Quiste odontogénico calcificante. Análisis de características clínicas e imagenológicas en reportes de casos / Calcifying odontogenic cyst. Analysis of clinical and imaging characteristics in case reports

Introducción: El quiste odontogénico calcificante (QOC) es un quiste odontogénico raro de los maxilares, que en un gran número de casos se asociaa otras patologías. Debido a esto, la presentación clínica e imagenológica puede variar. El objetivo del presente trabajo fue determinar las características clínicas e imagenológicas del QOC intraóseo, sin asociación a otras patologías, publicadas en reportes de casos.Material y métodos:Se realizó una búsqueda en PubMed, Scopus, Epistemonikos y Web of Science, de reportes de casos de QOC intraóseo, sin asociación a otras patologías, que tuvieran exámenes imagenológicos y diagnóstico histopatológico.Resultados:Se incluyeron 20 artículos, con 21 casos clínicos. El QOC sepresentó principalmente en la segunda década de vida, sexo masculino y zona posterior mandibular. El aumento de volumen estuvo presente en la mayoría de los casos. El dolor, alteraciones de mucosa y movilidad dentaria se observaron en un menor porcentaje. Radiográficamente se observó una lesión de densidad mixta, unilocular, de límites definidos y regulares, con expansión de corticales. La perforación, desplazamiento dentario y reabsorción radicular fueron poco comunes. El tamaño fue principalmente mayor a 3cm.Conclusiones:La información clínica e imagenológica fue escasa en todos los artículos incluidos. La mayoría de las características que no coinciden con lo reportado por la literatura podrían tener su explicación en el hecho de que los casos publicados suelen ser atípicos.En la presenterevisión se encontraron características del QOC diferentes a las reportadas, que son relevantes para el diagnóstico diferencial.(AU)

Introduction: Calcifying odontogenic cyst (COC) is a rare odontogenic cyst of the jaws, which in many cases is associated with other pathologies and can generate differences in terms of clinical and imaging presentation. The aim of this article was to determinate the clinical and imaging characteristics of intraosseous COC, without association to other pathologies, published in case reports.Material and methods:A search in PubMed, Scopus, Epistemonikos and Web of Science was performed, for case reports of intraosseous COC, without association to other pathologies, which had imaging examinations and histopathological diagnosis.Results:20 articles were included, with 21 clinical cases. COC was found to occur mainly in the second decade of life, male sex, and mandibular posterior area. Swelling was present in most cases. Pain, mucosal alterations, and dental mobility were observed in a lower percentage. Radiographically, a mixed density lesion, unilocular, with defined and regular limits, which generates cortical expansion was observed. Perforation, tooth displacement and root resorption were uncommon. The size was mainly larger than 3cm.Conclusion:Clinical and imaging information was found to be scarce in all articles included in this review. Most of the characteristics that did not coincide with what is reported by the literature could be explained by the fact that published cases are usually atypical. In this review, different COC characteristics than those previously reported were found, which are relevant for differential diagnosis.(AU)

Tinnitus: una revisión narrativa / Tinnitus: A narrative review / Tinnitus: uma revisão narrativa

El tinnitus o acúfeno es la percepción de sonido en ausencia de un estímulo acústico externo; es uno de los motivos de consulta más comunes en el área de otorrinolaringolo­gía. Se ha asociado a diversas etiologías tales como ototoxicidad, tumores, traumatismo craneoencefálico y trastornos psiquiátricos, siendo también las causas de carácter idio­pático ampliamente conocidas. Las características clínicas de los tinnitus son variables de paciente a paciente, por lo que su diagnóstico, tratamiento y seguimiento son un desafío clínico Si bien recientes estudios han propuesto distintos manejos clínicos y terapéuticos, estos continúan hoy en día en estudio. Esta revisión narrativa pretende realizar una actualización sobre el abordaje diagnóstico, clínico y terapéutico de los tinnitus en la última década.

Tinnitus, the perception of sound in the absence of an external acoustic stimulus, is one of the most common reasons for consultation in the area of otorhinolaryngology. It has been associated with various etiologies such as ototoxicity, tumors, head trauma, and psychiatric disorders; idiopathic causes are also widely known. The clinical characteristics of tinnitus are variable from patient to patient; therefore, its diagnosis, treatment, and follow-up are a clinical challenge. Although recent studies have proposed different clinical and therapeutic approaches, these are still under analysis today. This narrative review aims to update the diagnostic, clinical and therapeutic approach to tinnitus in the last decade.

