Tratamiento de un diente permanente avulsionado y seguimiento por 48 meses / Tratamento de dente permanente avulsionado e acompanhamento por 48 meses / Management of an avulsed permanent tooth and follow-up for 48 months

La avulsión dentaria es considerada una de las lesiones traumáticas más severas. Comprende el desplazamiento completo del diente fuera de su alvéolo con el consiguiente daño a la pulpa y al ligamento periodontal. Las acciones que se realicen en el lugar y momento del accidente y posteriormente al mismo influirán en forma considerable en el pronóstico. El diente deberá ser reimplantado inmediatamente, pero, si esto no fuera posible, el tiempo que transcurra, el medio en que fuera almacenado y el tratamiento profesional que reciba son algunos de los factores trascendentales. Objetivo: Informar el tratamiento de un diente permanente avulsionado y los controles clínico-radiográficos por un periodo de 48 meses. Presentación de caso: Un paciente de 8 años concurrió a la Cátedra Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires 30 minutos después de haber sufrido una caída, con avulsión del incisivo central superior derecho, mantenido en un recipiente con leche. El tratamiento de la urgencia consistió en el reimplante dentario y ferulización con resinas compuestas. Posteriormente se realizaron el tratamiento pulpar y los controles clínicos radiográficos correspondientes, con un seguimiento de 48 meses. En la actualidad, el diente se encuentra sano y funcional. Conclusión: El corto periodo de tiempo transcurrido hasta el reimplante, el adecuado medio de almacenamiento utilizado, las maniobras clínicas realizadas y la colaboración del paciente y sus padres contribuyeron al éxito de este tratamiento, con óptima curación del ligamento periodontal.

A avulsão dentária é considerada uma das lesões traumáticas mais graves. Envolve o deslocamento completo do dente para fora de seu alvèolo com consequente dano à polpa e ligamento periodontal. As ações que são realizadas no local e hora do acidente e posteriormente dele influenciarão significativamente o prognóstico. O dente deve ser reimplantado imediatamente, mas, se isso não for possível, o tempo decorrido, o meio em que o dente foi armazenado e o tratamento profissional que recebe são alguns dos fatores transcendentais. Objetivo: Informar o tratamento de um dente permanente avulsado e controles clínico-radiográficos por um período de 48 meses. Apresentação do caso: Um paciente de 8 anos compareceu à Cátedra de Odontologia Integral Infantil da Faculdade de Odontologia da Universidade de Buenos Aires, 30 minutos após sofrer uma queda, com avulsão do incisivo central superior direito, mantido em um recipiente com leite. O tratamento de emergência consistiu em reimplante dentário e imobilização com resinas compostas. Posteriormente, foram realizados o tratamento pulpar e os controles clínicos radiográficos correspondentes, com seguimento de 48 meses. Atualmente, o dente é saudável e funcional. Conclusão: O curto período decorrido até o reimplante, o meio de armazenamento adequado utilizado, as manobras clínicas realizadas e a colaboração do paciente e seus pais contribuíram para o sucesso desse tratamento, com ótima cicatrização do ligamento periodontal.

Avulsion is considered one of the most severe traumatic dental injuries. It involves the complete displacement of the tooth out of its socket with the consequent damage to the pulp and periodontal ligament. The prognosis is significantly influenced by the actions taken at the place and moment of the accident and subsequently. The tooth must be replanted immediately, but if this is not possible, time, storage media and professional management are some of the transcendental factors. Objective: To report the management and follow up for a period of 48 months of an avulsed permanent tooth. Case presentation: An 8-year-old patient attended the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires, 30 minutes after falling, suffering avulsion of the upper right central incisor, kept in a container with milk. The tooth was replanted and splinted using composite resins. Later, pulp treatment and clinical and radiographic controls were conducted, with a follow-up of 48 months. At present, the tooth is healthy and functional. Conclusion: The short extra-alveolar period, the adequate storage medium, the clinical management and the compliance of the patient and his parents contributed to the optimal healing of the periodontal ligament

Lipoproteínas ricas en triglicéridos y riesgo cardiovascular residual / Triglyceride rich lipoproteins and residual cardiovascular risk / Lipoproteínas ricas em triglicerídeos e risco cardiovascular residual / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen Una vasta evidencia científica de resultados de ensayos clínicos, preclínicos, epidemiológicos y genéticos, mostraron una asociación causal entre el aumento de triglicéridos (TG), lipoproteínas ricas en TG (LRT) y sus remanentes para la enfermedad cardiovascular aterosclerótica (ECA). La acumulación de LRT circulantes puede explicar, en parte, el riesgo cardiovascular residual que se observa en pacientes eficazmente tratados para reducir sus niveles de LDL; sin embargo, persiste el riesgo de ECA. Es imprescindible que en el estudio del perfil lipídico se considere la determinación o estimación de estas lipoproteínas, sumada a la medida de TG plasmáticos. El objetivo de la presente revisión fue actualizar el conocimiento acerca de los niveles incrementados de TG, de LRT y sus remanentes, brindar alternativas para su determinación y comprender los mecanismos que involucran a las LRT en el desarrollo acelerado de la aterosclerosis. La actualización de los diferentes parámetros asociados al aumento de TG y sus valores de corte o límites de decisión clínica según la clasificación del riesgo de ECA para cada paciente, permitirá el rediseño de un informe de resultados que será de gran utilidad para el médico y el paciente con respecto a las conductas preventivas y terapéuticas de la ECA.

