Preorthodontic dilacerated incisive crown modification in a pediatric patient: a case report.

Dental dilacerations are abrupt deviations of the longitudinal axis of the crown or root portion of the tooth, caused by traumatic axial displacement of previously formed hard tissue in relation to the developing soft tissue. CASE PRESENTATION: A 13-year-old boy in good general health was referred for root canal treatment of the maxillary left central incisor, for which abnormal crown morphology impeded orthodontic treatment. He presented bilateral crown dilaceration at both maxillary central incisors. Treatment involved a CAD/CAM milled veneer of the maxillary left central incisor and semidirect warm composite veneer of the maxillary right central incisor. Follow-up and monitoring of the restoration was performed through .stl file analysis. DISCUSSION: Crown dilaceration severity assessment is crucial for deciding the best treatment plan for each case. In this patient, additive restorative protocols, CBCT, and 3D digital model analysis were the most useful aids by providing key multidisciplinary information. CONCLUSION: A multidisciplinary treatment workflow with a minimally invasive approach aided by digital tools such as CBCT and CAD/CAM technologies is useful to achieve successful and predictable outcomes in crown dilaceration cases.

Retrospective Cohort Noninferiority Analysis of Barrier Cream in Preventing Pressure Injuries.

OBJECTIVE: To assess the effectiveness of a dimethicone- and zinc-based barrier cream compared with hyperoxygenated fatty acids in preventing pressure injuries (PIs) in patients at high or very high risk. METHODS: Researchers conducted a retrospective noninferiority study in an inpatient acute care hospital in Spain that included hospitalized patients in nonsurgical departments with impaired mobility. RESULTS: The study authors reviewed 522 patients in a control group (hyperoxygenated fatty acids) and an experimental group (barrier cream) over a period of 7 days. The incidence of PI was 31% in the control group and 31.1% in the experimental group. The hazard ratio for developing PI was 0.84 (confidence interval, 0.61-1.17; P = .32) in the experimental group compared with the control group, meeting the criteria for noninferiority. The Kaplan-Meier estimator indicated no statistically significant difference between groups (log-rank = 0.654). CONCLUSIONS: Dimethicone- and zinc-based barrier cream was not inferior to hyperoxygenated fatty acids in preventing PIs in hospitalized patients at high or very high risk of developing them during their hospital stay.

Methacrylate dressing on refractory venous leg ulcers.

Chronic leg ulcers can have a major impact on the quality of life of patients. These wounds can be complex and hard to heal, as several factors may affect the outcome. Underlying conditions, bacterial growth and excess moisture may prevent wounds from healing. We describe the case of a patient with known chronic venous disease, who was admitted to our hospital for several complex, irregular and infected chronic venous ulcers in his lower legs. The management was frustrating for several months, until we began to use methacrylate powder dressing for his hard-to-heal wounds.

Breastfeeding Duration and Anogenital Distance in 2-Year-Old Infants.

BACKGROUND: The anogenital distance (AGD) is an anthropometric marker determined by exposures to androgens in utero and throughout the first few months of life. Early exposures to endocrine-disrupting chemicals such as phthalates have been significantly associated with shortened AGD in boys. Limited studies have explored phthalate concentrations in breast milk and infant formula. OBJECTIVE: To explore the associations between breastfeeding duration and AGD measures in infants. MATERIALS AND METHODS: MALAMA (Medio Ambiente y Lactancia Materna) is a follow-up study of 430 mother-child pairs, from birth to 2 years, from two population-based cohorts in Murcia, Spain. Data were collected through medical visits and telephone surveys from birth to 2 years of age. World Health Organization breastfeeding definitions were used. AGD measurements were assessed in a subsample of 71 boys and 49 girls at the 2-year visit. Descriptive analyses, Pearson correlations, and linear regressions were calculated between AGD and breastfeeding duration. RESULTS: Duration of all types of breastfeeding, especially full breastfeeding (FB), is correlated with AGD measures in boys (p < 0.05). AGDAS (anoscrotal distance) and AGDAP (anopenile distance) were positively associated with FB (ß = 0.004, 95%CI: 0.001-0.007 and ß = 0.003, 95%CI: 0.000-0.007, respectively). CONCLUSIONS: A positive correlation between AGD in male infants and the duration of breastfeeding is reported. Inversely, early introduction of infant formula could lead to the reduction of AGD in boys.

