Antiplatelet therapy in patients undergoing oral surgery: A systematic review and meta-analysis.

BACKGROUND: The number of patients under antiplatelet therapy (APT) continues to raise as current recommendations foster this practice. Although some recommendations to manage this treatment during oral surgery procedures exist, these have methodological shortcomings that preclude them from being conclusive. MATERIAL AND METHODS: A systematic review and meta-analysis of the best current evidence was carried out; The Cochrane Library, EMBASE and MEDLINE databases were searched for Randomized Controlled Trials (RCT) concerning patients undergoing oral surgery with APT, other relevant sources were searched manually. RESULTS: 5 RCTs met the Inclusion criteria. No clear tendency was observed (RR= 0.97 CI 95%: 0,41-2,34; p=0,09; I2= 51%), moreover, they weren't clinically significant. CONCLUSIONS: According to these findings and as bleeding is a manageable complication it seems unreasonable to undermine the APT, putting the patient in danger of a thrombotic event and its high inherent morbidity, which isn't comparable in severity and manageability to the former."

La vía chilena a la psiquiatría social: propuestas y debates en torno al cambio del modelo de asistencia mental (1968-1973) / The Chilean path to social psychiatry: proposals and debates around the change of the mental assistance model (1968-1973)

En este sentido, nos hemos propuesto, en primer lugar, insertar el modelo intracomunitario de salud mental de Juan Marconi en el escenario de cambios que venían gestándose en América Latina y Chile a part de la década de 1950. En una segunda isntancia buscamos comparar la nueva propuesta de asistencia metnal con las respuestas tradicionales que el país había dado al control del alcoholismo, cuestionando así el carácter revolucionario que tendría, según su autor, el nuevo modelo. Finalmente, esperamos analizar los fundamentos teóricos y metodológicos que guiaron tanto la instalación de la propuesta intracominitaria de asistencia del alcoholismo, como su evaluación y extensión a los programas de neurosis en mujeres y de privación cognitiva en preescolares. Así, el texto comenta sobre los primeros estudios epidemiológicos en torno a la salud mental en Chile y el Programa Tradicional de Control del Alcoholismo(AU)

[Identification and in vitro antifungal susceptibility of vaginal Candida spp. isolates to fluconazole, clotrimazole and nystatin]. / Identificación y sensibilidad antifúngica in vitro de Candida spp. de origen vaginal a fluconazol, clotrimazol y nistatina.

OBJECTIVE: The aim of this study was to identify and determine the in vitro antifungal susceptibility testing to clotrimazole, fluconazole, and nystatin of 145 clinical isolates of Candida spp. METHODS: M27-A3 microdilution method was used to determine minimal inhibitory concentrations (MIC) and partial MICs (MIC50 and MIC90) of drugs. A total of 145 isolates were studied, 126 were C. albicans, 16 C. glabrata, 2 C. parapsilosis y 1 C. tropicalis. RESULTS: MIC50 and MIC90 for FLZ against C. albicans were 0.25 mg/L and 1 mg/L respectively and for C. glabrata was achieved at 8 mg/L and 16 mg/L for fluconazole. Five isolates of C. albicans and one isolate of C. tropicalis were in vitro resistant to fluconazole (M27-S4). In C. albicans MIC50 and MIC90 for clotrimazole were of 0.03 mg/L and 0.06 mg/L, respectively. These values for C. glabrata were 0.25 mg/L and 1 mg/L, respectively. Five C. glabrata and 1 C. tropicalis were in vitro resistant to clotrimazole. MIC50 and MIC90 of nystatin were of 1 mg/L and 2 mg/L, respectively for C. albicans and C. glabrata. CONCLUSIONS: In this study, C. albicans is the most frequently isolated yeast, followed by C. glabrata. The antifungals tested were found to be in vitro active for the isolates, except for 6 isolates for fluconazole and 6 to clotrimazole.

High condylectomy versus proportional condylectomy: is secondary orthognathic surgery necessary?

The objective of this study was to assess the need for secondary orthognathic surgery in patients undergoing two different condylectomy protocols for active unilateral condylar hyperplasia (UCH). A retrospective cohort study evaluated UCH patients treated by condylectomy. Two groups were established: group 1 comprised those who had undergone a high condylectomy (5 mm removed) and group 2 comprised those who had undergone a proportional condylectomy (removing the difference observed between the measurements of the hyperplastic and the healthy side). Data analysis was done with the Levene test and t-test; a P-value of <0.05 indicated a statistically significant relationship. Forty-nine patients, with an average age of 19.83 years, were analyzed; 11 were included in group 1 and 38 in group 2. There was no statistical difference between the two groups with regard to age or sex (P=0.781). An average of 5.81 mm was removed in the high condylectomy group, while an average of 9.28 mm was removed in the proportional condylectomy group; this difference was statistically significant (P=0.042). Comparing the two groups, proportional condylectomy reduced the need for secondary orthognathic surgery (P<0.001). The proportional condylectomy can be used as the sole surgical treatment in cases of UCH, thus avoiding the need for secondary orthognathic surgery.

Efficiency of pragmatic search strategies to update clinical guidelines recommendations.

BACKGROUND: A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database. METHODS: We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach. RESULTS: The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %). CONCLUSIONS: The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.