Abstract Vast scientific evidence from clinical, preclinical, epidemiological, and genetic trial results show a causal association between increased triglycerides (TG), TG-rich lipoproteins (TRL), and their remnants for atherosclerotic cardiovascular disease (ASCVD). The accumulation of circulating LRT may explain, in part, the residual cardiovascular risk observed in patients successfully treated to reduce their LDL levels, however, the risk of ASCVD still persists. It is essential that in the assessment of the lipid profile, the determination or estimation of these lipoproteins be considered, added to the measurement of plasmatic TG. The objective of this review is to update the knowledge about the increased levels of TG, LRT and their remnants, proprovide alternatives for their determination and understand the mechanisms that involve LRT in the accelerated development of atherosclerosis. Updating the different parameters associated with increased TG and their cut-off values or clinical decision limits according to the ASCVD risk classification for each patient will allow for the redesign of a results report that will be very useful for the physician and the patient regarding the preventive and therapeutic behaviours of the ASCVD.

Resumo Vastas evidências científicas de resultados de ensaios clínicos, pré-clínicos, epidemiológicos e genéticos mostraram uma associação causal entre o aumento de triglicerídeos (TG), lipoproteínas ricas em TG (LRT) e seus remanescentes para doença cardiovascular aterosclerótica (DCA). O acúmulo de LRT circulante pode explicar, em parte, o risco cardiovascular residual observado em pacientes tratados de maneira eficaz para reduzir seus níveis de LDL, no entanto, o risco de DCA persiste. É fundamental que no estudo do perfil lipídico seja considerada a determinação ou estimativa dessas lipoproteínas, somada à dosagem de TG plasmáticos. O objetivo desta revisão foi atualizar o conhecimento sobre os níveis aumentados de TG, LRT e seus remanescentes, fornecer alternativas para sua determinação e compreender os mecanismos que envolvem as LRT no desenvolvimento acelerado da aterosclerose. A atualização dos diferentes parâmetros associados ao aumento de TG, e seus valores de corte ou limites de decisão clínica de acordo com a classificação do risco de DCE para cada paciente, permitirá o redesenho de um relatório de resultados que será muito útil para o médico e o paciente quanto às condutas preventivas e terapêuticas da DCE.

Elevated Lipoprotein(a) prevalence and association with family history of premature cardiovascular disease in general population with moderate cardiovascular risk and increased LDL cholesterol.

Background: Elevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk. There are discrepancies regarding its epidemiology due to great variability in different populations. This study aimed to evaluate the prevalence of elevated Lp(a) in people with moderate CVD risk and increased LDL-c and to determine the association between family history of premature CVD and elevated Lp(a). Methods: Random subjects from the CESCAS population-based study of people with moderate CVD risk (Framingham score 10-20 %) and LDL-c ≥ 130 mg/dL, were selected to evaluate Lp(a) by immunoturbidimetry independent of the Isoforms variability. The association between family history of premature CVD and elevated Lp(a) was evaluated using multivariate logistic regression models. Elevated Lp(a) was defined as Lp(a) ​​≥ 125 nmol/L. Results: Lp(a) was evaluated in 484 samples; men = 39.5 %, median age = 57 years (Q1-Q3: 50-63), mean CVD risk = 14.4 % (SE: 0.2), family history of premature CVD = 11.2 %, Lp(a) median of 21 nmol/L (Q1-Q3: 9-42 nmol/L), high Lp(a) = 6.1 % (95 % CI = 3.8-9.6). Association between family history of premature CVD and elevated Lp(a) in total population: OR 1.31 (95 % CI = 0.4, 4.2) p = 0.642; in subgroup of people with LDL-c ≥ 160 mg%, OR 4.24 (95 % CI = 1.2, 15.1) p = 0.026. Conclusions: In general population with moderate CVD risk and elevated LDL-c from the Southern Cone of Latin America, less than one over ten people had elevated Lp(a). Family history of premature CVD was significantly associated with the presence of elevated Lp(a) in people with LDL-c ≥ 160 mg/dL.

Estudio de la adherencia al tratamiento con presión continua positiva en la vía aérea en pacientes con síndrome de apnea obstructiva del sueño en el confinamiento impuesto durante la pandemia de COVID-19 / Study of the Adherence to continuous positive airway pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome in the Confinement During the COVID-19 Pandemic

No disponible

Phenotype of definite familial hypercholesterolemia with negative genetic study in Argentina.

Objective: Familial hypercholesterolemia (FH) is a monogenic disease, associated with variants in the LDLR, APOB and PCSK9 genes. The initial diagnosis is based on clinical criteria like the DLCN criteria. A score > 8 points qualifies the patient as "definite" for FH diagnosis. The detection of the presence of a variant in these genes allows carrying out familial cascade screening and better characterizes the patient in terms of prognosis and treatment. Methods: In the context of the FH detection program in Argentina (Da Vinci Study) 246 hypercholesterolemic patients were evaluated, 21 with DLCN score > 8 (definite diagnosis).These patients were studied with next generation sequencing to detect genetic variants, with an extended panel of 23 genes; also they were adding the large rearrangements analysis and a polygenic score of 10 SNP (single nucleotide polymorphism) related to the increase in LDL-c. Results: Of the 21 patients, 10 had variants in LDLR, 1 in APOB with APOE, 1 in LIPC plus elevated polygenic score, and 2 patients showed one deletion and one duplication in LDLR, the later with a variation in LIPA. It is highlighted that 6 of the 21 patients with a score > 8 did not show any genetic alteration. Conclusions: We can conclude that 28% of the patients with definite clinical diagnosis of FH did not show genetic alteration. The possible explanations for this result would be the presence of mutations in new genes, confusing effects of the environment over the genes, the gene-gene interactions, and finally the impossibility of detecting variants with the current available methods.

