Factores asociados al desarrollo de eventos adversos en pacientes con hemodiálisis en Guerrero, México / Factors associated with the development of adverse events in hemodialysis patients in Guerrero, Mexico

Objetivo: Determinar los eventos adversos más prevalentes y los factores asociados a su desarrollo en el paciente que se somete a hemodiálisis en el estado de Guerrero, México. Material y Método: Estudio observacional, longitudinal, retrospectivo en 157 pacientes en hemodiálisis afiliados al Instituto Mexicano del Seguro Social en Guerrero, atendidos en 5 unidades privadas y 2 públicas. Se recolectaron variables socio-demográficas, mediciones de laboratorio, evolución de la enfermedad, complicaciones propias de la enfermedad y del tratamiento dialítico. Resultados: Los eventos adversos se presentaron en el 73% de la población estudiada, la principal causa etiológica fue Diabetes mellitus tipo 2 (DM2) e hipertensión arterial. Los eventos adversos más frecuentes fueron: hipotensión (35,5%) infección de angioacceso (24%), cefalea (22,3%), crisis hipertensiva (14,5%), mareos (9,9%), escalofríos (9,9%), y trombosis de fístula arteriovenosa (9,9%). Los factores que se asociaron a su desarrollo fueron: pacientes mayores de 65 años, (OR=6,859IC 95%;1,55-30,35), ser obeso, (OR=1,70, IC95%:1,60-4,81), e hipoalbuminemia (OR=0,251, IC 95%: 0,160-0,593). Conclusión: Los pacientes mayores de 65 años, obesos, con hipertensión diastólica e hipoalbuminemia tienen mayor probabilidad de desarrollar eventos adversos durante el periodo de hemodiálisis

Objective: To determine the most prevalent adverse events and the risk factors associated in the patient undergoing hemodialysis in the state of Guerrero, Mexico. Material and Method: Observational, longitudinal, retrospective study in 157 hemodialysis patients affiliated to the Mexican Institute of Social Security in Guerrero, assisted in 5 private and 2 public units. Socio-demographic variables, laboratory measurements, evolution of the disease, complications of the disease and dialysis treatment were collected. Results: Adverse events occurred in 73% of the studied population, the main etiological cause was Diabetes mellitus type 2 (DM2) and arterial hypertension. The most frequent adverse events were: hypotension (35.5%) angioaccess infection (24.0%), headache (22.3%), hypertensive crisis (14.5%), dizziness (9.9%), chills (9.9%), and thrombosis of arteriovenous fistula (9.9%). The associated risk factors: patients over 65, (OR=6.859, 95% CI:1.55-30.35) being obese, (OR=1.70, 95% CI: 1.60-4.81), and hypoalbuminemia (OR=0.251, 95% CI:0.160-0.593). Conclusion: Patients over 65, obese, with diastolic hypertension and hypoalbuminemia are more likely to develop adverse events during the hemodialysis

Relación entre las complicaciones y la calidad de vida del paciente en hemodiálisis / Relationship between complications and the quality of life of the patient on hemodialysis

Introducción: Los pacientes con Enfermedad Renal Crónica (ERC) son tratados con terapias de diálisis. Dentro de este tipo de tratamiento se encuentran la Diálisis Peritoneal (DP) y Hemodiálisis (HD). Los pacientes sometidos a HD tienen una evolución imprevisible por las complicaciones del tratamiento y/o complicaciones propias de la ERC. Estas aumentan el número de hospitalizaciones y deterioran la calidad de vida (CV). Objetivos: Evaluar la calidad de vida de pacientes en hemodiálisis y determinar la asociación entre las complicaciones y la CV. Material y Método: Estudio transversal analítico en 157 pacientes en HD (75 hombres, 82 mujeres), mayores de 18 años y con más de 3 meses en tratamiento. La CV se evaluó con el instrumento KDQOL-36, el cual, mide 5 dimensiones en escala del 0 al 100. Se realizó un análisis bivariado, ANOVA y regresión múltiple para evaluar la relación de cada una de las dimensiones con edad, sexo, ocupación, estado civil, escolaridad, tipo de acceso venoso, tiempo con la ERC, con la HD y complicaciones de la ERC y la HD. Resultados: La edad promedio fue de 50.9 años. El 77% de los participantes presentaron complicaciones, 69.4% por HD, 5% por evolución de la ERC y 25.6% ambas complicaciones. En el análisis multivariado se encontró que la presencia de ambas complicaciones deteriora más la calidad de vida que las ocasionadas únicamente por el tratamiento de HD. Conclusión: Las complicaciones del tratamiento de hemodiálisis aunadas a las de la ERC deterioran en gran medida la calidad de vida del paciente (AU)

Introduction: Patients with Cronic Kidney Disease (CKD) are treated with dialysis therapies. Within this type of treatment are Peritoneal Dialysis (PD) and Hemodialysis (HD). Patients undergoing HD have unexpected turn for treatment complications and / or complications of CKD. These increase the number of hospitalizations and deteriorate the quality of life (QOL). Objective: Evaluate the Quality of Life of Patients on hemodialysis and determine the association between complications and QoL. Material and Method: Analytical cross-sectional study in 157 patients in HD (75 men, 82 women), aged 18 years and over 3 months treatment. QoL was assessed with the KDQOL-36 instrument, which, measuring 5 dimensions on a scale of 0 to 100. Was conducted of the bivariate analysis, ANOVA and and multiple regression to assess the ratio v Each Dimensions with Age, sex, occupancy, marital status, education, access type venous access time with the ERC, with HD and complications of CKD and HD. Results: Average age was 50.9 m years. 77% of participants had complications, 69.4% for HD, 5% Evolution of CKD and 25.6% Complications Both. In the multivariate analysis it was found that the presence of both complications deteriorates the complications caused only by the HD tratment. Conclusion: Hemodialysis tratment complication together with CKD complications greatly deteriorate patinents quality of (AU)

Twenty-four month clinical evaluation of fissure sealants on partially erupted permanent first molars: glass ionomer versus resin-based sealant.

