Three-dimensional evaluation of postoperative stability: a comparative study between surgery-first and surgery-late protocols.

The main objective of this study was to compare the stability of the surgery-first and surgery-late approaches according to the standardized centre protocols, by three-dimensional evaluation after 1 year of follow-up. A retrospective study was designed that included a test group (surgery-first protocol) and a control group (surgery-late protocol), with a follow-up period of at least 1 year (average 14 months; range 12-24 months). Stability was evaluated using linear and angular measurements by superimposing cone beam computed tomography images obtained at specific points in time: preoperatively, 1 month after surgery, and at the end of the orthodontic treatment. A total of 56 patients with a mean age of 32.2 ± 11.1 years were included in the study. After surgery there were significant changes in all of the measurements in at least one dimension in both groups (except for the transverse maxillary dimension), which remained stable at the end of the treatment, with no statistically significant differences between the two groups. At the 1-year follow-up, both groups presented a SNA angle relapse; this relapse was more significant in the surgery-late group (P = 0.031) and was present only in Class III patients (P = 0.013). In conclusion, an equivalent three-dimensional stability between surgery-first and surgery-late protocols was demonstrated after 1 year of follow-up when eligibility criteria were strictly adhered to.

Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort.

We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90-1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65-85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88-6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

Forensic efficiency parameters of the Investigator Argus X-12 kit in women from two Mestizo and seven Amerindian populations from Mexico.

Allele frequency distribution and statistical parameters of forensic efficiency concerning the Investigator Argus X-12 kit (Qiagen, Hilden, Germany) were determined in a total sample of 641 unrelated Mexican females, including two Mestizo-admixed- populations (n=309) and seven Amerindian groups (n=332) from the main regions of the country. Most of the 12 X-STRs were in agreement with Hardy-Weinberg expectations in all nine Mexican populations. The power of discrimination in females (PD) and Median exclusion chance for trios (MECT) and duos (MECD) of this genetic system based on X-STRs were >99.99%. Although Mexican populations showed significant pairwise differentiation, a closer relationship was evident between Amerindian groups and nearby Mestizos, in agreement with historical records, previous genetic studies, and X-linked inheritance pattern expectations.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013).

UNLABELLED: Hip fracture is a serious public health problem. We used Spanish hospital discharge data to examine trends in 2004-2013 in the incidence of hip fracture among elderly patients. We found that hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. INTRODUCTION: This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without type 2 diabetes mellitus (T2DM) in Spain, 2004-2013. METHODS: We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by diabetes status: Incidences were calculated overall and stratified by diabetes status and year. We analyzed surgical procedures, length of hospital stay (LOHS), and in-hospital mortality (IHM). Multivariate analysis was adjusted by age, year, comorbidity, and in-hospital complications (IHC). RESULTS: From 2004 to 2013, 432,760 discharges with hip fracture were identified (21.3 % suffered T2DM). Incidence among diabetic men and women increased until year 2010 and then remained stable. Diabetic women have three times higher incidence than diabetic men. Incidences and IHC were higher among patients with diabetes beside sex. The proportion of patients that underwent internal fixation increased for all groups of patients and the arthroplasty repair decreased. After multivariate analysis, IHM has improved over the study period for all patients. Suffering diabetes was associated to higher IHM in women (odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.07-1.17). CONCLUSIONS: Hip fracture incidence is higher in subjects with than without diabetes and is much higher among women than men. In diabetic patients, incidence rates increased initially but have leveled from 2010 onwards. For all groups, the use of internal fixation has increased overtime and IHM and LOHS have decreased from 2004 to 2013.

Social disparities in access to breast and cervical cancer screening by women living in Spain.

OBJECTIVES: To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN: Cross-sectional study using data from the 2011 Spanish national health survey. METHODS: Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS: Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION: Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.

Predictors of medication use in the Roma population in Spain: a population-based national study.

OBJECTIVES: To describe the prevalence of prescribed and self-medicated use of medication in the Spanish Roma population, and identify the associated factors. STUDY DESIGN: Descriptive cross-sectional study. METHODS: Data from the first National Health Survey conducted on the Roma population in Spain were used. The sample comprised 1000 Spanish Roma adults of both sexes aged ≥16 years. Answers (yes/no) to the question, 'In the last two weeks have you taken the following medicines [in reference to a list of medicines that might be used by the population] and were they prescribed for you by a doctor?' were used to ascertain 'medication use'. 'Self-medication' referred to use of these medicines without medical prescription. Using multivariate logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors. RESULTS: The overall prevalence of medication use in the Roma population for both sexes was 69.1%, and 38.7% was self-medicated. Females reported higher use of medication than males (75.1% vs 62.3%); however, self-medication was higher among males. Analgesics and antipyretics were used most often (35.8%). Among males, the variables that were independently and significantly associated with a higher probability of medication use were: age; negative perception of health; presence of chronic disease (OR 2.81; 95% CI 1.67-4.73); and medical visits (OR 4.51; 95% CI 2.54-8.01). The variables were the same among females, except for age. CONCLUSION: A high percentage of the Spanish Roma population use medication, and a significant proportion of them self-medicate. The presence of chronic diseases, a negative perception of health and medical consultations were associated with increased use of medication in the study population.