Objetivo: La hipercolesterolemia familiar (HF) es una enfermedad monogénica asociada a variantes en los genes RLDL, APOB y PCSK9. El diagnóstico inicial se basa en criterios clínicos, como el de la red de clínica de lípidos holandesa (DLCN). Un puntaje > 8 puntos califica al paciente como "definitivo" para diagnóstico de HF. La identificación de una variante en estos genes permite realizar el cribado en cascada familiar y caracterizar mejor al paciente en cuanto al pronóstico y el tratamiento. Métodos: En el marco del Programa de Detección de HF en Argentina (Estudio Da Vinci) se evaluó a 246 pacientes hipercolesterolémicos, 21 con puntaje DLCN > 8 (diagnóstico definitivo). Se estudió a estos pacientes con secuenciación de próxima generación para reconocer variantes genéticas, con un panel ampliado de 23 genes, sumado al análisis de grandes rearreglos y por último se aplicó un score poligénico de 10 SNP (polimorfismo de nucleótido único) relacionados con aumento del c-LDL. Resultados: De los 21 pacientes, 10 presentaron variantes en RLDL, uno en APOB junto a APOE, uno en LIPC más puntaje poligénico elevado, dos pacientes con una deleción y una duplicación en RLDL y este último caso con una variante en LIPA. Es destacable que 6 de los 21 pacientes con puntaje DLCN > 8 no mostraron ninguna alteración genética. Conclusiones: El 28% de los pacientes con diagnóstico clínico definitivo de HF no evidenció alteración genética. Las posibles explicaciones de este resultado serían la presencia de mutaciones en nuevos genes, los efectos confundidores del ambiente sobre los genes o la interacción gen-gen y por último la imposibilidad de detectar variantes con la metodología actual disponible.

The antagonic behavior of GPIHBP1 between EAT and circulation does not reflect lipolytic enzymes levels in the tissue and serum from coronary patients.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Recently, triglyceride rich lipoproteins are proposed to contribute to CAD risk; its concentrations would be partly determined by lipoprotein lipase (LPL) and endothelial lipase (EL). Epicardial adipose tissue (EAT), a visceral AT surrounding myocardium and coronary arteries, emerged as an important actor in CAD; the increase in its volume could be a consequence of LPL and EL. Circulating enzymes levels would be conditioned by local tissue factors. Our aim was to evaluate LPL, EL and their regulators levels in serum and EAT from CAD patients, searching for possible parallelisms and their role in the lipoprotein profile. METHODS: In serum, EAT and subcutaneous AT (SAT) from patients undergoing coronary artery bypass graft (CABG, n = 25) or valve replacement (No CABG, n = 25), LPL, EL and glycosylphosphatidylinositol-anchored high density lipoprotein-binding protein-1 (GPIHBP1) expression were evaluated. Besides, Apoprotein (Apo)CII, CIII and AV were determined in serum, along with lipoprotein profile. RESULTS: Insulin-resistance markers were higher in CABG (p < 0.05). Serum LPL levels were decreased (p = 0.045), while EL levels increased (p < 0.001) in CABG, without differences in EAT or SAT. Circulating GPIHBP1 concentrations were decreased in CABG (p = 0.047), while EAT GPIHBP1 expression was increased (p < 0.001). ApoCII and ApoAV concentrations were higher in CABG (p = 0.016 and p = 0.047, respectively), without differences in ApoCIII concentrations between groups. CONCLUSIONS: In EAT, LPL and EL protein levels were not changed in CAD, although GPIHBP1 protein levels were higher. EAT would be a minor contributor to the circulating levels of the enzymes.

Phenotype of definite familial hypercholesterolemia with negative genetic study in Argentina / Fenotipo de hipercolesterolemia familiar definitivo con estudio genético negativo en Argentina

Abstract Objective: Familial hypercholesterolemia (FH) is a monogenic disease, associated with variants in the LDLR, APOB and PCSK9 genes. The initial diagnosis is based on clinical criteria like the DLCN criteria. A score > 8 points qualifies the patient as "definite" for FH diagnosis. The detection of the presence of a variant in these genes allows carrying out familial cascade screening and better characterizes the patient in terms of prognosis and treatment. Methods: In the context of the FH detection program in Argentina (Da Vinci Study) 246 hypercholesterolemic patients were evaluated, 21 with DLCN score > 8 (definite diagnosis).These patients were studied with next generation sequencing to detect genetic variants, with an extended panel of 23 genes; also they were adding the large rearrangements analysis and a polygenic score of 10 SNP (single nucleotide polymorphism) related to the increase in LDL-c. Results: Of the 21 patients, 10 had variants in LDLR, 1 in APOB with APOE, 1 in LIPC plus elevated polygenic score, and 2 patients showed one deletion and one duplication in LDLR, the later with a variation in LIPA. It is highlighted that 6 of the 21 patients with a score > 8 did not show any genetic alteration. Conclusions: We can conclude that 28% of the patients with definite clinical diagnosis of FH did not show genetic alteration. The possible explanations for this result would be the presence of mutations in new genes, confusing effects of the environment over the genes, the gene-gene interactions, and finally the impossibility of detecting variants with the current available methods.

Resumen Objetivo: La hipercolesterolemia familiar (HF) es una enfermedad monogénica asociada a variantes en los genes RLDL, APOB y PCSK9. El diagnóstico inicial se basa en criterios clínicos, como el de la red de clínica de lípidos holandesa (DLCN). Un puntaje > 8 puntos califica al paciente como "definitivo" para diagnóstico de HF. La identificación de una variante en estos genes permite realizar el cribado en cascada familiar y caracterizar mejor al paciente en cuanto al pronóstico y el tratamiento. Métodos: En el marco del Programa de Detección de HF en Argentina (Estudio Da Vinci) se evaluó a 246 pacientes hipercolesterolémicos, 21 con puntaje DLCN > 8 (diagnóstico definitivo). Se estudió a estos pacientes con secuenciación de próxima generación para reconocer variantes genéticas, con un panel ampliado de 23 genes, sumado al análisis de grandes rearreglos y por último se aplicó un score poligénico de 10 SNP (polimorfismo de nucleótido único) relacionados con aumento del c-LDL. Resultados: De los 21 pacientes, 10 presentaron variantes en RLDL, uno en APOB junto a APOE, uno en LIPC más puntaje poligénico elevado, dos pacientes con una deleción y una duplicación en RLDL y este último caso con una variante en LIPA. Es destacable que 6 de los 21 pacientes con puntaje DLCN > 8 no mostraron ninguna alteración genética. Conclusiones: El 28% de los pacientes con diagnóstico clínico definitivo de HF no evidenció alteración genética. Las posibles explicaciones de este resultado serían la presencia de mutaciones en nuevos genes, los efectos confundidores del ambiente sobre los genes o la interacción gen-gen y por último la imposibilidad de detectar variantes con la metodología actual disponible.