Riesgo de Tuberculosis en trabajadores de tres hospitales clínico quirúrgicos de La Habana / Tuberculosis risk in the staff of three clinical surgical hospitals at Havana city

Introducción: la transmisión nosocomial de la tuberculosis ha sido reconocida como un problema para el control de la tuberculosis a nivel mundial. Objetivos: estimar la prevalencia de Infección Tuberculosa Latente y evaluar el riesgo de infección tuberculosa en trabajadores de tres Hospitales Clínico Quirúrgicos de La Habana, Cuba. Métodos: estudio de corte transversal en muestra de 804 trabajadores de una plantilla total de 5 737 en tres hospitales Clínico Quirúrgicos de La Habana; se les aplicó prueba de tuberculina y encuesta con datos personales, de ubicación laboral y exposición a Mycobacterium tuberculosis. Se consideraron positivas las reacciones 10 mm. Para probar la posible influencia de las variables predictoras sobre la presencia o no de infección, se realizó análisis bivariado y posteriormente multivariado. El riesgo individual se clasificó en Alto, Intermedio, Bajo y Mínimo. El Riesgo Colectivo se midió por departamentos; se clasificaron como Riesgo Alto, Intermedio, Bajo, Muy Bajo y Mínimo. Resultados: la prevalencia de Infección Tuberculosa Latente fue 28,8 por ciento, inferior en el Albarrán (26,6 por ciento) y superior en Allende (31,5 por ciento). La media de induración fue 10,4 mm excluyendo los no reactores. Se encontró posible asociación de la Infección Tuberculosa Latente con las categorías enfermero y trabajador de servicios, tener contacto con casos de tuberculosis y llevar 6 años o más trabajando en el centro. El 28,6 por ciento de los trabajadores se evaluó con riesgo alto; 33,6 por ciento de los departamentos se evaluaron con Riesgo Alto. Conclusiones: el riesgo de Infección por Mycobacterium tuberculosis para los trabajadores de los tres hospitales clínico quirúrgicos de La Habana fue evaluado entre intermedio y alto, con un tercio de sus áreas que constituyen un potencial de riesgo de tuberculosis para el personal que labora en ellas(AU)

Introduction: nosocomial tuberculosis transmission has been recognized worldwide as a problem for TB control. Objectives: to estimate the prevalence of Latent Tuberculosis Infection and to evaluate the risk of Tuberculosis Infection in Health Care Workers of three Surgical Clinical Hospitals at Havana City. Methods: across sectional study in a sample of 804 Health Care Workers out of 5737 staff of three hospitals at Havana City was carried out; a tuberculin skin test was applied along with an interview on personal data, labor location and exposition to M. tuberculosis. A 10 mm cut-off point was used. To prove the possible influence of predictor variables on the presence of infection, a bivariate analysis and a multivariate model were applied. The individual risk was classified as high, Intermediate, Low and Minimum. The Collective Risk was measured by departments and were classified as High, Intermediate, Low, Very Low and Minimum Risk. Results: the prevalence of Latent Tuberculosis Infection was 28.8 percent, lower in Albarrán (26.6 percent) and higher in Allende (31.5 percent). Induration mean: 10.4 mm excluding non-reactors. A possible association of Latent Tuberculosis Infection with the categories: nurses and services workers, having contact with tuberculosis cases, and ≥ 6 years working in the hospital was found. 28.6 percent of workers were evaluated as high risk; 33.6 percent of the departments were evaluated as High Risk, 31 percent Intermediate and none as Minimum risk. Conclusions: the risk of Micobacterium tuberculosis Infection for Health Care Workers of 3 hospitals at Havana city was evaluated among intermediate and high, with a third of their areas constituting a potential tuberculosis risk for the personnel working in them(AU)

Riesgo de Tuberculosis en trabajadores de tres hospitales clÍnico quirúrgicos de La Habana / Tuberculosis risk in the staff of three clinical surgical hospitals at Havana city

