfare.
RESUMEN: El trastorno de apego reactivo (RAD, por sus siglas en inglés) es una enfermedad de salud mental en la primera infancia caracterizada por interacciones sociales y capacidades de comunicación deterioradas y por déficits neurológicos en el cerebro en desarrollo del niño. Este trastorno puede afectar significativamente el comportamiento del paciente pediátrico en el entorno dental. Una niña mexicana de 9 años de edad, poco cooperadora, que residía en un hogar temporal, fue remitida a la Clínica de Odontología Pediátrica con su cuidadora, solicitando un examen y tratamiento dental. La paciente presentó un diagnóstico previo de RAD con discapacidad intelectual/ social. Con la orientación del Psiquiatra, se llevó a cabo una profilaxis oral exhaustiva en las citas iniciales, seguidas de diversos tratamientos de restauración bajo la aplicación continua de técnicas de manejo del comportamiento. Estos procedimientos de restauración incluyeron restauraciones de resina y selladores de fosas y fisuras, bajo anestesia local y aislamiento con dique de goma, en los primeros cuatro molares permanentes. Todo el tratamiento se completó en seis semanas. La paciente y su cuidadora recibieron estrategias educativas y motivacionales detalladas para mejorar la higiene oral y también recibieron asesoría nutricional. Para las revisiones de control y refuerzo de los hábitos preventivos, las citas posteriores se programaron cuidadosamente. Una colaboración pediátrica interdisciplinaria entre el dentista, la enfermera y el psiquiatra fue fundamental para mejorar la salud oral y el bienestar general del paciente.
Subject(s)
Humans , Female , Child , Child Reactive Disorders , Dental Care for Disabled , Dental Care for Children , Mental Disorders , MexicoABSTRACT
BACKGROUND: Cuenca, a city in the Andean Region of southern Ecuador, has 591,996 inhabitants. A decade-old study showed the prevalence of multiple sclerosis in Cuenca was 0.75 cases per 100,000 inhabitants but no new epidemiological studies in this city have been performed since then. The aim of this study, conducted in 2016, was to update the prevalence records of multiple sclerosis in Cuenca. METHODS: We performed a descriptive cross-sectional study in which we investigated prevalence rates in November of 2016. We estimated the prevalence of multiple sclerosis by cross-matching registries from the two neurological referral hospitals in Cuenca. RESULTS: A total of 23 records were obtained from the two sources. The estimated prevalence was 3.88 per 100,000 inhabitants (95% confidence interval: 3.83-3.94). The disease was predominant among women (60%). The mean age of this cohort was 37 years (standard deviation ±12.4). Of the cases, 78% were relapsing-remitting multiple sclerosis. The mean Expanded Disability Status Scale score was 2.5. CONCLUSIONS: This study is an update to the first study conducted 10 years ago and shows the prevalence of multiple sclerosis in Cuenca has increased. However, the prevalence of multiple sclerosis is still low and very similar to that reported in neighbouring countries.
ABSTRACT
La uveítis es la tercera causa de ceguera evitable, siendo una de sus complicaciones el glaucoma uveítico. Presentamos el caso de una paciente de 25 años tratada con extracción extra capsular de cristalino y trabeculectomía AO, con posterior ciclocrioterapia bilateral, llegando a controlar la enfermedad inflamatoria de fondo y presión intraocular (PIO) en el ojo derecho por siete años con posterior pérdida de la visión (pthisis bulbi). El ojo izquierdo se mantuvo estable por 15 años, presentando luego una PIO de 50 mmHg, por lo que se implanta una válvula de Ahmed por vía pars plana con previa vitrectomía, debido a las alteraciones anatómicas del segmento anterior. Se controló la PIO y se obtuvo una visión de 20/70 con correctores, sin uso de antihipertensivo ocular. El manejo adecuado de la enfermedad de fondo y el uso de dispositivos de drenaje valvulados son la mejor opción para el glaucoma uveítico. Una gran alternativa de abordaje es el implante vía pars plana, previa vitrectomía.
Uveitis is the third preventable cause of blindness, and uveitic glaucoma is one of its complications. We present the case of a 25-year old female patient who underwent an extracapsular lens excision and AO trabeculectomy, and afterwards bilateral cyclocryotherapy was performed. The underlying inflammatory condition was controlled, and the intraocular pressure (IOP) in the right eye was also controlled for seven years, although she later lost sight (pthisis bulbi). The left eye remained in a stable condition for 15 years, but afterwards it developed 50 mm Hg IOP, so an Ahmed Valve through the pars plana was placed, after having performed a vitrectomy because of the anatomic alterations in the anterior segment. The IOP got controlled and 20/70 vision using glasses was attained, without the use of an ocular antihypertensive compound. Adequate management of the underlying disease and the use of valve drainage systems constitute the best choice for the management of uveitic glaucoma. A good approach option is placing the device through the pars plana, after having performed a vitrectomy.
