Antibiotic prescribing patterns in the placement of dental implants in Europe: A systematic review of survey-based studies.

BACKGROUND: The present systematic review aims to investigate the guidelines for prescribing Preventive Antibiotic Therapy (PAT) in the placement of dental implants (DIs) without anatomical constraints in healthy patients by clinicians in Europe and to compare them with current recommendations. MATERIAL AND METHODS: A search was performed in 4 databases: Medline (via PubMed), Web of Science, Scopus, and LILACS. The criteria employed were those described in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) declaration (PROSPERO Registration number: CRD42022382278). RESULTS: The electronic search identified 10 studies published between 2010 and 2023 that met the established criteria. Overall, 60.8% ± 24.1% of European professionals routinely prescribe PAT, with the most frequent regimen being perioperative (mean= 46.7% ± 24.3%), followed by postoperative PAT only (mean= 20.3% ± 9.7%). CONCLUSIONS: The most commonly prescribed antibiotic both pre- and postoperatively is amoxicillin and, in allergic patients, clindamycin. In Europe, more doses of PAT are being prescribed than suggested by current recommendations. For this reason, more PAT education is needed in educational curricula to promote a more rational use of antibiotics to reduce the occurrence of antimicrobial resistance.

Prevalence of aphthous stomatitis in patients with inflammatory bowel disease after the treatment with monoclonal antibodies: a systematic review and meta-analysis.

BACKGROUND: Currently, the most frequently employed therapies in the treatment of inflammatory bowel diseases (IBD), i.e., Crohn's Disease (CD), Ulcerative Colitis (UC) or unclassified IBD (IBD-U) are monoclonal anti-TNFs and anti-integrin therapies, such as vedolizumab (VDZ). Forty-seven per cent of these patients present extra-intestinal manifestations, the second most prevalent being aphthous stomatitis (AS). The present study aims to investigate which of the two therapies is associated with a lower prevalence of AS after treatment. MATERIAL AND METHODS: An electronic search of the MEDLINE (via PubMed), Web of Science, SCOPUS, LILACS and OpenGrey databases was carried out. The criteria used were those described by the PRISMA Statement. The search was not temporarily restricted and was updated to January 2022. The quality assessment was analyzed using the JBI Prevalence Critical Appraisal Tool. RESULTS: After searching, 7 studies were included that met the established criteria. Of these, 6 analysed the prevalence of AS in CD patients and 4 in UC. A total of 1,744 patients were analysed (CD=1,477 patients; 84.69%; UC=267; 15.31%). The greatest reduction in AS prevalence was observed after anti-TNF therapy. The effect of these therapies on the prevalence of AS in patients with IBD-U could not be determined. CONCLUSIONS: Both biologic therapies achieve a reduction in the prevalence of AS in IBD patients (CD and UC). However, the best results were obtained in patients treated with anti-TNFs, possibly because VDZ is often used in patients who do not respond adequately to previous treatment with anti-TNFs and because of its intestinal specificity.

Un caso pediátrico infrecuente de hiperplasia nodular focal estudiado con 99mTc-mebrofenin / A unusual pediatric case of focal nodular hyperplasia studied with 99mTc-mebrofenin

No disponible

Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de ácidos biliares / 75SeHCAT scan in bile acid malabsorption in chronic diarrhoea

La diarrea crónica es una entidad común en la práctica clínica diaria y supone un deterioro en la calidad de vida de los pacientes. Puede ser el síntoma principal de múltiples etiologías, entre las que se encuentra la malabsorción de ácidos biliares (MAB), que en la población general presenta una prevalencia comparable a la enfermedad celíaca. La MAB ocurre por una alteración en la homeostasis de los ácidos biliares en la circulación enterohepática. Puede aparecer como consecuencia de una disfunción o enfermedad ileal (MAB tipo II), por causas idiopáticas (MAB tipo II) o asociada con otras entidades gastrointestinales (MAB tipo III). Entre los diferentes métodos diagnósticos disponibles destacamos la gammagrafía con 75SeHCAT como gold standard debido a sus valores de sensibilidad, especificidad, seguridad y bajo coste. La principal desventaja es que no se encuentra disponible en todos los países, por lo que se han desarrollado otros métodos como la medición sérica de FGF19 y C4 que, sin embargo, presentan una mayor complejidad y coste. El tratamiento de primera línea ante un diagnóstico de MAB es con quelantes de ácidos biliares como la colestiramina, pero presenta baja tolerabilidad y efectos secundarios, que son menores con los nuevos fármacos como el colesevelam. En resumen, la MAB es una entidad común que se encuentra infradiagnosticada e infratratada, por lo que es fundamental establecer un adecuado algoritmo diagnóstico de la diarrea crónica en el que el estudio con 75SeHCAT ocuparía la primera o segunda línea en el diagnóstico diferencial de estos pacientes (AU)

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type I), it can be considered idiopathic or primary (BAM type II) or associated with other gastrointestinal entities (BAM type III). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients (AU)

Evaluation of a new impedancemeter to independently measure extracellular, intracellular and total body water volumes: application to the measurement of hydration.