BACKGROUND: Glass ionomer sealants are an alternative to resin-based sealants, especially for use in partially erupted permanent molars. The authors conducted a study to compare the retention, marginal staining and cariostatic properties of a glass ionomer sealant with those of a resin-based sealant during a 24-month period. METHODS: We included in this study 39 patients aged 5 through 9 years who had bilateral partially erupted first permanent molars. One of us (S.B.) placed a resin-based sealant (Delton Plus FS+, Dentsply Professional, York, Pa.) (group D) on a partially erupted first molar in one quadrant of the maxilla or mandible and a glass ionomer sealant (GC Fuji Triage White, GC America, Alsip, Ill.) (group T) in the other quadrant. Two masked and calibrated investigators (S.A.A., J.C.) evaluated the sealants for retention, marginal staining and carious lesions at three, six, 12 and 24 months. The authors used a multinomial regression for statistical analysis (P < .05). RESULTS: The recall rate was 69.2 percent at 24 months. Two sealants from group D and three from group T were lost completely. Complete retention rates at 24 months were 40.7 and 44.4 percent for groups D and T, respectively. The authors found no statistically significant difference in retention rates between groups at each recall examination (P > .05). For marginal staining, sealants in the resin-based group exhibited statistically higher marginal staining than did sealants in the glass ionomer group (P < .05). Although the authors detected no caries in teeth in group T, teeth in group D in which the sealant was lost completely experienced demineralization. CONCLUSIONS: Resin-based and glass ionomer sealants exhibited similar retention rates at 24 months. However, marginal staining was lower in the glass ionomer group, and the authors found no caries in teeth in this group. Consequently, glass ionomer sealants may be a better choice when salivary contamination is expected. CLINICAL IMPLICATIONS: Sealing during tooth eruption presents a particular challenge owing to difficulty in isolating the tooth. Glass ionomers may be a better material for sealing partially erupted molars.

A novel nonoperative technique in the initial management and treatment of congenital microstomia.

Congenital microstomia in the newborn can result in poor functional and aesthetic outcomes. In the past, treatment options have included surgical methods such as commissurotomies and z-plasties as well as nonsurgical treatments using oral splints. In severe microstomia, a surgical release may be required to permit splint placement. Because of the small diameter of the stoma, such surgical releases are not optimal and frequently must be repeated. We devised a nonoperative technique for the initial treatment of congenital microstomia that will slowly enlarge the stomal diameter without the need for surgical release. The patient is a newborn male born with multiple congenital anomalies including severe mandibular hypoplasia and retrusion, microstomia, and microglossia. The size of his oral cavity was less than 1 cm at birth with no clinical signs of a tongue. After initial dilation in the operating room with Hagar dilators, the oral stoma was serially dilated using Boston Scientific esophageal balloons. Once full dilation was achieved, we fabricated oral splints to continue the dilation process while maintaining oral competence with no surgical intervention.

Clinical variant of ablepharon macrostomia syndrome.

Ablepharon syndrome is an extremely rare genetic problem that causes severe craniofacial deformities and numerous other abnormalities of the face, genitalia, and skin. The literature regarding this condition is scarce. We present a case of this syndrome with dental manifestations, not reported before, and discuss its characteristics in order to increase the knowledge of this condition among the dental profession.

Hereditary osteodystrophy with multiple hormone resistance--a case report.

Hereditary Osteodystrophy, also called pseudohypoparathyroidism, Type 1A (PHP), is a very rare condition composed of a heterogeneous group of autosomal dominant disorders with the common feature of organ resistance to multiple hormones. These patients produce the right amount of hormones but there is resistance to its effect. PHP is difficult to diagnose and the lack of diagnosis may have serious implications for the patient. We report a case of PHP, diagnosed by the dentist, due to the dental and jaw manifestations.

A new method for the treatment of macrocephaly caused by hydrocephalus.

OBJECTIVE: This report will discuss a new surgical technique for treating severe cases of macrocephaly in which the bony architecture is markedly distorted. The procedure relies on several novel surgical tools for its success that have not been previously applied to the treatment of this condition. It utilized the use of contraction osteogenesis devices, resorbable plating systems, and an age- and sex-matched computer-generated skull model, which was derived from a computed tomographic scan as a template for the new calvarium. RESULTS: In the case reported, combined use of these technologies allowed for the complete reconstruction of the calvarium down to the level of the cranial base to produce an appropriately sized skull. The skull model created a template onto which bony fragments could be placed and fixated into a normal shape using the resorbable plating system. The contraction osteogenesis devices then allowed for a slow, safe reduction of the hydrocephalus via a ventriculoperitoneal shunt over a period of several days. On completion of the contraction process, the devices served to fixate the calvarium to the cranial base during the period of bone healing. CONCLUSION: The combination of these modalities represents a unique state-of-the-art method for the correction of severe macrocephaly without the risks of intracranial hemorrhage and provides a useful adjunct to the treatment of hydrocephalus.