Análisis forense de dientes, materiales de obturación y restauraciones protésicas en restos humanos expuestos a elevadas temperaturas. Revisión de la literatura / Forensic analysis of teeth, filling materials and prosthetic restorations in human remains exposed to high temperatures. Literature review

Resumen El proceso para establecer una identificación odontológica inequívoca se sustenta en la recuperación de la mayor cantidad posible de información post mortem, y su posterior cotejo con aquellos registros ante mortem de la víctima. Los dientes son tejidos del cuerpo humano con una elevada resistencia en su estructura, lo que les permite tolerar el embate de los efectos ambientales como el fuego, la desecación, la descomposición o la inmersión prolongada. En la mayoría de los desastres naturales, y también en los provocados por el hombre, los registros odontológicos pueden contribuir para identificar cuerpos que sería irreconocibles aplicando metodologías tradicionales. En cadáveres quemados o carbonizados, resulta imperativo conservar la evidencia odontológica recuperada, para evitar que su manipulación pueda desvirtuarla e incluso destruirla; por eso se suele fijar y estabilizar antes de ser transportada. Los recursos imagenológicos constituyen una sólida estrategia de perennización de evidencia, los cuales pueden ser complementados por fotografías y toma de impresiones. El presente artículo revisa varios estudios sobre restos dentales, materiales de obturación y aparatos protésicos quemados o carbonizados, haciendo énfasis sobre su importancia en el proceso de identificación humana.

Abstract The process to establish an unequivocal dental identification is based on the recovery of the greatest possible amount of post mortem information, and its subsequent comparison with the ante mortem records of the victim. Teeth are tissues of the human body with high resistance in their structure, which allows them to tolerate the onslaught of environmental effects such as fire, desiccation, decomposition, or prolonged immersion. In most natural disasters, an also in those caused by men, dental records can help identify a body that would be unrecognizable using traditional methodologies. In burned or charred corpses, it is imperative to preserve the recovered dental evidence, to avoid its manipulation from distorting and even destroying it; this is why it is usually fixed and stabilized before being transported. Imaging resources constitute a solid strategy for the perpetuation of evidence, which can also be complemented by photographs and impression taking. This article reviews several studies on dental remains, materials and burned or charred prosthetic devices, emphasizing their importance in the human identification process.

Manifestaciones cognitivas y neuropsiquiátricas de la COVID-19 en el Adulto Mayor con y sin demencia: Revisión de la literatura / Cognitive and Neuropsychiatric Manifestations of COVID-19 in elderly people with and without dementia: A literature review

RESUMEN Durante la pandemia del síndrome agudo respiratorio severo por COVID-19, la demencia se ha identificado como desproporcionadamente común en los adultos mayores de 65 años que desarrollaron un cuadro viral grave. El Consorcio Internacional de infecciones respiratorias agudas graves y emergentes confirma una alta prevalencia de hospitalizaciones en adultos mayores con demencia. Esta sub-población presenta, en su mayoría, una variedad de comorbilidades, en particular, la fragilidad que puede exacerbar aún más el riesgo de infección muy severa. Además, hasta un tercio de los pacientes con COVID-19 puede presentar secuelas cerebrales o neurológicas, efectos directos (infección viral de las neuronas, efectos vasculares) e indirectos (respuesta inmunológica del huésped, impacto del tratamiento). Esta revisión plantea la posibilidad de que la infección pueda acentuar cualquier enfermedad neurodegenerativa preexistente. Por otro lado, varios estudios han descrito que una proporcion de pacientes presenta despues del alta deterioro cognitivo, ánimo deprimido, ansiedad, insomnio y manifestaciones de trastorno por estrés postraumático. Enfermedades crónicas como la demencia están pues asociadas con tasas más altas de hospitalización y mortalidad, y exacerban aún más la vulnerabilidad de los adultos mayores y el colapso en sus cuidadores.