ABSTRACT
Objetivos: describir, en niños de 1-4 meses, a 3200 m de altura, la saturación de oxígeno (SpO2), los índices de apnea y la respiración periódica (RP) durante el sueño. Se realizaron polisomnografías en 18 lactantes sanos. Resultados: las medianas fueron de 87% para la SpO2 y de 7,2% para la RP del tiempo total de sueño. El índice de apnea central tuvo una mediana de 30,5 /hora, que disminuyó a 5,4/hora al descontar las apneas asociadas a RP. El p5 de la SpO2 para niños despiertos fue de 76% y, para niños dormidos, de 66%. Conclusiones: la SpO2 fue inferior a la del nivel del mar y la RP y el índice de apnea central, mayores; al descontar las apneas centrales asociadas a RP. Este último, fue similar a la del nivel del mar. A 3200 m, se requieren puntos diferentes para la SpO2 normal, uno para niños despiertos y otro si están dormidos.
Objectives: To describe, in infants aged 1-4 months old living at 3200 meters above sea level (MASL), oxygen saturation (SpO2), sleep apnea indices, and periodic breathing (PB) during sleep. Polysomnographies were done in 18 healthy infants. Results: The median SpO2 was 87%, and the median PB was 7.2% for the total sleep time. The median central sleep apnea index was 30.5/hour, which decreased to 5.4/hour once sleep apneas associated with PB were excluded. The 5th percentile for SpO2 was 76% among awake infants, and 66% among asleep infants. Conclusions: The SpO2 was lower than that observed at sea level, whereas PB and the central sleep apnea index were higher, once sleep apneas associated with PB were excluded. The latter was similar to that observed at sea level. At 3200 MASL, different cut-off points are required for a normal SpO2, one for infants during the waking state and one for infants during sleep.
Subject(s)
Humans , Infant , Oxygen/metabolism , Respiration , Sleep/physiology , Sleep Apnea Syndromes/physiopathology , Sleep Apnea Syndromes/metabolism , Altitude , Cross-Sectional Studies , Prospective Studies , EcuadorABSTRACT
OBJECTIVES: To describe, in infants aged 1-4 months old living at 3200 meters above sea level (MASL), oxygen saturation (SpO2), sleep apnea indices, and periodic breathing (PB) during sleep. Polysomnographies were done in 18 healthy infants. RESULTS: The median SpO2 was 87%, and the median PB was 7.2% for the total sleep time. The median central sleep apnea index was 30.5/hour, which decreased to 5.4/hour once sleep apneas associated with PB were excluded. The 5th percentile for SpO2 was 76% among awake infants, and 66% among asleep infants. CONCLUSIONS: The SpO2 was lower than that observed at sea level, whereas PB and the central sleep apnea index were higher, once sleep apneas associated with PB were excluded. The latter was similar to that observed at sea level. At 3200 MASL, different cut-off points are required for a normal SpO2, one for infants during the waking state and one for infants during sleep.
Objetivos: describir, en niños de 1-4 meses, a 3200 m de altura, la saturación de oxígeno (SpO2 ), los índices de apnea y la respiración periódica (RP) durante el sueño. Se realizaron polisomnografías en 18 lactantes sanos. Resultados: las medianas fueron de 87% para la SpO2 y de 7,2% para la RP del tiempo total de sueño. El índice de apnea central tuvo una mediana de 30,5/hora, que disminuyó a 5,4/hora al descontar las apneas asociadas a RP. El p5 de la SpO2 para niños despiertos fue de 76% y, para niños dormidos, de 66%. Conclusiones: la SpO2 fue inferior a la del nivel del mar y la RP y el índice de apnea central, mayores; al descontar las apneas centrales asociadas a RP. Este último, fue similar a la del nivel del mar. A 3200 m, se requieren puntos diferentes para la SpO2 normal, uno para niños despiertos y otro si están dormidos.
Subject(s)
Altitude , Oxygen/metabolism , Respiration , Sleep Apnea Syndromes/metabolism , Sleep Apnea Syndromes/physiopathology , Sleep/physiology , Colombia , Cross-Sectional Studies , Ecuador , Humans , Infant , Prospective StudiesABSTRACT
OBJECTIVES: To determine the characteristics of mistreatment among medical students at a public university in the province Ica, Peru. MATERIALS AND METHODS: This cross-sectional study was performed in 2012, and used a probability sample of medical students (freshman to sixth year) at the Universidad Nacional San Luis Gonzaga. A 23-item survey with a Likert scale was used to measure the students' perceptions of psychological, physical, academic and sexual mistreatment. Univariate and bivariate statistical analysis were performed. RESULTS: A total of 281 students were surveyed. The perception of psychological mistreatment was 96.8%; academic, 86.8%; physical, 62.6% and sexual, 20.6%. Physical abuse increased during the clinical-surgical study cicle (p = 0.001). Medical doctors and residents were the main aggressors. Male students reported of receiving assignments as a punishment, not receiving credits for their work, physical mistreatment, verbal threats, insults, or being teased because of their etnic background. Female students were more likely to have experienced sexual abuse. Report of sexual abuse frequently ocurred at the university (45.3%, p=0.002) and hospital (45.0%, p=0.046). Women frequently reported not knowing to whom or where to denounce the abuse (54.6%, p=0.042) and not reporting it because it stopped (56.9%, p=0.048). CONCLUSIONS: There is a high prevalence of abuse among students in which their characteristics as sex, level of study and aggressor allow to identify the types of abuse that they receive.