Introducción: la transmisión nosocomial de la tuberculosis ha sido reconocida como un problema para el control de la tuberculosis a nivel mundial. Objetivos: estimar la prevalencia de Infección Tuberculosa Latente y evaluar el riesgo de infección tuberculosa en trabajadores de tres Hospitales Clínico Quirúrgicos de La Habana, Cuba. Métodos: estudio de corte transversal en muestra de 804 trabajadores de una plantilla total de 5 737 en tres hospitales Clínico Quirúrgicos de La Habana; se les aplicó prueba de tuberculina y encuesta con datos personales, de ubicación laboral y exposición a Mycobacterium tuberculosis. Se consideraron positivas las reacciones 10 mm. Para probar la posible influencia de las variables predictoras sobre la presencia o no de infección, se realizó análisis bivariado y posteriormente multivariado. El riesgo individual se clasificó en Alto, Intermedio, Bajo y Mínimo. El Riesgo Colectivo se midió por departamentos; se clasificaron como Riesgo Alto, Intermedio, Bajo, Muy Bajo y Mínimo. Resultados: la prevalencia de Infección Tuberculosa Latente fue 28,8 por ciento, inferior en el Albarrán (26,6 por ciento) y superior en Allende (31,5 por ciento). La media de induración fue 10,4 mm excluyendo los no reactores. Se encontró posible asociación de la Infección Tuberculosa Latente con las categorías enfermero y trabajador de servicios, tener contacto con casos de tuberculosis y llevar 6 años o más trabajando en el centro. El 28,6 por ciento de los trabajadores se evaluó con riesgo alto; 33,6 por ciento de los departamentos se evaluaron con Riesgo Alto. Conclusiones: el riesgo de Infección por Mycobacterium tuberculosis para los trabajadores de los tres hospitales clínico quirúrgicos de La Habana fue evaluado entre intermedio y alto, con un tercio de sus áreas que constituyen un potencial de riesgo de tuberculosis para el personal que labora en ellas(AU)

Introduction: Nosocomial tuberculosis transmission has been recognized worldwide as a problem for TB control.Objectives: To estimate the prevalence of Latent Tuberculosis Infection and to evaluate the risk of Tuberculosis Infection in Health Care Workers of three Surgical Clinical Hospitals at Havana City. Methods: A cross sectional study in a sample of 804 Health Care Workers out of 5737 staff of three hospitals at Havana City was carried out; a tuberculin skin test was applied along with an interview on personal data, labor location and exposition to M. tuberculosis. A 10 mm cut-off point was used. To prove the possible influence of predictor variables on the presence of infection, a bivariate analysis and a multivariate model were applied. The individual risk was classified as high, Intermediate, Low and Minimum. The Collective Risk was measured by departments and were classified as High, Intermediate, Low, Very Low and Minimum Risk. Results: The prevalence of Latent Tuberculosis Infection was 28.8 percent, lower in Albarrán (26.6 percent) and higher in Allende (31.5 percent). Induration mean: 10.4 mm excluding non-reactors. A possible association of Latent Tuberculosis Infection with the categories: nurses and services workers, having contact with tuberculosis cases, and ≥ 6 years working in the hospital was found. 28.6 percent of workers were evaluated as high risk; 33.6 percent of the departments were evaluated as High Risk, 31 percent Intermediate and none as Minimum risk. Conclusions: The risk of Micobacterium tuberculosis Infection for Health Care Workers of 3 hospitals at Havana city was evaluated among intermediate and high, with a third of their areas constituting a potential tuberculosis risk for the personnel working in them(AU)

[Thoracic drainage]. / Drenaje torácico.

Pleural pathology is a frequent clinical problem. In some cases, treatment includes draining the cavity which can be carried out by thoracentesis evacuators, but on occasions treatment requires maintaining a drainage permanently inside the pleural cavity Pleural drainage consists in inserting a catheter in the pleural sack to drain the presence of air; liquid or blood which causes a variable degree of lung collapse having a clinical consequence in function of the reserve breathing capacity the patient previously had and the degree of collapse. There are various models of thoracic tubes as well as systems to drain the pleural cavity and their spot for insertion depends on the type of pathology being dealt with for the patient under treatment. Nursing is fundamental in this entire process, including in the preparation of the patient for this treatment, the insertion of the catheter and the adequate maintenance so that this procedure succeeds as well as during the removal of the catheter and the subsequent care required. It is fundamental that the nursing professionals know the materials used as well as their maintenance. A good technique to cure the punt/orifice where a catheter is inserted will prevent numerous complications which could be deadly for the patient. The authors create a procedural protocol for nurses to use when treating patients who have thoracic drains; this protocol deals with changing the catheters as well as the entire process related to how to treat patients with a pleural drain. This protocol should serve as reference material and as a guide to a systematic and homogenous working procedure.

Prevalencia de reactores tuberculínicos en trabajadores del Instituto de Medicina Tropical “Pedro Kourí”, 1996-2000 / Prevalence of tuberculin reactors among the workers of “Pedro Kourí” Tropical Medicine Institute, 1996-2000