SUMMARY During the severe acute respiratory syndrome due to the COVID-19 pandemic, dementia has been identified as disproportionately common in adults older than 65 years who develop a serious viral infection.vere coronavirus disease in 2019. Data from the International Consortium on Severe and Emerging Acute Respiratory Infections confirmed a high prevalence of dementia in older hospitalized adults. Dementia is likely to be associated with a variety of comorbidities, in particular, frailty, which can further exacerbate the risk of serious infection. In addition, up to a third of patients with COVID-19 have demonstrated cerebral/neurological sequelae with direct (brain infection, vascular effects) and indirect (host immune response, treatment impact) effects. It is possible that the infection may accentuate any pre-existing neurodegenerative disease. Several studies have described cognitive decline, depressed mood, anxiety, insomnia, and post-traumatic stress disorder in a proportion of patients after discharge. Therefore, chronic illnesses, such as dementia, can be associated with higher hospitalization and mortality rates, and may exacerbate the vulnerability of older adults and the breakdown of their caregivers.

Facial emotion recognition and its association with symptom severity, functionality, and cognitive impairment in schizophrenia: preliminary results / Reconocimiento facial de emociones y su asociación con la gravedad sintomática, funcionalidad y deterioro cognitivo en esquizofrenia: hallazgos preliminares

Abstract Introduction There is evidence to suggest that individuals with schizophrenia have greater difficulty in recognizing facial emotions, which has been related to cognitive impairment and higher symptom severity in this disease and seems to lead to a worse functional prognosis. Objective To determine the association between facial emotion recognition and symptom severity, functionality, and cognitive impairment in a sample of schizophrenic patients. Method This is an observational, cross-sectional, and correlational study conducted on 72 patients. The following scales: PANSS, MOCA, ERI, and FACT-Sz were used to assess symptom severity in schizophrenia, cognitive functioning, facial emotion recognition, and functionality, respectively. The Pearson Correlation Coefficient was used to measure the linear association between all variables. Results Overall, moderate symptom severity and mild cognitive and functional disability were found. The most frequently recognized emotion was joy (70%) and the least frequently recognized one was anger. A positive association was also found between anger recognition and severity of the PANSS cognitive subscale (r = - .24, p = .03), sadness recognition and severity of the PANSS negative subscale (r = - .24, p = .03), and the FACT-Sz score and fear recognition (r = .31, p = .008). Discussion and conclusion The present study yields preliminary results that provide a broader perspective on facial emotion recognition and, indirectly, social interaction and functionality in people with schizophrenia.

Resumen Introducción Existe evidencia de que los pacientes con esquizofrenia tienen mayor dificultad para reconocer las emociones faciales, lo cual se ha relacionado con el deterioro cognitivo que se manifiesta en esta enfermedad y con una mayor gravedad sintomática, que parece dar lugar a un peor pronóstico funcional. Objetivo Determinar la asociación del reconocimiento facial de emociones con la gravedad sintomática, funcionalidad y deterioro cognitivo en un grupo de pacientes con esquizofrenia. Método Un estudio observacional, transversal y correlacional realizado con 72 pacientes. Se utilizaron las escalas: PANSS, MOCA, ERI y FACT-Sz para evaluar la gravedad sintomática, el funcionamiento cognitivo, el reconocimiento facial de emociones y la funcionalidad, respectivamente. Se utilizó el Coeficiente de Correlación de Pearson para medir la asociación lineal entre dichas variables. Resultados Se encontró de forma global una gravedad sintomática moderada y una discapacidad cognitiva y funcional leve. La alegría fue la emoción más reconocida (70%) y la ira la menos reconocida. Se encontró una asociación positiva entre el reconocimiento de la ira y la gravedad de la subescala cognitiva de la PANSS (r = -.24, p = .03), el reconocimiento de la tristeza y la gravedad de la subescala negativa de la PANSS (r = -.24, p = .03), y la puntuación de la FACT-Sz y el reconocimiento del miedo (r = .31, p = .008). Discusión y conclusión El presente estudio muestra algunos resultados preliminares que nos permiten tener una perspectiva más amplia de lo que ocurre con el reconocimiento facial de emociones en la esquizofrenia y, de forma indirecta, en la interacción social y la disfunción que presentan quienes lo padecen.

Safety of Dual Antiplatelet Therapy After Carotid Endarterectomy for Prevention of Restenosis: A Single Center Experience.