Fenotipo de hipercolesterolemia familiar definitivo con estudio genético negativo en Argentina.

Objective: Familial hypercholesterolemia (FH) is a monogenic disease, associated with variants in the LDLR, APOB and PCSK9 genes. The initial diagnosis is based on clinical criteria like the DLCN criteria. A score > 8 points qualifies the patient as "definite" for FH diagnosis. The detection of the presence of a variant in these genes allows carrying out familial cascade screening and better characterizes the patient in terms of prognosis and treatment. Methods: In the context of the FH detection program in Argentina (Da Vinci Study) 246 hypercholesterolemic patients were evaluated, 21 with DLCN score > 8 (definite diagnosis).These patients were studied with next generation sequencing to detect genetic variants, with an extended panel of 23 genes; also they were adding the large rearrangements analysis and a polygenic score of 10 SNP (single nucleotide polymorphism) related to the increase in LDL-c. Results: Of the 21 patients, 10 had variants in LDLR, 1 in APOB with APOE, 1 in LIPC plus elevated polygenic score, and 2 patients showed one deletion and one duplication in LDLR, the later with a variation in LIPA. It is highlighted that 6 of the 21 patients with a score > 8 did not show any genetic alteration. Conclusions: We can conclude that 28% of the patients with definite clinical diagnosis of FH did not show genetic alteration. The possible explanations for this result would be the presence of mutations in new genes, confusing effects of the environment over the genes, the gene-gene interactions, and finally the impossibility of detecting variants with the current available methods.

Objetivo: La hipercolesterolemia familiar (HF) es una enfermedad monogénica asociada a variantes en los genes RLDL, APOB y PCSK9. El diagnóstico inicial se basa en criterios clínicos, como el de la red de clínica de lípidos holandesa (DLCN). Un puntaje > 8 puntos califica al paciente como "definitivo" para diagnóstico de HF. La identificación de una variante en estos genes permite realizar el cribado en cascada familiar y caracterizar mejor al paciente en cuanto al pronóstico y el tratamiento. Métodos: En el marco del Programa de Detección de HF en Argentina (Estudio Da Vinci) se evaluó a 246 pacientes hipercolesterolémicos, 21 con puntaje DLCN > 8 (diagnóstico definitivo). Se estudió a estos pacientes con secuenciación de próxima generación para reconocer variantes genéticas, con un panel ampliado de 23 genes, sumado al análisis de grandes rearreglos y por último se aplicó un score poligénico de 10 SNP (polimorfismo de nucleótido único) relacionados con aumento del c-LDL. Resultados: De los 21 pacientes, 10 presentaron variantes en RLDL, uno en APOB junto a APOE, uno en LIPC más puntaje poligénico elevado, dos pacientes con una deleción y una duplicación en RLDL y este último caso con una variante en LIPA. Es destacable que 6 de los 21 pacientes con puntaje DLCN > 8 no mostraron ninguna alteración genética. Conclusiones: El 28% de los pacientes con diagnóstico clínico definitivo de HF no evidenció alteración genética. Las posibles explicaciones de este resultado serían la presencia de mutaciones en nuevos genes, los efectos confundidores del ambiente sobre los genes o la interacción gen-gen y por último la imposibilidad de detectar variantes con la metodología actual disponible.

Untargeted Lipidomics Reveals a Specific Enrichment in Plasmalogens in Epicardial Adipose Tissue and a Specific Signature in Coronary Artery Disease.

OBJECTIVE: Epicardial adipose tissue (EAT) is an active endocrine organ that could contribute to the pathophysiology of coronary artery disease (CAD) through the paracrine release of proatherogenic mediators. Numerous works have analyzed the inflammatory signature of EAT, but scarce informations on its lipidome are available. Our objective was first to study the differences between EAT and subcutaneous adipose tissue (SAT) lipidomes and second to identify the specific untargeted lipidomic signatures of EAT and SAT in CAD. Approach and Results: Subcutaneous and EAT untargeted lipidomic analysis was performed in 25 patients with CAD and 14 patients without CAD and compared with paired plasma lipidomic analysis of isolated VLDL (very low-density lipoprotein) and HDL (high-density lipoprotein). Lipidomics was performed on a C18 column hyphenated to a Q-Exactive plus mass spectrometer, using both positive and negative ionization mode. EAT and SAT had independent lipidomic profile, with 95 lipid species differentially expressed and phosphatidylethanolamine 18:1p/22:6 twenty-fold more expressed in EAT compared with SAT false discovery rate =3×10-4). Patients with CAD exhibited more ceramides (P=0.01), diglycerides (P=0.004; saturated and nonsaturated), monoglycerides (P=0.013) in their EAT than patients without CAD. Conversely, they had lesser unsaturated TG (triglycerides; P=0.02). No difference was observed in the 295 lipid species found in SAT between patients with and without CAD. Fifty-one lipid species were found in common between EAT and plasma lipoproteins. TG 18:0/18:0/18:1 was found positively correlated (r=0.45, P=0.019) in EAT and HDL and in EAT and VLDL (r=0.46, P=0.02). CONCLUSIONS: CAD is associated with specific lipidomic signature of EAT, unlike SAT. Plasma lipoprotein lipidome only partially reflected EAT lipidome.