Tinnitus ou zumbido é a percepção do som na ausência de um estímulo acústico externo; é um dos motivos mais comuns de consulta na área de otorrinolaringologia. Tem sido associada a várias etiologias, como ototoxicidade, tumores, traumatismo craniano e distúrbios psiquiátricos, sendo também amplamente conhecidas causas idiopáticas. As características clínicas do zumbido são variáveis de paciente para paciente, por isso seu diagnóstico, tratamento e acompanhamento são um desafio clínico, embora estudos recentes tenham proposto diferentes abordagens clínicas e terapêuticas, ainda hoje estão em estudo. Esta revisão narrativa visa atualizar a abordagem diagnóstica, clínica e terapêutica do zumbido na última década.

Niveles séricos de la isoenzima creatina quinasa-MB y lactato deshidrogenasa como indicadores de daño miocárdico en perros con enfermedad valvular degenerativa / Serum levels of the isoenzyme creatine kinase-MB and lactate dehydrogenase as indicators of myocardial damage in dogs with degenerative valve disease

RESUMEN Se analizaron los niveles séricos de creatina quinasa-MB (CK-MB) y lactato deshidrogenasa (LDH) en 10 perros diagnosticados con enfermedad valvular degenerativa y en seis perros clinicamente sanos, con el objetivo de evaluar si sus niveles séricos indican daño miocárdico. Las muestras de suero se analizaron mediante el método UV. Se utilizó la prueba de diferenciación de medias para determinar diferencias entre medias, y la prueba de correlación de Pearson para determinar si existe correlación entre los niveles séricos de ambas enzimas. Los valores de CK-MB y de LDH fueron significativamente diferentes entre los dos grupos de pacientes. Los niveles de CK-MB y LDH tuvieron correlación positiva, pero no significativa.

ABSTRACT Serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) were analyzed in 10 dogs diagnosed with degenerative valvular disease and in six clinically healthy dogs with the objective of evaluating whether their serum levels indicate myocardial damage. Serum samples were analyzed by UV method. The mean differentiation test was used to determine differences between means and the Pearson correlation test was performed to determine if there was a correlation between the serum levels of both enzymes. The CK-MB and LDH values were significantly different between the two groups of patients. The levels of CK-MB and LDH had a positive but not significant correlation.

Experiencia en el uso de fibrina rica en plaquetas en pacientes con pie diabético / Experience in the use of platelet-rich fibrin in patients with diabetic foot

Resumen Objetivos: Describir las características clínicas y de laboratorio de los pacientes diabéticos tipo 2 (DM2) en tratamiento con fibrina rica en plaquetas (FRP) en el Hospital Clínico Herminda Martín entre los años 2014 y 2016. Materiales y Método: Se revisaron las fichas clínicas de todos los pacientes tratados con FRP en el policlínico de biomateriales en busca de los valores de HbA1c y glicemia, además de otras variables clínicas y de laboratorio que pudieren estar relacionadas con la evolución de las heridas de pie diabético. Se estableció tres grupos de comparación según el tiempo de cicatrización en cicatrización rápida (tiempo percentil 75). Resultados: De un universo de 147 pacientes con DM2 se reportan resultados de 85 (58%). El promedio de edad fue de 61 años, con una glicemia promedio de 243 g/dL y HbA1c de 9,4%. Presentaron un contaje plaquetario dentro de los parámetros normales (promedio 279 plaquetas/mm3). Se encontraron diferencias estadísticas en la escala de valoración de heridas, específicamente en la valoración del puntaje total, así como los parámetros como extensión, profundidad, y dolor entre los grupos de cicatrización rápida y lenta. No se evidenciaron diferencias en el nivel de HbA1c o glicemia en los grupos de cicatrización rápida o lenta, como tampoco en otras variables como edad, creatinina, recuento de plaquetas. Conclusión: No se encontró una asociación entre la velocidad de cicatrización y el nivel de HbA1c en individuos tratados con FRP.

Aims: To describe the clinical and laboratory characteristics of type 2 diabetic patients (DM2) treated with Platelet Rich Fibrin (FRP) at Hospital Clínico Herminda Martín between 2014 and 2016. Materials and Method: Analytical study that includes information from a secondary database. The clinical records of all patients treated with FRP at the Biomaterials Polyclinic were reviewed to search the HbA1c and glycemia values, as well as other clinical and laboratory variables that could be related to the evolution of diabetic foot wounds. Three comparison groups were established according to the healing time in rapid (time 75th percentile). Results: From a universe of 147 patients with DM2, results of 85 (58%) are reported. The average age in the included patients was 61 years. They had an average glycaemia of 243 g/dL, and HbA1c of 9.4%. They presented a platelet count within normal range (average 279 platelets/mm3). Statistical differences between the fast and slow healing groups were found in the wound assessment scale, specifically in the assessment of the total score, extension, depth, and pain. There were no differences in the HbA1c or glycemia level in the fast or slow healing groups, nor in other variables such as age, creatinine, and platelet count. Conclusion: No association was found between healing speed and HbA1c level in individuals treated with FRP.