INTRODUCTION: The incidence of recurrent carotid stenosis after carotid endarterectomy varies from 1% to 37% with only 0-8% symptomatic restenosis. Safety of short-term (30 days) dual-antiplatelet therapy has not been established in this type of procedure. AIMS: To investigate the safety of dual antiplatelet therapy after carotid endarterectomy to prevent restenosis. METHODS: We retrospectively identified all the patients who underwent carotid endarterectomy (symptomatic or asymptomatic) treated at our center between July 2010 and July 2013 according to local protocols. All patients received a dose of 100 mg of aspirin daily immediately after carotid endarterectomy, with subsequent 100 mg of aspirin daily for the rest of the study period, and some patients received 75 mg of Clopidogrel for 30 days starting immediately after surgical procedure (dual therapy group), assigned according to medical criteria. Duplex carotid ultrasound and clinical assessments were performed at 30 days and 1 year after the procedure. RESULTS: A total of 44 patients (71.2 ± 7.9 years old; 77.2% symptomatic) were analyzed; 35 of them with dual therapy (79.54%). At 30 days, two patients from the mono-therapy group developed restenosis (22.2%), compared to none in dual therapy group (p=0.04). At one year follow-up, only one patient from the dual group showed restenosis (p=0.10). No deaths, major bleeding or new strokes were reported in both groups. CONCLUSIONS: Short-term dual antiplatelet therapy with aspirin and clopidogrel after carotid endarterectomy might be associated with a lower incidence of restenosis. This observation must be validated in a prospective trial.

The general prognosis of patients with peripheral arterial disease differs according to the disease localization.

OBJECTIVES: The purpose of this study was to assess the general prognosis of patients with peripheral arterial disease (PAD) according to the disease localization. BACKGROUND: PAD is associated with poor cardiovascular disease prognosis. However, it is unknown whether the general prognosis could differ according to PAD topography. METHODS: Data for all patients who underwent a first digital subtraction angiography of their lower limbs between January 2000 and December 2005 at our hospital were reviewed. Arterial stenoses > or = 50% were located by 2 experienced vascular physicians. The following events were collected until April 2007: death, nonfatal myocardial infarction or stroke, and coronary or carotid revascularization. The primary outcome combined all these events. RESULTS: We studied 400 PAD patients (age 68.3 + or - 12.3 years, 77.5% men). Aortoiliac disease (proximal PAD) and infrailiac disease (distal PAD) were noted in 211 (52.8%) and 344 (86.0%) cases, respectively. Male sex and smoking were more prevalent in proximal PAD, whereas older age, diabetes, hypertension, and renal failure were more prevalent in distal PAD (p < 0.05). During the follow-up period (34 + or - 23 months), the event-free survival curves differed according to the PAD localization (p < 0.03). Adjusted for age, sex, cardiovascular disease history and cardiovascular disease risk factors, critical leg ischemia status, and treatments, proximal PAD was significantly associated with a worse prognosis (primary outcome hazard ratio: 3.28; death hazard ratio: 3.18, p < 0.002 vs. distal PAD). CONCLUSIONS: This is the first study to report a poorer general prognosis of patients with proximal (aortoiliac) PAD compared with those with more distal PAD, independent of risk factors and comorbidities.

[Obliterating arterial disease of the legs in women]. / Artériopathie oblitérante des membres inférieurs chez la femme.

The widespread use of the ankle-brachial index (ABI) enabled to reveal the high prevalence of lower extremities peripheral arterial disease (PAD) in women, even higher than in men in several series. Nonetheless, the use of a same ABI threshold for men and women may overestimate the prevalence of subclinical PAD in women. Conversely, the clinical manifestations of PAD are more often atypical in women, with as a result, a delayed diagnosis and management. The level of association between cardiovascular disease risk factors and PAD is similar in both genders. To date, there is no evidence for any association between PAD and different hormonal events in women. Despite an inverse association between hormonal replacement therapy (HRT) after menopause and PAD in epidemiological studies, the trials failed to evidence any protective effect of HRT to prevent PAD. Women with PAD are advised to discontinue HRT in case of limb revascularization. The long-term local and functional prognosis of PAD seems more severe in women, but this is partly explained by a delayed onset of the disease, occurring at a later age. Similarly, the general cardiovascular prognosis PAD is also poorer in women than in men.