The objective of this study was to evaluate the accuracy of independent hydric data for the quantification of total body water (V t), extracellular water (V e) and intracellular water (V i), obtained by a multifrequency impedancemeter Z-Métrix(®) (ZM), in standing and lying position, with respect to the Xitron reference. In a second step, the aim was to consider whether it is possible to quantify daily hydration. The average repeatability error of the ZM impedancemeter is less than 0.5 %. For total body water (V t), we note a low R (2) dispersion with an average of 0.9 for men and 0.6 for women. The estimation of extracellular water is equivalent to a maximum error of 3.1 % in standing position for women against 2.97 % for men in the same position. The estimation of the total body water by direct measurement and by summing the volumes of extracellular and intracellular water obtained by the Z-Metrix(®) shows very low dispersions with R (2) = 0.89 and average error from 1.3 % for healthy women in lying position to 3.9 % for healthy women in standing position. Finally, despite the impact of events on the daily measurements, it is viable to track a subject's overall hydration.

Importancia y requisitos de la fotografía clínica en odontología

En el siglo XVII fue fabricada la primera cámara fotográfica y a partir de entonces, la fotografía experimentó una evolución gracias al trabajo de científicos e investigadores. Actualmente existen en el mercado cámaras digitales que igualan o superan a las cámaras profesionales convencionales, son fáciles de manejar y de gran utilidad en odontología. El odontólogo general puede aprovechar las ventajas de esta nueva tecnología para: captar, visualizar, analizar, recortar, duplicar y archivar imágenes con gran facilidad; lo que enriquece el diagnóstico y el seguimiento de los casos clínicos. Además, las fotografías mejoran la comunicación con los pacientes y los laboratorios; permiten ser instrumentos legales; facilitan el mercadeo y la promoción de nuevos tratamientos dentales.Este artículo expone las ventajas y aplicaciones de la fotografía clínica digital, también clasifica en forma sencilla los tipos de fotografías clínicas odontológicas y describe cuáles deben ser los criterios para que las fotografías clínicas adquieran validez documental. Tomando en cuenta las ventajas expuestas, sería muy acertado incluir este aprendizaje como parte de la formación integral del odontólogo general y que no sea sólo conocimiento de especialistas, ya que, debe ser parte del trabajo diario en el ambiente clínico. (AU)

Screening de síndrome metabólico y nuevos factores de riesgo cardiovascular en una muestra de pacientes obesos sanos / Screening of metabolic syndrome and new cardiovascular risk factors in a sample of healthy obese patients

OBJETIVOS. Estudiar la proporción de pacientes con índice de cintura (IC) elevado que tienen síndrome metabólico (SM) previamente no diagnosticado. Analizar la asociación entre IC elevado con otras variables no definitorias de SM. Medición de resistencia a insulina (RI) y riesgo cardiovascular (RCV). DISEÑO, EMPLAZAMIENTO Y PARTICIPANTES. Estudio observacional descriptivo de una serie de casos, prospectivo. Se seleccionaron aleatoriamente pacientes con IC mayor de 102 cm en varones y de 88 cm en mujeres, no diagnosticados previamente de SM y que no recibían tratamiento médico. Se les midió: peso, talla, IC, índice de masa corporal (IMC), consumo de tabaco, tensión arterial (TA), glucemia basal (GB), triglicéridos (TG), colesterol ligado a lipoproteínas de alta densidad (c-HDL), uricemia, proteína C reactiva (PCR), insulinemia, homocisteína, apolipoproteína B (APO B). Posteriormente de determinó la RI mediante escala HOMA y el RCV con tablas de riesgo coronario adaptadas a población española. Finalmente se emplearon criterios ATP III para evaluar el diagnóstico de SM. RESULTADOS. Se recogieron datos de 98 pacientes. Un 45,9% reunían al menos 3 criterios para el diagnóstico de SM. El RCV fue: alto 4,1%, moderado 14,3%, ligero 40,8%, y bajo 40,8%. Se hallaron diferencias significativas (p < 0,05) en los siguientes parámetros estudiados con respecto al SM: sexo, tabaco, TA, IMC, TG, c-HDL, insulinemia y RCV. CONCLUSIONES. Predominaron todos los factores de riesgo cardiovascular (FRCV) excepto PCR e insulinemia. Se detectó un RCV moderado/alto en gran parte de la población estudiada