Subject(s)
Punishment , Sexual Harassment , Social Behavior , Students, Medical , Adult , Cross-Sectional Studies , Female , Humans , Male , Peru , Surveys and Questionnaires , Universities , Young AdultABSTRACT
Es escasa literatura sobre la enfermedad por priones en poblaciones latinomericanas. La etiología es la alteración genética que origina una proteína aberrante mal plegada, que se acumula en distintas estructuras encefálicas, generando demencia de rápida instauración y posteriormente déficits neurológicos variables. El objetivo es presentar un particular deterioro multisistémico relacionado con la variante esporádica de la enfermedad de Creutzfeldt-Jakob que por este hecho lo convierte en un reto diagnóstico.
Sporadic prion disease is an unusual condition in Latin American populations. The etiology is genetic alteration that causes an aberrant misfolded protein that accumulates in various encephalic structures, generating rapid dementia and subsequently variables neurological deficits. The aim is to present a particular multisystem impairment related to the sporadic variant of Creutzfeldt-Jakob disease that this fact makes it a diagnostic challenge.
ABSTRACT
Determinar las características del maltrato hacia estudiantes de Medicina de una universidad pública en la provincia de Ica, Perú. Materiales y métodos. Investigación transversal realizada el 2012 en una muestra probabilística de estudiantes de Medicina de primer a sexto año de la Universidad Nacional San Luis Gonzaga. Se elaboró una encuesta con un total de 23 ítems en una escala likert, para medir la percepción de maltrato de tipo psicológico, físico, académico y sexual; se usaron análisis estadísticos univariados y bivariados. Resultados. Se encuestaron 281 estudiantes. La percepción de maltrato psicológico fue 96,8%, académico 86,8%, físico 62,6% y sexual 20,6%; el maltrato físico se incrementó durante el ciclo de estudio clínico-quirúrgico (p=0,001). Los médicos docentes y médicos residentes fueron los principales agresores. Estudiantes hombres reportaron con mayor frecuencia haber recibido tareas como castigo, no recibir los créditos por su trabajo, maltrato físico, amenazas verbales, insultos o recibir burlas con respecto a su etnia; mientras que el maltrato sexual fue mayor en mujeres. El reporte de maltrato sexual fue más frecuente en la universidad (45,3%, p=0,002) y el hospital (45,0%, p=0,046). Las mujeres reportaron con mayor frecuencia no saber a quién o dónde acudir para denunciar el maltrato (54,6%, p=0,042) y no denunciarlo porque se detuvo el maltrato (56,9%, p=0,048). Conclusiones. Existe una alta prevalencia de maltrato, donde las características de los estudiantes según el sexo, los ciclos de estudio y el agresor permiten identificar los tipos de maltrato que reciben los estudiantes de medicina...
To determine the characteristics of mistreatment among medical students at a public university in the province Ica, Peru. Materials and methods. This cross-sectional study was performed in 2012, and used a probability sample of medical students (freshman to sixth year) at the Universidad Nacional San Luis Gonzaga. A 23-item survey with a Likert scale was used to measure the students' perceptions of psychological, physical, academic and sexual mistreatment. Univariate and bivariate statistical analysis were performed. Results. A total of 281 students were surveyed. The perception of psychological mistreatment was 96.8%; academic, 86.8%; physical, 62.6% and sexual, 20.6%. Physical abuse increased during the clinical-surgical study cicle (p = 0.001). Medical doctors and residents were the main aggressors. Male students reported of receiving assignments as a punishment, not receiving credits for their work, physical mistreatment, verbal threats, insults, or being teased because of their etnic background. Female students were more likely to have experienced sexual abuse. Report of sexual abuse frequently ocurred at the university (45.3%, p=0.002) and hospital (45.0%, p=0.046). Women frequently reported not knowing to whom or where to denounce the abuse (54.6%, p=0.042) and not reporting it because it stopped (56.9%, p=0.048). Conclusions. There is a high prevalence of abuse among students in which their characteristics as sex, level of study and aggressor allow to identify the types of abuse that they receive...
Subject(s)
Humans , Male , Female , Young Adult , Schools, Medical , Students, Medical , Observational Studies as Topic , Cross-Sectional StudiesABSTRACT
UNLABELLED: There are few data in the literature related to polysomnography in infants in altitudes from 2,200 m to 2,800 m. The main objective of this investigation was to describe oxygen saturation (SpO2) levels during sleep in infants aged between 1 and 4 months living at an altitude of 2,560 m. The secondary objectives were the description of periodic breathing (PB) and apnea indexes. Polysomnography was performed in 35 healthy infants 1-4 months in Cuenca (Ecuador) at 2,560 m. The median for SpO2 was 92% and 4.9% for PB. The median for the central apnea index was 23.7/hour and 15.4/hour when related to PB. No correlation was found between PB and SpO2. CONCLUSION: SpO2 was lower than the values at sea level and PB and central apnea index were higher. When apneas associated with PB were not considered, the central apnea index was similar to that found at sea level.