Sampling and processing blood samples within the South American Youth/Child cARdiovascular and Environmental (SAYCARE) Study.

Obesity and overweight in children and adolescents is increasing rapidly worldwide; however, scarce data have been reported from South America countries. With the purpose of assessing hyperlipidemia, insulin resistance and chronic inflammation, the evaluation of blood biomarkers such as glucose, lipoproteins and chronic inflammation proteins is required. In the context of the SAYCARE study, in children and adolescents (3 to 18 years) from seven South American cities, our aim was to assess the impact of pre analytical conditions on different biomarkers evaluated in 474 fresh serum samples, in different country centers. We also evaluated the stability according to time and frozen storage within this study across the concordance of the results obtained from the 49 blood samples measured in three different centers. Significant correlations as well as concordance were observed in TG, Total-C, HDL-C and glucose between Buenos Aires and São Paulo. The samples evaluated in Teresina and São Paulo presented similar results, with exception of total cholesterol. We observed acceptable concordance between Buenos Aires vs São Paulo and Teresina vs São Paulo, suggesting that samples could be processed in each of these centers. This concordance is a consequence of the strict pre analytical conditions previously established in the SAYCARE study.

Armonizacion del estudio de lipidos en el laboratorio clinico / Harmonization of the study of lipids in the clinical laboratory

Los profesionales que ejercen la bioquimica clinica son conscientes de la falta de resultados comparables entre laboratorios, independientemente de donde y cuando se realicen. Durante muchos anos el centro de la gestion de la calidad estuvo en la estandarizacion de los procedimientos de medida, la armonizacion va mas alla del metodo y los resultados analiticos e incluye todos los aspectos que hay que tener en cuenta durante el proceso total de la prueba. Los laboratorios de bioquimica clinica han logrado en las ultimas decadas importantes mejoras en la calidad de los procesos analiticos, pero es necesario un esfuerzo mayor dedicado a la vulnerabilidad de los procedimientos extra analiticos para asegurar la comparacion y la concordancia de los resultados obtenidos por diferentes laboratorios clinicos. Las iniciativas destinadas a mejorar la armonizacion de los resultados de laboratorio tienen una dimension etica y de gran importancia en el diagnostico de las dislipemias asociadas al desarrollo de aterosclerosis y la evaluacion del riesgo cardiovascular. Los estudios poblacionales aun muestran dificultades en la identificacion del mejor biomarcador que pueda evidenciar adecuadamente el riesgo cardiovascular en un individuo. La correlacion, discordancia y concordancia muestran que es necesario el diseno de un perfil de pruebas de laboratorio personalizado, con marcadores estandarizados y armonizados, que permita la prediccion del riesgo.

The health professionals who practice clinical biochemistry are aware of the lack of comparable results between laboratories, regardless of where and when they are performed. For many years, the objective of the quality management was the standardization of measurement procedures. The harmonization is beyond the methods and the analytical results, and it includes all the aspects to be taken into account during the whole process of the test. The clinical biochemistry laboratories have achieved important improvements in the quality of the analytical processes in the last decades, but greater effort is necessary for the vulnerability of the extra analytical procedures to ensure the comparison and the agreement of the results obtained by different clinical laboratories. The initiatives aimed to improve the harmonization of laboratory results have an ethical dimension and importance in the diagnosis of dyslipidemia associated with the development of atherosclerosis and the assessment of cardiovascular risk. The population studies still show difficulties in the identification of the best biomarker that can adequately show the cardiovascular risk in an individual. The correlation, discordance and concordance between biomarkers show that it is necessary to design a personalized laboratory test profile, and with standardized and harmonized markers that allow the prediction of risk.

Os profissionais que exercem a bioquímica clínica Clinical estão cientes da falta de resultados comparáveis entre laboratórios, independentemente de onde e quando forem realizados. Por muitos anos, o centro de gestão da qualidade esteve na padronização dos procedimentos de medição, a harmonização vai além do método analítico e dos resultados analíticos e inclui todos os aspectos a considerar durante o processo do teste. Laboratórios bioquímica clínica têm alcançado, nas últimas décadas grandes melhorias na qualidade dos processos analíticos, mas precisa de um esforço maior dedicado à vulnerabilidade dos procedimentos extra-analíticos, para garantir a comparação e concordancia dos resultados obtidos pelos diferentes laboratórios clínicos. Iniciativas para melhorar a harmonização dos resultados laboratoriais têm uma dimensão ética e de grande importȃncia no diagnóstico de dislipidemias associadas ao desenvolvimento de aterosclerose e à avaliação do risco cardiovascular. As pesquisas populacionais mostram ainda dificuldades em identificar o melhor biomarcador que possa demonstrar em forma adecuada o risco cardiovascular em um individuo, a correlação, discordância e concordância mostram que é necessário o desenho de um perfil de testes personalizado, com marcadores padronizados e harmonizada, que permite a previsão de risco.