Health Belief Model applied to non-compliance with HPV vaccine among female university students.

OBJECTIVES: To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students. STUDY DESIGN: Cross-sectional. A self-administered questionnaire based on the HBM was used. METHODS: Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable. RESULTS: The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for 'general perceived barriers', 'perceived barriers to vaccination', 'no perceived general benefits', 'no perceived specific benefits' and 'no general benefits' were more likely to report being unvaccinated. CONCLUSIONS: The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination.

Effect of unilateral posterior crossbite and unilateral cleft lip and palate on vertical mandibular asymmetry.

OBJECTIVE: Evaluate condylar, ramal, and condylar plus ramal vertical mandibular asymmetry in patients with unilateral posterior crossbite (UPCB) and in patients with unilateral cleft lip and palate (UCLP) compared with subjects having normal occlusion. DESIGN: This cross-sectional study evaluated panoramic radiographs of three groups of subjects: UPCB, 20 patients; UCLP, 20 patients; and normal occlusion sample, 20 subjects. All subjects were picked at random from Rey Juan Carlos University, Madrid, and all films were traced and measured manually by the same author. RESULTS: Kruskal-Wallis test revealed no statistically significant differences (P < 0.05) in condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar plus ramal asymmetry index (C + RAI) among the three groups. The average CAI for group UPCB was 9.03 ± 7.65; 8.03 ± 6.89 for group UCLP; 6.93 ± 9.87 for normal group. Mean RAI for group UPCB was 2.53 ± 2.52; 2.61 ± 1.22 for group UCLP; 2.65 ± 1.90 for normal group. CONCLUSIONS: Condylar asymmetry was observed in all three groups (UPCB, UCLP and normal occlusion) because condylar asymmetry indexes were higher in each group at the 3 % threshold. No statistically significant differences were found among the three study groups for any of the asymmetry indexes.

Bioavailability of heavy metals in water and sediments from a typical Mediterranean Bay (Málaga Bay, Region of Andalucía, Southern Spain).

Concentrations of heavy metals were measured in sediment and water from Málaga Bay (South Spain). In the later twentieth century, cities such as Málaga, have suffered the impact of mass summer tourism. The ancient industrial activities, and the actual urbanization and coastal development, recreation and tourism, wastewaters treatment facilities, have been sources of marine pollution. In sediments, Ni was the most disturbing metal because Ni concentrations exceeded the effects range low (ERL), concentration at which toxicity could start to be observed in 85% of the samples analyzed. The metal bioavailability decreased in the order: Cd>Ni>Pb>Cu>Cr. In the sea water samples, Cd and Pb were the most disturbing metals because they exceeded the continuous criteria concentration (CCC) of US EPA in a 22.5% and 10.0% of the samples, respectively. Statistical analyses (ANOVA, PCA, CA) were performed.

Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey.

OBJECTIVES: Breast cancer remains a public health problem worldwide. Early detection through mammography practice has been shown to be effective in improving survival among women. Nevertheless, it is necessary to have high participation in mammography screening to achieve that goal. The aim of this study is to estimate the adherence to recommended preventive practices for breast cancer (mammography) in Spain and to identify predictors of uptake according to sociodemographic variables, health related variables and lifestyles. STUDY DESIGN: This is a descriptive cross-sectional study based on data from the European Health Interview Survey for Spain. Breast cancer screening included self-reported mammography in the last two years. The age target range was 40-69 years (n = 5771). The following independent variables were analysed: sociodemographic (marital status, educational level, monthly income, and nationality), visit to a general practitioner, chronic conditions and lifestyles. Predictors of mammography adherence were explored using multivariate logistic regression. RESULTS: The screening coverage in the target population was 67.7% (95% CI: 66.2-69.1). Mammography uptake was positively associated with being married, higher educational and income levels, Spanish nationality, having visited a general practitioner in the previous four weeks and suffering from musculoskeletal disease. Otherwise, the youngest age group studied (40-49 years) and obesity was associated with lower adherence to mammography. CONCLUSIONS: Compliance with mammography practice in Spain is acceptable to achieve the goal of reducing mortality from breast cancer among women. However significant inequalities in uptake of breast screening in Spain were found. Future campaigns must aim to improve participation especially among women with disadvantaged socio-economic situations and immigrants.

Adherence and factors associated with influenza vaccination among subjects with asthma in Spain.

PURPOSE: Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥ 16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010. METHODS: We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥ 16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13-7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services. RESULTS: Vaccination coverage was 35.2 % (95 % CI, 32.5-37.9) among asthmatics and 22.1 % (95 % CI, 21.4-22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69-2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods. CONCLUSIONS: Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.