Granuloma central a células gigantes agresivo, de presentación atípica: reporte de un caso / Aggressive central giant cell granuloma: report of an atypical case

El granuloma central a células gigantes (GCCG) es una lesión osteólitica poco frecuente, no odontogénica, benigna, localizada y potencialmente agresiva, caracterizada por la presencia de células gigantes en un estroma vascular. Se presenta mayoritariamente en mujeres, más frecuentemente en las dos primeras décadas de vida. Radiográficamente el GCCG se puede observar desde una imagen radiolúcida de aspecto quístico, a una imagen multilocular extensa de límites pocos definidos. De acuerdo a la presentación clínica, radiográfica e histológica del GCCG, se ha propuesto un tipo agresivo caracterizado por crecimiento rápido, dolor, parestesia, expansión y perforación de corticales, rizalisis y alta tasa de recidiva. Existe controversia respecto a la etiología. Si bien está descrito como una lesión de carácter reparativo asociada a trauma, se observan características potencialmente destructivas, expansivas e infiltrativas. Se presenta un caso de GCCG agresivo, de presentación atípica en relación con la edad, sexo del paciente y ubicación de la lesión. (AU)

Central giant cell granuloma (CGCG) is an infrequent benign, localized, potentially aggressive, non-odontogenic osteolytic lesion, characterized by the presence of giant cells in a vascular stroma. CGCG is seen mainly in women, more frequently in the first two decades of life. Radiographically, CGCG can be seen from a cystic-like radiolucent image, to an extensive multilocular image, with less defined margins. According to clinical, radiographic and histological aspects of CGCG, an aggressive type has been proposed, which is characterized by rapid growing, pain, paresthesia, expansion/perforation of cortical bone, rizalisis, and high rates of recurrence. Of controversial etiology, CGCG has been described as a reparative lesion, associated to trauma. However, potentially destructive, expansive and infiltrative characteristics have been observed in CGCG. An atypical case of an aggressive CGCG is presented. (AU)

Dosimetric evaluation of radiopharmaceuticals in kidneys and uterine wall of a woman with early pregnancy using Stabin/Segars representations.

MIRD method with the Stabin/Segars anthropomorphic representations were used to calculate the absorbed doses in kidneys and uterine wall of an early-stage pregnant woman when 99mTc (DTPA), 99mTc (DMSA) and 99mTc (MAG3) are used for renal studies. Stabin and Segars anatomical representations are phantoms that are used in Monte Carlo calculations to determine the SAF, that with the pharmaceutical residence time are used to calculate the absorbed dose, from source organs, on target organs. Concerns about the impact on the absorbed dose due to the use of the three 99mTc-based compounds as well as the use of different phantoms were here treated for the case of a female at early pregnant state. The lowest absorbed dose in the kidneys was obtained with 99mTc (MAG3), and the relative difference of using Stabin and Segars anthropomorphic representations was 2.5%. For bladder and rest of organs the relative difference 14.63%. The lowest absorbed dose by uterine wall was obtained with 99mTc(DMSA), however the relative difference of using Stabin and Segars anthropomorphic representations was 12%.

Manejo de vía aérea en paciente con leontiasis ossea. Reporte de caso / Airway management in a patient with leontiasis ossea. Case report

Leontiasis ossea is an uncommon complication of advanced chronic kidney disease that alters the facial bone and the airway, making its perioperative management more complex. We present a clinical case of a female with Leontiasis ossea presenting a difficult airway which requires parathyroidectomy. Assessment, planning and management of the airway by awake intubation is described.

La leontiasis ossea es una complicación infrecuente de la enfermedad renal crónica avanzada que altera el macizo facial óseo y la vía aérea, complejizando su manejo perioperatorio. Presentamos caso clínico de mujer portadora de leontiasis ossea con vía aérea difícil requiriendo paratiroidectomía. Se describe valoración, planificación y manejo de vía aérea mediante intubación vigil.

Diseño de intervención y estaciones ECOE sobre alimentación del menor de dos años / Design of intervention and oser stations on feeding children under two years of age