Fractura radicular de tercio medio: tratamiento y cinco años de seguimiento / Treatment and 5-year follow-up of root fractures in the middle third

Objetivo: Informar el tratamiento de dos piezas con fractura radicular horizontal del tercio medio, patrones de curación y seguimiento por cinco años. Caso clínico: Se presentó a la consulta una niña de 9 años de edad con traumatismo de 10 días de evolución. Examen clínico: fractura amelodentinaria restaurada en la pieza 2.2, movilidad y sensibilidad a la percusión y palpación en ambos incisivos centrales superiores. Examen radiográfico: fractura radicular horizontal de tercio medio en piezas 1.1 y 2.1. Tratamiento: inmovilización con placa removible durante 4 semanas, indicaciones de higiene y uso, y controles de seguimiento. Al primero y al cuarto mes, ambos incisivos mostraron ausencia de movilidad, reacción positiva de sensibilidad y signos radiográficos de reabsorción superficial interna y externa. A los 6 meses, el 1.1 evidenció signos de reparación con tejido conectivo, y el 2.1, signos clínicos y radiográficos de necrosis pulpar del fragmento coronario. Se realizó el tratamiento endodóntico de la pieza 2.1 hasta el nivel de la fractura con pasta a base de hidróxido de calcio, y luego de la comprobación de la formación de una barrera de tejido duro, se obturó definitivamente con gutapercha y sellador endodóntico. Cinco años después del traumatismo, ambos incisivos se mostraron asintomáticos y los estudios por imágenes evidenciaron una completa consolidación de las fracturas. Conclusión: Un diagnóstico temprano, procedimientos apropiados de tratamiento, el conocimiento de los procesos curativos y un monitoreo cuidadoso de todos los parámetros clínicos y radiográficos son claves para un enfoque correcto y conservador de las piezas dentarias con fractura radicular (AU)

Aim: To report the treatment, healing patterns and fiveyear follow-up of two permanent incisors with horizontal root fracture located in the middle third. Case report: A 9-year-old girl who came to our consultation 10 days after a dental trauma. Clinical examination: restored enamel-dentin fracture in upper left lateral incisor; mobility and sensitivity to percussion and palpation in both upper central incisors. Radiographic examination: horizontal root fracture in the middle third of both upper central incisors. Treatment: stabilization with a removable splint for 4 weeks, indications for hygiene, use of the splint and follow-up controls. At first and fourth month, central incisors presented absence of mobility, positive response to pulp testing and radiographic signs of internal and external superficial resorption. At sixth month, signs of healing with connective tissue were found on the right central incisor, while the left one showed clinical and radiographic signs of necrosis of the coronal fragment. The root canal of this segment was treated initially with a calcium hydroxide paste and, after verifying the formation of a hard tissue barrier, it was filled with gutta- percha and endodontic sealer. Five years after the trauma, both central incisors were asymptomatic and imaging studies showed complete healing of the fractures. Conclusion: Early diagnosis, appropriate treatment procedures, knowledge of healing patterns and careful monitoring of clinical and radiographic parameters are key factors for a proper and conservative approach of injured tooth with root fracture (AU)

Glycosylphosphatidylinositol-anchored high density lipoprotein-binding protein 1 and angiopoietin-like protein 4 are associated with the increase of lipoprotein lipase activity in epicardial adipose tissue from diabetic patients.

BACKGROUND AND AIMS: Epicardial adipose tissue (EAT) is a visceral AT, surrounding myocardium and coronary arteries. Its volume is higher in Type 2 diabetic (DM2) patients, associated with cardiovascular disease risk. Lipoprotein lipase (LPL) hydrolyses triglycerides (TG) from circulating lipoproteins, supplying fatty acids to AT, contributing to its expansion. We aimed to evaluate LPL expression and activity in EAT from DM2 and no DM2 patients, and its regulators ANGPTL4, GPIHBP1 and PPARγ levels, together with VLDLR expression and EAT LPL association with VLDL characteristics. METHODS: We studied patients undergoing coronary by-pass graft (CABG) divided into CABG-DM2 (n = 21) and CABG-noDM2 (n = 29), and patients without CABG (No CABG, n = 30). During surgery, EAT and subcutaneous AT (SAT) were obtained, in which LPL activity, gene and protein expression, its regulators and VLDLR protein levels were determined. Isolated circulating VLDLs were characterized. RESULTS: EAT LPL activity was higher in CABG-DM2 compared to CABG-noDM2 and No CABG (p=0.002 and p<0.001) and in CABG-noDM2 compared to No CABG (p=0.02), without differences in its expression. ANGPTL4 levels were higher in EAT from No CABG compared to CABG-DM2 and CABG-noDM2 (p<0.001). GPIHBP1 levels were higher in EAT from CABG-DM2 and CABG-noDM2 compared to No CABG (p= 0.04). EAT from CABG-DM2 presented higher PPARγ levels than CABG-noDM2 and No CABG (p=0.02 and p=0.03). No differences were observed in VLDL composition between groups, although EAT LPL activity was inversely associated with VLDL-TG and TG/protein index (p<0.05). CONCLUSIONS: EAT LPL regulation would be mainly post-translational. The higher LPL activity in DM2 could be partly responsible for the increase in EAT volume.

Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars.

Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3Mix-MP and pulpectomy with Maisto-Capurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with Maisto-Capurro paste; and G2: Treatment with 3Mix-MP paste. Treatments were evaluated at 1, 3, 6,12 and 18 months (intra and inter-rater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and non-physiological mobility, while radiographic success was considered to be: absence of internal or external non-physiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study periods.