Se realizó prueba tuberculínica según técnica estándar de la Organización Mundial de la Salud a los trabajadores del Instituto de Medicina Tropical “Pedro Kourí” en 2 ocasiones, distribuidos según las áreas de trabajo, para determinar la prevalencia de reactores y estimar la proporción de conversión a la tuberculina. En el primer corte se encuestaron 472 trabajadores durante 1996-1997 y en el segundo corte se encuestaron 217 trabajadores en octubre de 2000. El número de no reactores disminuyó de 58,4 por ciento en la primera encuesta a 24,6 por ciento en la segunda, mientras que la cantidad de positivos (diámetro ³ 10 mm) aumentó de 33,5 a 55,2 por ciento de la primera a la segunda encuesta. También se incrementó la media de las induraciones de 5,2 a 9,6 mm. Un total de 42 trabajadores (14,6 por ciento) sufrieron viraje tuberculínico en este período. En las áreas expuestas a mayor riesgo fue donde mayor cantidad de virajes tuberculínicos se produjeron. La prevalencia de infección tuberculosa aumentó de una encuesta a la otra en la mayoría de las subdirecciones(AU)

Prevalencia de reactores tuberculínicos en trabajadores del Instituto de Medicina Tropical “Pedro Kourí”, 1996-2000 / Prevalence of tuberculin reactors among the workers of “Pedro Kourí” Tropical Medicine Institute, 1996-2000

Se realizó prueba tuberculínica según técnica estándar de la Organización Mundial de la Salud a los trabajadores del Instituto de Medicina Tropical “Pedro Kourí” en 2 ocasiones, distribuidos según las áreas de trabajo, para determinar la prevalencia de reactores y estimar la proporción de conversión a la tuberculina. En el primer corte se encuestaron 472 trabajadores durante 1996-1997 y en el segundo corte se encuestaron 217 trabajadores en octubre de 2000. El número de no reactores disminuyó de 58,4 % en la primera encuesta a 24,6 % en la segunda, mientras que la cantidad de positivos (diámetro ³ 10 mm) aumentó de 33,5 a 55,2 % de la primera a la segunda encuesta. También se incrementó la media de las induraciones de 5,2 a 9,6 mm. Un total de 42 trabajadores (14,6 %) sufrieron viraje tuberculínico en este período. En las áreas expuestas a mayor riesgo fue donde mayor cantidad de virajes tuberculínicos se produjeron. La prevalencia de infección tuberculosa aumentó de una encuesta a la otra en la mayoría de las subdirecciones.

Tuberculin tests according to WHO standard technique were twice performed on the workers of “Pedro Kourí” Institute, distributed according to workstations, with the objective of determining the prevalence of reactors and estimating the proportion of tuberculin converters. In the first test, 472 workers were surveyed during 1996-1997 and in the second one 217 workers in October 2000. The number of non reactors decreased from 58.4% in the first survey to 24.6% in the second one whereas the quantity of positive cases (diameter ≥10 mm) increased from 33.5% to 55.2%. The Induration diameter mean also increased from 5.2 mm to 9.6 mm. A total of 42 workers (14.6%) suffered tuberculin conversion in that period. The highest amount of tuberculin conversions was found in areas exposed to higher risks. The prevalence of tuberculosis infection increased from the first to the second survey in most of the areas.

Comportamientos sobre sexualidad en adolescentes de un Policlínico cubano / Behaviors about sexuality in adolescents of a cuban Policlinic

La adolescencia constituye un período de transición difícil y crítico, donde se desarrollan emociones concomitantes con la maduración sexual genital que propician la iniciación de las relaciones sexuales, fundamentalmente coitales, favoreciendo que las Infecciones de Transmisión Sexual (ITS) tiendan a manifestarse de una manera progresiva. OBJETIVO: Identificar comportamientos sobre sexualidad y precisar aquellos aspectos que puedan favorecer las ITS y las secuelas que éstas puedan dejar en los adolescentes. MÉTODO: Se realizó un estudio descriptivo de corte transversal para identificar comportamientos sobre sexualidad en 78 adolescentes pertenecientes al Policlínico “1ro de Enero” del Municipio Playa en Ciudad de La Habana, de Abril hasta Junio del 2002. La información se obtuvo aplicando una encuesta validada en estudios anteriores. RESULTADOS: Predominaron los adolescentes del sexo masculino, de 7mo grado y del grupo etáreo de 11-12 años; la mayoría de los adolescentes estudiados mantienen comportamientos riesgosos con respecto a la sexualidad tales como: precocidad en la iniciación de las relaciones sexuales, práctica de relaciones sexuales con personas desconocidas en muchas ocasiones e inadecuada utilización de los métodos anticonceptivos, fundamentalmente del condón. CONCLUSIONES: Se evidencia la necesidad de intensificar las acciones educativas en este grupo de edad para incorporarles las pautas de una sexualidad sana, basada en el amor, el cariño y respeto mutuo hacia la pareja y desviarlos de la promiscuidad y la superficialidad en las relaciones sexuales. Palabras clave: Adolescencia, Sexualidad, Infecciones de Transmisión Sexual, Promiscuidad, Anticonceptivos