OBJETIVO: Probar una metodología de enseñanza-aprendizaje, instrumentos de medición y sistema de implementación de la ECOE en relación con lactancia materna, alimentación complementaria, crecimiento y consejería. MATERIAL Y MÉTODOS: Se estudió la adquisición de competencias sobre alimentación en menores de dos años en internos de pediatría aplicando la evaluación clínica objetiva estructurada (ECOE) antes y después del desarrollo de un proceso de enseñanza aprendizaje (PEA) estructurado. Se organizaron cuatro estaciones de evaluación de los aspectos centrales de alimentación y crecimiento, en un grupo de internos seleccionados al azar. RESULTADOS: Las cuatro estaciones de la ECOE se aplicaron sin dificultades antes y después del PEA. Los resultados mostraron una mejora en el rendimiento de los internos, de manera individual y de grupo; en este último las diferencias en la media fueron para alimentación complementaria pre 2,5 (DE 0,93) y post 5 (DE 2,39); consejería pre 5,75 (DE 1,49) y post 8,13 (DE 1,25); lactancia materna pre 12,63 (DE 2,5) y post 16,38 (DE 2) y velocidad de crecimiento pre 3,13 (DE 1,36) y post 3,38 (DE 0,92). Los resultados fueron estadísticamente significativos para los tres primeros rubros. CONCLUSIONES: En base a estos resultados se sugieren mejoras en el programa de enseñanza y se verifica la aplicabilidad de la ECOE en el internado del Hospital del Niño Dr. Ovidio Aliaga Uría.

OBJECTIVE: To test a teaching-learning methodology, measurement tools and OSCE implementation system in relation to breastfeeding, complementary feeding, growth and counseling. METHODOLOGY: The acquisition of competences was studied by applying objective structured clinical examination (OSCE) before and after the development of a structured teaching-learning process. Four assessment stations were organized considering central aspects on feeding and growth of children under two years of age, in a group of randomly selected students during medical internship. RESULTS: The four OSCE stations were applied without difficulties before and after the learning and teaching process. The results showed an improvement in the performance of interns, individually and in groups; in the latter, mean differences were: for complementary feeding pre 2.5 (SD 0.93) and post 5 (SD 2.39); counseling pre 5.75 (SD 1.49) and post 8.13 (SD 1.25); breastfeeding pre 12.63 (SD 2.5) and post 16.38 (SD 2) and growth velocity pre 3.13 (SD 1.36) and post 3.38 (SD 0.92). The results were statistically significant for the first three items. CONCLUSIONS: Based on these results, the authors suggest improvements in the teaching program, and verify the applicability of the OSCE for the evaluation of rotatory internship at the Hospital del Nino Dr. Ovidio Aliaga Uria.

Association of eating behaviour with clock gene polymorphism 3111 T > C in children based on nutritional status.

Background: The CLOCK (circadian locomotor output cycle kaput) gene is a central regulator of circadian rhythm. The CLOCK gene has been related to energy intake and therefore to nutritional status. However, its specific associations with aspects of food behaviour in children have been scarcely investigated.Aim: To determine the association between the CLOCK gene polymorphism 3111 T > C and eating behaviours in children based on nutritional status.Methods: A cross-sectional study of the association between a CLOCK gene variant and eating behaviour in children (n = 256) was performed. Eating behaviour was evaluated by the Child Eating Behaviour Questionnaire (CEBQ). In addition, the genotype of the CLOCK 3111 T > C (TT, CC, TC) gene polymorphism and BMI were determined.Results: The obese carriers of the C allele of the polymorphism had lower scores in the dimensions "response to satiety" and "slowness to eat" (p < 0.001), both of which constitute an anti-intake dimension and are related to food satiety.Conclusions: The C allele CLOCK gene could be considered a genetic risk factor for satiety-altered eating behaviour dimensions.

Estado de salud periodontal de pacientes trasplantados renales y calidad de vida asociada. Estudio exploratorio / Periodontal health of renal patients and quality of life associated. Exploratory study

Objetivo. Determinar el estado de salud periodontal del paciente trasplantado renal, mediante la revisión de las historias clínicas diligenciadas por odontólogos generales o especialistas así como por la percepción de calidad de vida post-transplante, en relación con la salud bucal. Métodos. Estudio descriptivo transversal con 30 participantes de una unidad de transplante renal de la ciudad de Medellín, Colombia. Se exploraron antece- dentes médico-odontológicos personales y familiares, examen bucal y periodontograma completo, por un solo examinador (Kappa= 0,79). Se aplicó la encuesta Oral Health Impact Profile (OHIP-14). Resultados . Edad promedio de 35 años (d.s±20,5), 50% hombres y 70% residentes en Medellín. El 46,7% tuvo falla renal de carácter idiopático. Del 44,3% que presentaron problemas periodontales, el 73% tuvo periodontitis locali- zada, 31,8% bolsas periodontales de 4 mm. El cuestionario de calidad de vida aplicado mostró dos dimensiones afectadas: dolor físico y malestar psicológico (23,4% y 20% res- pectivamente). Conclusiones. Los pacientes trasplantados renales tuvieron compromiso periodontal. La severidad medida por la pérdida de inserción, mostró un resultado poco satisfactorio, considerando que los pacientes deben estar libres de factores irritativos e inflamatorios en la boca. El OHIP-14 es un instrumento amigable y sencillo para valorar la calidad de vida asociada a salud bucal.