Las pulpectomías en molares primarios se ven dificultadas frecuentemente por las características anatómicas y fisiológicas de éstos y por la escasa colaboración que brindan los pacientes de corta edad ante tratamientos tan laboriosos. En búsqueda de terapéuticas más sencillas, pero igualmente eficaces, que consigan eliminar la infección para conservar las piezas y evitar las exodoncias, se ha planteado como objetivo de este estudio: estimar y comparar la proporción de éxito clínico y radiográfico entre el tratamiento pulpar con 3Mix-MP y la pulpectomía con pasta de Maisto-Capurro en molares primarios con necrosis. Se realizó un estudio longitudinal y prospectivo en la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (2015 - 2017). Formaron parte del estudio 46 molares primarios con diagnóstico de necrosis pulpar, de niños sin compromiso inmunológico ni metabólico y que junto con sus responsables legales brindaron el asentimiento y el consentimiento informado. Los molares seleccionados fueron divididos aleatoriamente en 2 grupos: G1: Tratamiento de pulpectomía con pasta de Maisto-Capurro y G2: Tratamiento con pasta 3Mix-MP. Los tratamientos fueron evaluados al mes, 3, 6, 12y 18 meses (concordancia intra-examinador 0,92 e interexaminador 0,84), considerando como éxito clínico la ausencia de dolor, sensibilidad a la percusión y palpación, edema, fístula y movilidad no fisiológica; y como éxito radiográfico, ausencia de reabsorción interna o externa no fisiológica, no progresión o reducción de la lesión radiolúcida interradicular/periapical y evidencia de regeneración ósea. Se calcularon porcentajes, I.C 95% y CHI2para la comparación. El éxito clínico global fue de 91,5%y 87,5% (p=0.48) y el éxito radiográfico global de 88,3% y 82,3% (p=0.31)para G1 y G2 respectivamente, sin diferencias significativas entre ambos grupos. En los periodos estudiados ambos tratamientos mostraron comportamientos clínico y radiográfico semejantes.

Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars

Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3MixMP and pulpectomy with MaistoCapurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with MaistoCapurro paste; and G2: Treatment with 3MixMP paste. Treatments were evaluated at 1, 3, 6, 12 and 18 months (intra and interrater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and nonphysiological mobility, while radiographic success was considered to be: absence of internal or external nonphysiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study period (AU)

Las pulpectomías en molares primarios se ven dificultadas frecuentemente por las características anatómicas y fisiológicas de éstos y por la escasa colaboración que brindan los pacientes de corta edad ante tratamientos tan laboriosos. En búsqueda de terapéuticas más sencillas, pero igualmente eficaces, que consigan eliminar la infección para conservar las piezas y evitar las exodoncias, se ha planteado como objetivo de este estudio: estimar y comparar la proporción de éxito clínico y radiográfico entre el tratamiento pulpar con 3MixMP y la pulpectomía con pasta de MaistoCapurro en molares primarios con necrosis. Se realizó un estudio longitudinal y prospectivo en la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (2015 2017). Formaron parte del estudio 46 molares primarios con diagnóstico de necrosis pulpar, de niños sin compromiso inmunológico ni metabólico y que junto con sus responsables legales brindaron el asentimiento y el consentimiento informado. Los molares seleccionados fueron divididos aleatoriamente en 2 grupos: G1: Tratamiento de pulpectomía con pasta de MaistoCapurro y G2: Tratamiento con pasta 3MixMP. Los tratamientos fueron evaluados al mes, 3, 6, 12 y 18 meses (concordancia intraexaminador 0,92 e interexaminador 0,84), considerando como éxito clínico la ausencia de dolor, sensibilidad a la percusión y palpación, edema, fístula y movilidad no fisiológica; y como éxito radiográfico, ausencia de reabsorción interna o externa no fisiológica, no progresión o reducción de la lesión radiolúcida interradicular/periapical y evidencia de regeneración ósea. Se calcularon porcentajes, I.C 95% y CHI2 para la comparación. El éxito clínico global fue de 91,5% y 87,5% (p=0.48) y el éxito radiográfico global de 88,3% y 82,3% (p=0.31) para G1 y G2 respectivamente, sin diferencias significativas entre ambos grupos. En los periodos estudiados ambos tratamientos mostraron comportamientos clínico y radiográfico semejantes (AU)

Endothelial Lipase Is an Alternative Pathway for Fatty Acid Release from Lipoproteins: Evidence from a High Fat Diet Model of Obesity in Rats.

Lipoprotein lipase (LPL) and endothelial lipase (EL) are involved in lipoprotein metabolism. In insulin-resistance, their behavior is altered. Peroxisome proliferator-activated receptors (PPAR) and apoproteins (apo)CII and CIII could be partly responsible for these alterations. To evaluate this response, we assessed Lpl and Lipg expression, protein levels, and enzyme activity in adipose tissue (AT) and heart in an obesity model. Besides, we assessed the role of PPAR and apoC. Male Wistar rats were fed with standard diet (Control, n = 14) or high-fat diet (HFD, n = 14) for 14 weeks. Glucose and lipoprotein profiles were measured. Histological studies were performed in heart and epididymal AT. Lpl and Lipg were assessed by reverse transcription polymerase chain reaction (RT-qPCR), protein levels by Western Blot, and activities by radiometric assays. Cardiac and AT PPAR expression were measured by Western Blot and hepatic Apoc2 and Apoc3 mRNA by RT-qPCR. In HFD, fat deposits were observed in hearts, whereas AT presented a higher adipocyte size. In heart and AT, no differences were found in Lipg mRNA between groups, while AT Lpl mRNA and LPL protein were decreased in HFD, without differences in heart. In both tissues, EL protein levels and activity were increased and inversely associated with decreased LPL activity, being partially responsible for the atherogenic lipoprotein profile in HFD. PPARγ expression in AT was decreased in HFD, without differences in cardiac PPARδ expression and hepatic apoC mRNA. The increase in EL activity could be an alternative pathway for fatty acid release from lipoproteins and uptake in tissues with decreased LPL activity. In AT, PPARγ could be involved in enzyme regulation.

Unusual genetic variants associated with hypercholesterolemia in Argentina.