OBJECTIVES. Study the proportion of patients with elevated waist index (WI) who have previously undiagnosed metabolic syndrome (MS). Analyze the association between elevated WI with other none-defining variables of MS. Measurement of insulin resistance (IR) and cardiovascular risk (CR). DESIGN, SITE AND PARTICIPANTS. Observational, descriptive study of a series of prospective cases. Patients with WI greater than 102 cm in men and 88 cm in women, not previously diagnosed of MS and who had not received medical treatment were randomly selected. The following were measured: weight, height, WI, body mass index (BMI), tobacco consumption, blood pressure (BP), basal glycemia (BG), triglycerides (TG), high density lipoprotein (c-HDL), uricemia, C-reactive protein (CRP), insulinemia, homocysteine, apolypoprotein B (APO B). After, IR was determined using the HOMA scale and CVR with coronary risk tables adapted to the Spanish population. Finally, ATP III criteria were used to evaluate the diagnosis of MS. RESULTS. Data of 98 patients were collected. A total of 45.9% had at least 3 criteria for the diagnosis of MS. CVR was high in 4.1%, moderate in 14.3%, mild in 40.8% and low in 40.8%. Significant differences were found (p < 0.05) in the following parameters studied in regards to MS: gender, tobacco, BP, BMI, TG, c-HDL, insulinemia and CVR. CONCLUSIONS. All the cardiovascular risk factors (CVRF) predominate except CRP and insulinemia. Moderate/high CVR was detected in a large part of the population studied

Monitorización de las concentraciones plasmáticas de vancomicina en pacientes en hemodiálisis / Monitorins of vancomycin plasma levels in patients undergoing hemodialysis

Objetivo: El objetivo del estudio es confirmar que los pacientesen hemodiálisis y en tratamiento con vancomicina, recibiendodosis de 1 g semanal o 500 mg/48 horas, alcanzan niveles plasmáticosóptimos (10-25 mcg/ml).Método: Se incluyeron 32 pacientes sobre un total de 34 episodiosde infección. La dosis más utilizada fue la de 1 g/semana(67,6% de los episodios de infección), frente a la de 500 mg/48horas (32,4%). Las membranas más frecuentemente empleadasfueron las de baja ultrafiltración (64,7%) frente a las de alta ultrafiltración(35,3%).La administración de vancomicina se realizó en infusión de unahora, durante la última hora de la sesión de hemodiálisis y lasmuestras plasmáticas se extrajeron antes del inicio de la sesión.Las muestras fueron analizadas por inmunoanálisis de polarizaciónde fluorescencia.Resultados: Los resultados de concentración promedio parala población total no alcanzaron en ningún momento los valoresóptimos (10-25 mg/ml). En el grupo que recibió 500 mg/48horas los valores promedio óptimos no se alcanzaron en ningunade las determinaciones y en el grupo de 1 g/semanal sólo sealcanzaron dichos valores en la cuarta determinación. Los nivelesplasmáticos promedio del antibiótico están por debajo de los valoresóptimos independientemente del tipo de membrana, baja oalta ultrafiltración, empleada.Conclusiones: A la vista de los resultados recomendamosmodificar las dosis de vancomicina en este grupo de pacientes yadministrar dosis de carga 20 mg/kg durante la última hora de lasesión de hemodiálisis y posteriormente dosis de mantenimientode 7 mg/kg después de cada sesión, así como monitorizar losniveles del fármaco en este grupo de pacientes

Objective: The aim of this study was to confirm whetherpatients undergoing dialysis and treated with vancomycin 1g/week or 500 mg/48 hours reach optimum plasma levels (10-25 mcg/ml).Method: Thirty two patients were included with a total numberof 34 infectious events. The most commonly used dose was 1g/week (67.6% of infectious events), versus 500 mg/48 hours(32.4%). Low ultrafiltration membranes were used more frequently(64.7%) than high ultrafiltration membranes (35.3%).Vancomycin was infused over an one-hour period during thelast hour of the hemodialysis session and plasma samples weredrawn prior to the beginning of the session. Samples were analyzedusing fluorescent polarization immunoassays.Results: Mean concentration results for the total populationdid not reach optimum values (10-25 mg/ml). In the group receiving500 mg/48 hours, optimum mean values were not reachedin any of the determinations, whereas in the group receiving 1g/week, optimum values were reached in the fourth determination.Mean plasma levels of the antibiotic were bellow optimumvalues, regardless the type of membrane used, either low or highultrafiltration.Conclusions: Based on the above results, we recommendtitration of the vancomycin dose in this group of patients and theadministration of a loading dose of 20 mg/kg during the last hourof the hemodialysis session, followed by a maintenance dose of 7mg/kg after each session, as well as the monitoring of the druglevels in this group of patients