Objective. Determine the periodontal health status of the renal transplantation patient, by reviewing the medical records filled out by general dentists or specialists as well as the perception of post-transplantation quality of life, in relation to oral health. Methods . Cross-sectional descriptive study with 30 participants from renal transplantation unit in the city of Medellín, Colombia. Personal and family medical-dental history, oral exam and complete periodontogram were explored by a single examiner (Kappa = 0.79). The Oral Health Impact Profile (OHIP-14) survey was applied. Results. Average age: 35 years (d.s ± 20.5), 50% men and 70% residents in Medellín. 46.7% had idiopathic renal failure. From the 44.3% who presented periodontal problems, 73% had localized peri- odontitis, 31.8% periodontal pockets of 4 mm. The quality of life applied questionnaire showed two affected dimensions: physical pain and psychological distress (23.4% and 20% respectively). Conclusions. The kidney transplantation patients had periodontal involvement. The severity measured by the loss of insertion, showed an unsatisfactory result, considering that patients should be free of irritating and inflammatory factors in the mouth. The OHIP-14 is a friendly and simple instrument to assess the quality of life associated with oral health

Evolución del estado nutricional y de la función pulmonar en una cohorte de pacientes con fibrosis quística seguidos en un centro de atención integral / Change over time of nutritional status and lung function in a cohort of patients with cystic fibrosis followed in a multidisciplinary care center

Cystic Fibrosis is a multisystemic inherited disease that requires ongoing care by multidisciplinary teams. The objective of this study is to describe changes on nutrition and lung function in a cohort of patients in a Cystic Fibrosis (CF) Care Center at the Hospital Infantil Universitario San José in Bogotá (HIUSJ), between 2010 and 2013.Is a descriptive study in a cohort of CF patients during four years of follow-up. The quantitative variables were described using medians and interquartile ranges, and the qualitative variables with absolute frequencies and percentages. Descriptive statistics was used to summarize the findings. Of the 63 patients in the initial group, 47 (74.6%) completed the follow-up time. The age range was between 3 to 30 years. The median BMI increased as follows: 17.9 (RIQ: 12.5-25.6) in 2010, 18.6 (RIQ: 12.9-24.8) in 2011, 18.9 RIQ (13.6-26.5) in 2012 and 19.0 (RIQ: 13.5-25.8) in 2013, with lower values in men. The forced expiratory volume in the first second (FEV1) at admission was classified as severe (FEV1 <40%) in 7.1%, moderate (FEV1 40-69%) in 35.7%, mild (FEV1 70-79%) in 7.1% and as normal (FEV1> 80%) in 50%. It is concluded that during the 4 years of follow-up at the HIUSJ CF Center there is an improvement in BMI and a deterioration in lung function in the whole group. The importance of establishing more reference centers to improve clinical outcomes and of implement a National registry to follow up over time are highlighted.

La fibrosis quística es una enfermedad hereditaria, multisistémica, cuyo manejo continuo requiere de equipos multidisciplinarios de salud. El objetivo de este trabajo es describir la evolución nutricional y de la función pulmonar en una cohorte de pacientes en el centro de atención integral de la fibrosis quística (FQ), del Hospital Infantil Universitario San José de Bogotá (HIUSJB), entre 2010 y 2013. Estudio descriptivo, en una cohorte de pacientes, en seguimiento durante cuatro años. Las variables cuantitativas fueron descritas mediante medianas y rangos intercuartílicos y las cualitativas con frecuencias absolutas y porcentajes. De los 63 pacientes del grupo inicial, 47 (74.6%), completaron el tiempo de seguimiento. El rango de edad fue de 3 a 30 años. La mediana del IMC (índice de masa corporal) se incrementó así: 17.9 (RIQ:12.5-25.6) en el 2010, 18.6 (RIQ:12.9-24.8) en el 2011, 18.9 ( RIQ(13.6-26.5) en el 2012 y 19.0 (RIQ:13.5-25.8) en el 2013, con menores valores en los hombres. El volumen espiratorio forzado en el primer segundo (VEF1) al ingreso fue clasificado como severo (VEF1<40%) en el 7.1%, moderado (VEF1 40-69%) en el 35.7%, leve (VEF1 70-79%) en el 7.1% y como normal (VEF1>80%) en el 50%. Se concluye que durante los 4 años de seguimiento en el programa de FQ del HIUSJ, ocurre una mejoría del IMC en todo el grupo y un deterioro de la función pulmonar. Se resalta la importancia de constituir más centros de referencia para mejorar los desenlaces clínicos e implementar un registro Nacional para hacer seguimiento a través del tiempo.

Population Data Centre Profile: SA NT DataLink (South Australia and Northern Territory).