BACKGROUND AND AIMS: Marked hypercholesterolemia, defined as low density lipoprotein cholesterol (LDL-C) levels ≥ 190 mg/dL, may be due to LDLR, APOB, and PCSK9 variants. In a recent analysis, only 1.7% of cases had such variants. Our goal was to identify other potential genetic causes of hypercholesterolemia. METHODS: In a total of 51,253 subjects with lipid testing, 3.8% had elevated total cholesterol >300 mg/dL and/or LDL-C≥190 mg/dL. Of these, 246 were further studied, and 69 without kidney, liver, or thyroid disease and who met Dutch Lipid Clinic Network criteria of ≥6 points had DNA sequencing done at the LDLR, APOB, PCSK9, APOE, LDLRAP1, STAP1, ABCG5, ABCG8, CYP27A1, LIPA, LIPC, LIPG, LPL, and SCARB1 gene loci and also had 10 SNP analysis for a weighted high LDL-C genetic risk score. RESULTS: In the 69 subjects with genetic analyses, the following variants were observed in 37 subjects (53.6%): LDLR (n = 20, 2 novel), ABCG5/8 (n = 7, 2 novel), APOB (n = 3, 1 novel), CYP27A1 (n = 3, 1 novel), LIPA (n = 2, 1 novel), APOE (n = 2), LIPC (n = 1, novel), LIPG (n = 1, novel), and SCARB1 (n = 1); 14 subjects (20.3%) had a high polygenic score, with 4 (5.8%) having no variants. CONCLUSIONS: Our data indicate that in addition to variants in LDLR, APOB, PCSK9, APOE, LDLRAP1, and STAP1, variants in ABCG5/8, CYP27A1, LIPA, LIPC, and LIPG may be associated with hypercholesterolemia and such information should be used to optimize therapy.

El sondaje vesical y sus complicaciones en una Unidad de Cuidados Intensivos Pediátricos / Bladder catheterization and its complications at a Paediatric Intensive Care Unit

Objetivo: conocer la incidencia de complicaciones relacionadas con los sondajes vesicales en una Unidad de Cuidados Intensivos Pediátricos (UCIP) e identificar los factores asociados.Método: estudio observacional prospectivo. Como población diana se consideró a todo paciente portador de sondaje vesical (SV) ingresado en la UCIP durante el periodo de seis meses en el que tuvo lugar el estudio. Los datos recogidos en el formulario creado ad hoc para esta investigación se analizaron utilizando el programa informático estadístico SPSS versión 19.0. Se realizó análisis descriptivo y bivariante. Se consideraron como significativos los valores de p<0,05. Resultados: de los 192 niños y niñas ingresados en la UCIP, el 18,75% de los pacientes requirió un SV. El 64,2% fue realizado a niños. La edad media y desviación estándar (DE) fue de 5,32 (4,74) años. En el 77,4% de los casos existía una patología de base, siendo las causas genéticas (34%) y neurológicas (17%) las más habituales. Se produjeron complicaciones relacionadas con la SV en el 30,2% de los casos, siendo la obstrucción la que mayor incidencia mostró seguida de rebosamiento y hematuria. Más de la mitad de los SV se retiraron antes del cuarto día. Conclusiones: la incidencia de complicaciones fue alta, atendiendo a la circunstancia de que se incluyó a un niño que acumuló la mitad de las complicaciones registradas por hematuria persistente. La complicación más frecuente fue la obstrucción. Los factores asociados a las complicaciones relacionadas con el sondaje vesical fueron la edad, la patología de base y el tiempo de permanencia de la SV (AU)

Objective: to learn about the incidence of complications associated with bladder catheterizations at a Paediatric Intensive Care Unit (PICU), and to identify any associated factors. Method: an observational prospective study. The target population included all patients with bladder catheterization (BC) admitted to the PICU during the six-month period of the study. Data were collected in the ad hoc form prepared for this research and analyzed using the SPSS statistical computer program, version 19.0. Descriptive and bivariate analysis was conducted. The «p» values <0.05 were considered significant for the study. Results: of the 192 boys and girls admitted at PICU, 18.75% of patients required BC; 64.2% of these were conducted in children. The mean age and standard deviation (SD) was 5.32 (4.74) years. In 77.4% of cases there was an underlying condition; the most frequent were genetic (34%) and neurological causes (17%). BC associated complications appeared in 30.2% of cases: obstruction presented the highest incidence, followed by overflow and hematuria. Over half of Bfs were removed before the fourth day. Conclusions: there was a high incidence of complications, taking into account the circumstance of including a child who experienced half of the complications recorded due to persistent hematuria. The most frequent complication was obstruction. The factors associated with complications related to bladder catheterization were: age, underlying condition, and length of time with BC (AU)

Preliminary spectrum of genetic variants in familial hypercholesterolemia in Argentina.

BACKGROUND: Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein cholesterol and early cardiovascular disease. As cardiovascular disease is a leading cause of mortality in Argentina, early identification of patients with FH is of great public health importance. OBJECTIVE: The aim of our study was to identify families with FH and to approximate to the characterization of the genetic spectrum mutations of FH in Argentina. METHODS: Thirty-three not related index cases were selected with clinical diagnosis of FH. Genetic analysis was performed by sequencing, multiplex ligation-dependent probe amplification, and bioinformatics tools. RESULTS: Twenty genetic variants were identified among 24 cases (73%), 95% on the low-density lipoprotein receptor gene. The only variant on APOB was the R3527Q. Four were novel variants: c.-135C>A, c.170A>C p.(Asp57Ala), c.684G>C p.(Glu228Asp), and c.1895A>T p.(Asn632Ile); the bioinformatics' analysis revealed clear destabilizing effects for 2 of them. The exon 14 presented the highest number of variants (32%). Four variants were observed in more than 1 case and the c.2043C>A p.(Cys681*) was carried by 18% of index cases. Two true homozygotes, 3 compound heterozygotes, and 1 double heterozygote were identified. CONCLUSION: This study characterizes for the first time in Argentina genetic variants associated with FH and suggest that the allelic heterogeneity of the FH in the country could have 1 relative common low-density lipoprotein receptor mutation. This knowledge is important for the genotype-phenotype correlation and for optimizing both cholesterol-lowering therapies and mutational analysis protocols. In addition, these data contribute to the understanding of the molecular basis of FH in Argentina.