Sebaceoma o sebomatricoma. A propósito de un caso / Sebaceoma o sebomatricoma. A case report

El Sebaceoma o Sebomatricoma es una neoplasia benigna rara con diferenciación sebácea. Se presentó paciente masculino, de 25 años de edad,que hace 20 días atrás mientras se peinaba le sangró una lesión en cuero cabelludo, hasta ese momento inadvertida. Acude a nuestro centro donde se constata pequeña lesión tumoral de color amarillento, en región parietal derecha. Desde el punto de vista clínico se hicieron los siguientes planteamientos diagnósticos: nevus intradérmico, nevus sebáceo de Jadassohn. Se realizó exéresis quirúrgica del tumor con estudio histopatológico. El diagnóstico histológico fue sebaceoma. Se revisó la entidad y se coincidió con el diagnóstico histopatológico, sin embargo los numerosos términos usados en la literatura médica internacional para describir esta afección engendran gran confusión en la práctica médica diaria por lo que consideramos necesario un consenso mundial entre dematopatólogos (AU)

The sebomatricoma or sebaceoma is a rare benign cutaneous neoplasm with sebaceous differentiation. A 25 years old, male patient who notice acutaneous mass in the scalp after bleeding on combing is reported. At the physical examination the patient showed a yello wish tumoral lesion.The first clinical diagnosis was intradermic nevus and sebaceous nevus of Jadassohn. A surgical exceresis was performed and the histological study defined a sebaceoma. The reason of this publication is to take into account this entity for the confusion that this term offer to the dermatologist and pathologist world (AU)

Condiloma acuminado: eficacia terapéutica comparativa entre el 5-fluorouracilo tópico y la criocirugía / No disponible

ANTECEDENTES. En el condiloma acuminado se han estado utilizando numerosas modalidades terapéuticas; sin embargo, existen pocos estudios que comparen la efectividad entre estas. PACIENTES Y MÉTODO. Se realizó un estudio prospectivo, abierto, para comparar la eficacia terapéutica entre el 5-fluorouracilo en crema al 5% y la criocirugía en el tratamiento tópico del condiloma acuminado. Se incluyeron al azar 40pacientes adultos con este diagnóstico: los primeros 20 pacientes que acudieron a la consulta del consultorio médico de familia 9 del policlínico Managua y los primeros 20 pacientes que acudieron al policlínico docente Joaquín Albarrán, en el período comprendido entre febrero y abril de2006. Se formaron por tanto dos grupos de 20 pacientes cada uno, aplicándose un esquema terapéutico diferente en cada caso, recibiendo los pacientes del policlínico Managua (grupo I) dos aplicaciones semanales de 5-fluorouracilo en crema al 5% y los pacientes del policlínico Joaquín Albarrán (grupo II) una aplicación quincenal de criocirugía. La duración de ambos tratamientos fue la misma (6 semanas en cada grupo).La eficacia terapéutica fue evaluada dos semanas después de culminar el tratamiento, comparando el estado inicial y final de las lesiones. A los pacientes con respuesta total al medicamento se les realizó un seguimiento trimestral durante un año para detectar posibles recidivas. RESULTADO. El análisis pareado inicio-final demostró una respuesta significativa al tratamiento en ambos grupos. Hubo diferencias estadísticamente significativas entre los grupos estudiados. Las tasas de recidivas fueron elevadas en ambos grupos. Los principales eventos adversos observados en ambos grupos fueron: ardor, dolor e inflamación; de intensidad leve y de desaparición espontánea. COMENTARIO. Se demostró que la criocirugía es más eficaz que el 5-fluorouracilo en crema al 5% en el tratamiento tópico del condiloma acuminado (AU)

BACKGROUND. Many different therapies have been used for condyloma acuminata, however, few studies comparing their effectivity have been made. PATIENTS AND METHODS. A prospective, open-label study was conducted to compare therapeutical efficacy between topical 5-fluorouracil (5% cream) and cryosurgery in the topical treatment of condyloma acuminata. Forty adult patients with this diagnosis were randomly chosen, these being the first 20 patients who came to the family doctor’s office 9 in the Managua polyclinic and the first 20 patients who came to the Joaquín Albarrán teaching polyclinic in the period from February to April 2006. Two groups of 20 patients each were formed, applying a different therapeutical scheme in each case. Thus, the patients from the Managua polyclinic (group I) received a twice a week application of topical 5-fluorouracil and those from the Joaquín Albarrán polyclinic (group II) received a fortnightly application of cryosurgery. Both treatments had the same duration (6 weeks in each group). Therapeutical efficacy was assessed two weeks after completing the treatment, comparing the initial and final state of lesions. The patients who responded totally to the medicine were followed-up quarterly for one year in order to detect possible relapses. RESULTS. The start-end comparative analysis showed an outstanding response to the treatment in both groups. There were statistically significant differences between the groups studied. Relapse rates were high in both groups. The majored verse events observed in both group were burning sensation, pain and swelling having mild intensity and spontaneous disappearance. COMMENT. It has been demonstrated that cryosurgery is more effective than topical 5-fluorouracil in the topical treatment of the condyloma acuminate (AU)

Espiradenoma ecrino zosteriforme. Presentación de un caso / Eccrine Spiradenoma in a Zosteriform Distribution: Presentation of a Case

No disponible

No disponible