INTRODUCTION: Originally piloted as a multi-departmental project within the Government of South Australia, SA NT DataLink is now the key provider of data linkage services in South Australia, the Northern Territory of Australia and the Commonwealth of Australia, enabling academics and policy makers to undertake research, policy, planning and evaluation. APPROACH: Uniquely governed by a broad range of consortium partners, SA NT DataLink's business model operates with flexibility to adapt to researcher priorities and government requirements. Its Data Linkage Unit routinely links data from over 50 sources with more than 57 million records on approximately 2.9 million individuals. It arguably provides the broadest range of linked data sources in Australia, focusing on administrative datasets and clinical registries from various health and human services domains. Operating in strict adherence with the separation principal, SA NT DataLink's Data Integration Unit separately manages anonymised clinical and service use data in collaboration with the respective data custodians through the Custodian Controlled Data Repository, allowing approved analysts to efficiently access high quality linked anonymised data. To protect individual privacy throughout the process of data linkage and data provision, SA NT DataLink's processes align with state, territory and federal privacy legislations. Operating consistently with National Health and Medical Research Council guidelines, linkage projects are subject to approvals by the relevant data custodians and approved Human Research Ethics Committees. NOTEWORTHY OUTPUTS: SA NT DataLink has provided linkage services to over 160 data linkage projects, informing nationally significant research and policy initiatives, including initiatives to improve indigenous children's hearing and child development. CONCLUSION: To respond to a changing data linkage landscape, SA NT DataLink is continuously reviewing and improving its systems, linkage processes and governance, addressing administrative, funding, data access, social licence and data linkage challenges and opportunities to meet increasing demand and new business developments.

Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2).

BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery. METHODS: POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery. Patients were assigned to perioperative aspirin or placebo. The primary outcome was a composite of death or myocardial infarction at 30 days. Secondary outcomes included: vascular occlusive complications (a composite of amputation and peripheral arterial thrombosis) and major or life-threatening bleeding. RESULTS: Of 10 010 patients in POISE-2, 603 underwent vascular surgery, 319 in the continuation and 284 in the initiation stratum. Some 272 patients had vascular surgery for occlusive disease and 265 had aneurysm surgery. The primary outcome occurred in 13·7 per cent of patients having aneurysm repair allocated to aspirin and 9·0 per cent who had placebo (hazard ratio (HR) 1·48, 95 per cent c.i. 0·71 to 3·09). Among patients who had surgery for occlusive vascular disease, 15·8 per cent allocated to aspirin and 13·6 per cent on placebo had the primary outcome (HR 1·16, 0·62 to 2·17). There was no interaction with the primary outcome for type of surgery (P = 0·294) or aspirin stratum (P = 0·623). There was no interaction for vascular occlusive complications (P = 0·413) or bleeding (P = 0·900) for vascular compared with non-vascular surgery. CONCLUSION: This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).

Quiste bucal mandibular infectado bilateral en segundos molares permanentes: reporte de un caso / Bilateral mandibular infected buccal cyst in second permanent molars: a case report

El quiste bucal mandibular infectado corresponde a una lesión poco frecuente, de etiología desconocida, que se presenta en niños de 6 a 13 años, generalmente de forma unilateral, durante el proceso de erupción de los primeros molares permanentes. Con menor frecuencia puede afectar a segundos molares permanentes. El diente asociado a la lesión se encuentra vital, presentando un patrón alterado de erupción. Puede presentarse sintomatología, sensibilidad, incremento en la profundidad del saco periodontal, aumento de volumen en fondo de vestíbulo y supuración. Además, puede observarse un retraso en la erupción del molar involucrado, con inclinación de su corona hacia vestibular. Al examen imagenológico se observa una lesión radiolúcida sobre la corona del molar comprometido, rodeada por un halo radiopaco de concavidad superior sobreproyectado parcialmente sobre sus raíces. Este quiste no presenta características histológicas específicas, por lo que el diagnóstico de esta lesión debe realizarse en base a las características clínicas, imagenológicas e histopatológicas. Se presenta un particular caso clínico de quiste bucal mandibular infectado bilateral en segundos molares permanentes

The mandibular infected buccal cyst is an infrequent lesion, of unknown etiology, presented usually in 6-13-year-old children. Generally, this cyst occurs unilaterally, in association with tooth eruption of first lower permanent molars. With a lower frequency, it can affect second lower permanent molars. The associated tooth is found to be vital, with an altered eruption pattern. This tooth may show some symptoms, such as sensitivity, clinical appearance of periodontal pocket, swelling of the buccal vestibule and suppuration. Moreover, a delayed eruption of the involved molar can be seen, with its crown buccally tilted. The imaging examination shows a radiolucent lesion over the crown and rootsof the involved tooth, surrounded by a concave up radiopaque inferior margin. This cyst does not have any specific histological features; thus, its diagnosis should be performed based on its clinical, histological and imaging features. An unusual clinical case of a mandibular infected buccal cyst involving both second permanent mandibular molars is reported

Chemotherapy induced peripheral neuropathy: the modified total neuropathy score in clinical practice.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, potentially reversible side effect of some chemotherapeutic agents. CIPN is associated with decreased balance, function and quality of life (QoL). This association has to date been under-investigated. AIMS: To profile patients presenting with CIPN using the modified Total Neuropathy Score (mTNS) in this cross-sectional study and to examine the relationship between CIPN (measured by mTNS) and indices of balance, quality of life (QoL) and function. METHODS: Patients receiving neurotoxic chemotherapy regimens were identified using hospital databases. Those who did not have a pre-existing neuropathy were invited to complete mTNS, Berg Balance Scale (BBS), timed up and go (TUG), and FACT-G QoL questionnaire. mTNS scores were profiled and also correlated with BBS, TUG and FACT-G using Spearmans correlation coefficient. RESULTS: A total of 29 patients undergoing neurotoxic chemotherapy regimens were tested. The patients mTNS scores ranged between 1 and 12 (median = 5), indicating that all patients had clinical evidence of neuropathy on mTNS. No significant correlations were found between mTNS and BERG (r = -0.29), TUG (r = 0.14), or FACT-G (r = 0.05). CONCLUSIONS: This study found a high prevalence of CIPN in patients treated with neurotoxic chemotherapy regimens. The mTNS provided a clinically applicable, sensitive screening tool for CIPN which could prove useful in clinical practice. mTNS did not correlate with BBS, TUG or FACT-G in this sample, possibly due to relatively mild levels of CIPN and consequent subtle impairments which were not adequately captured by gross functional assessments.

Prevalencia de queilitis actínica en trabajadores expuestos a radiación ultravioleta en Talca, Chile / Prevalence of actinic cheilitis in chilean workers exposed to ultraviolet radiation

El objetivo de esta investigación es determinar la prevalencia de queilitis actínica (QA) y factores asociados en trabajadores expuestos a radiación UV solar en la ciudad de Talca, Chile. Se examinaron 151 trabajadores, donde un 16.6 por ciento presentó QA. Todas las lesiones se presentaron en el labio inferior. El 40 por ciento de los casos poseía una edad entre 50 y 59 años y el 96 por ciento de los pacientes diagnosticados trabajaba más de 6 horas diarias expuestos al sol. El 56 por ciento de los diagnósticos de QA presentaron un historial 20 o más años totales de exposición a radiación UV por motivos laborales. El 56 por ciento de los casos de QA presentaron antecedentes de hábito de fumar. Los principales signos presentes en los casos de QA fueron la sequedad (100 por ciento), esfumación del margen del bermellón (88 por ciento) y el edema labial (84 por ciento). La mayoría de las lesiones fueron asintomáticas (60 por ciento).

The objective of this research is to determine the prevalence of actinic cheilitis (AC) and associated factors in workers exposed to solar UV radiation in the city of Talca (Chile). A total of 151 workers, of which 16.6 percent exhibited AC, were examined. All lesions appeared on the lower lip. The 40 percent of cases aged between 50-59 years and 96 percent of patients diagnosed worked up to 6 hours daily exposed to the sun. 56 percent of the diagnoses of AC had a history of 20 or more years of exposure to UV radiation for work. 56 percent of cases of AC had a history of smoking. Major signs present in the AC cases were the dryness (100 percent), blurred demarcation between the lip vermilion border and the skin (88 percent) and labial edema (84 percent). Most lesions were asymptomatic (60 percent).

Cáncer de senos paranasales y sus manifestaciones orales: reporte de dos casos clínicos / Paranasal sinus cancer and oral manifestations: report of two cases

Los carcinomas de senos paranasales son entidades poco frecuentes y cuando se diagnostican, generalmente ya se encuentran en estados avanzados de la enfermedad, dado que el proceso neoplásico en las etapas iniciales crece invadiendo las cavidades paranasales, para luego en etapas avanzadas producir la deformación de las corticales. Dentro de las manifestaciones clínicas se pueden presentar epistaxis, obstrucción nasal, dolor en zona maxilar, dolor o movilidad dentaria. Se presentan dos casos clínicos que dentro de las primeras manifestaciones cursaron con dolor de la zona maxilar y movilidad anormal de un diente. Al momento de realizar el diagnóstico definitivo los procesos tumorales se encontraban muy avanzados, comprometiendo diversas estructuras como seno maxilar, etmoidal, esfenoidal, y piso de órbita, lo que obliga a realizar grandes resecciones de la zona maxilofacial. El rol del odontólogo en el diagnóstico de la enfermedad podría ser de gran importancia, al sospechar que un aumento de volumen del reborde, la movilidad dentaria anormal o un dolor de la zona maxilar no siempre corresponden a causas odontogénicas.

Paranasal sinus cancer are rare entities, but when diagnosed, often already in advanced stages of the disease, because the neoplastic process in the initial stages grows invading the paranasal sinuses and then in advanced stages, produces deformation of cortical bone. Among the clinical manifestations epistaxis, nasal obstruction, pain in maxillary area, pain or tooth mobility may occur. We present two clinical cases in which within the first manifestations are the maxillary pain and abnormal tooth mobility. When making the final diagnosis, tumor processes were well advanced, engaging various structures as maxillary sinus, ethmoid, sphenoid, and orbital floor, forcing large resections perform maxillofacial area. The role of the dentist in the diagnosis of the disease could be of great importance, suspecting that an increase maxillary volume, abnormal tooth mobility or pain of the maxillary not always correspond with odontogenic causes.

Extension plant pathology: strengthening resources to continue serving the public interest.

Extension plant pathologists deliver science-based information that protects the economic value of agricultural and horticultural crops in the United States by educating growers and the general public about plant diseases. Extension plant pathologists diagnose plant diseases and disorders, provide advice, and conduct applied research on local and regional plant disease problems. During the last century, extension plant pathology programs have adjusted to demographic shifts in the U.S. population and to changes in program funding. Extension programs are now more collaborative and more specialized in response to a highly educated clientele. Changes in federal and state budgets and policies have also reduced funding and shifted the source of funding of extension plant pathologists from formula funds towards specialized competitive grants. These competitive grants often favor national over local and regional plant disease issues and typically require a long lead time to secure funding. These changes coupled with a reduction in personnel pose a threat to extension plant pathology programs. Increasing demand for high-quality, unbiased information and the continued reduction in local, state, and federal funds is unsustainable and, if not abated, will lead to a delay in response to emerging diseases, reduce crop yields, increase economic losses, and place U.S. agriculture at a global competitive disadvantage. In this letter, we outline four recommendations to strengthen the role and resources of extension plant pathologists as they guide our nation's food, feed, fuel, fiber, and ornamental producers into an era of increasing technological complexity and global competitiveness.

Isolation and identification of ochratoxin A-producing Aspergillus section Nigri strains from California raisins.

AIMS: To determine incidence and levels of ochratoxin A (OTA) in California raisins and to isolate and characterize OTA-producing fungi from California raisin vineyard populations. METHODS AND RESULTS: Forty raisin clusters sampled from four California vineyards in the San Joaquin Valley were analysed for OTA content using immunoaffinity and HPLC methods. OTA was detected in 93% of the samples, at levels from 0·06 to 11·4 ng g⁻¹. From these raisin samples, a total of 400 strains of Aspergillus were isolated and analysed for OTA production. Twelve isolates (3%), from five raisin samples, produced OTA. These isolates were identified as Aspergillus carbonarius, based on morphological characteristics and multilocus sequence analysis. Levels of OTA produced by these isolates on raisin agar ranged from 0·9 to 15 µg g⁻¹. CONCLUSIONS: OTA is a common contaminant of raisin vineyards, but average levels are much lower than EU regulatory limits for dried fruit. The primary species responsible for OTA contamination in California raisins is A. carbonarius. SIGNIFICANCE AND IMPACT OF THE STUDY: This study illustrates that low-level OTA contamination of raisins occurs in California and that ecological studies of A. carbonarius within the Aspergillus section Nigri population on raisins are warranted to monitor ochratoxigenic potential of the crop.

Diet and caries-associated bacteria in severe early childhood caries.

Frequent consumption of cariogenic foods and bacterial infection are risk factors for early childhood caries (ECC). This study hypothesized that a short diet survey focused on frequency of foods, categorized by putative cariogenicity, would differentiate severe ECC (S-ECC) from caries-free children. Children's diets were obtained by survey and plaque bacteria detected by PCR from 72 S-ECC and 38 caries-free children. S-ECC children had higher scores for between-meal juice (p < 0.01), solid-retentive foods (p < 0.001), eating frequency (p < 0.005), and estimated food cariogenicity (p < 0.0001) than caries-free children. S-ECC children with lesion recurrence ate fewer putative caries-protective foods than children without new lesions. Streptococcus mutans (p < 0.005), Streptococcus sobrinus (p < 0.005), and Bifidobacteria (p < 0.0001) were associated with S-ECC, and S. mutans with S. sobrinus was associated with lesion recurrence (p < 0.05). S. mutans-positive children had higher food cariogenicity scores. Food frequency, putative cariogenicity, and S. mutans were associated with S-ECC individually and in combination.