A Non-inferiority Pilot Study Comparing the Clinical Efficacy and Safety of Generic Wide-spectrum Antibiotic Use in Septic Oncology Patients.

The present study is a non-inferiority study based on a descriptive and comparative case series for comparison of generic vs. original intravenous antimicrobials in septic oncology patients at an oncology private ICU. 1906 cancer patients admitted to Arturo Lopez Perez Foundation, Chile, were included in this study. After recruitment, a first retrospective group of 206 septic cancer patients recorded from 1st January, 2008 until July 14th, 2010, treated with original antibiotics (cefoperazone-sulbactam, imipenem-cilastatin, piperacillin-tazobactam) were included for analyses and a second prospective group of 143 septic cancer patients recorded from July 15th, 2010 until January 02, 2013, treated with the same but generic antibiotics were also included for comparisons. The trial protocol was developed in accordance with Helsinki and Good Clinical Practices recommendations. The results of this study showed no significant differences between the 2 groups in days of treatment, rate of success and lab test determinations (white cell count, PCR and procalcitonin), with lower, but not significant, total bed days and CPU bed days for generic antibiotics. Therefore, we conclude that the safety and efficacy of the generic antibiotics cefactam®, imipen® and Piperazam® are not inferior to original antibiotics for the treatment of severe sepsis in hospitalised patients at the Arturo Lopez Perez Foundation.

Uso de sellantes de fosas y fisuras para la prevención de caries en población infanto-juvenil: revisión metodológica de ensayos clínicos / Use of pit and fissure sealants for preventing caries in child population: Methodological review of clinical trials

La caries dental es uno de los problemas más relevantes dentro del ámbito odontológico y de la Salud Pública. En Chile existe una alta prevalencia de caries en la población infanto-juvenil, siendo esta una de las prioridades de salud del país. Se constata la necesidad de utilizar métodos complementarios para su control. Los sellantes de fosas y fisuras representan una de las intervenciones preventivas más efectivas en odontología, siendo considerados como un aporte a la Salud Pública. Sin embargo, no existen evidencias consistentes acerca de su verdadera efectividad e impacto en la prevención de caries. Las inconsistencias encontradas podrían deberse a la presencia de sesgos o a la heterogeneidad de los estudios disponibles en la literatura. Así, se propone realizar una revisión sistemática con el fin de evaluar la calidad metodológica de los ensayos clínicos controlados que utilizan sellantes de fosas y fisuras. Se condujo una búsqueda de ensayos realizados entre 1990 y 2007, encontrándose trece que cumplieron con los criterios de inclusión y exclusión. Los estudios incluidos fueron obtenidos y evaluados por un único revisor. Se concluye que la evidencia que avala la utilización de esta intervención es metodológicamente muy pobre. Estos hallazgos debieran estimular a los profesionales a esclarecer la verdad referente a la efectividad de los sellantes, antes de aplicarlos indiscriminadamente. Se recomienda la realización de nuevos ensayos clínicos ejecutados con un adecuado diseño metodológico y de análisis estadístico, cuyos resultados sirvan como evidencia confiable para la toma de decisiones que guíen las políticas de Salud Pública.

Dental decay is one of the most important problems within the Public Oral Health. Chile has a high prevalence of decay among children and adolescents, being this issue one of the priorities of public health in the country. Taking into account this context, there is a necessity of using complementary methods for its control. Pit and fissures sealants represent one of the most effective preventive interventions in dentistry, being considered as a contribution to the public health interventions. Nevertheless, there are no consistent evidences about their true effectiveness and impact in the prevention of caries. These inconsistencies could be due to the presence of bias or the heterogeneity of the studies available in literature. Thus, we propose to make a review with the aim to evaluate the methodological quality of clinical trials using pit and fissure sealants. A search of studies between 1990 and 2012 was conducted and 18 clinical trials that fulfilled the inclusion and exclusion criteria were found. The studies included were obtained and evaluated by a single reviewer. This review concludes that the evidence that guarantees the use of this intervention is methodologically poor. These findings may stimulate the professionals to clarify the truth referring to the effectiveness of sealants, before applying it indiscriminately. The accomplishment of new clinical trials executed with an appropriate methodological design and statistical analysis is recommended, generating reliable results for the decision making that guides the Public Health Policies.

Aspectos sobre la medición del impacto de la caries dental en la calidad de vida de las personas: artículo de revisión / Bearing impact measure of the dental caries in the quality of life: review article

Objetivo: Determinar, mediante una revisión de literatura publicada, la existencia de estudios enfocados en la relación entre historia de caries y calidad de vida relacionada a salud oral (CVRSO) utilizando instrumentos validados. Material y Método: Artículo de revisión bibliográfica de literatura publicada los últimos diez años usando la base de datos MEDLINE. Dos revisores independientes recopilaron y analizaron los artículos en dos etapas: En una primera etapa fueron seleccionados aquellos artículos en que en su resumen relacionaran historia de caries y calidad de vida utilizando un instrumento de medición validado, excluyendo todos aquellos en que los individuos tuvieran alguna patología base que por si misma afecta su calidad de vida y artículos de validación. En una segunda etapa fue analizado el texto completo de los artículos previamente seleccionados, se aceptaron estudios experimentales y observacionales, se excluyeron artículos de revisión. Los desacuerdos fueron resueltos por consenso. Resultados: De un total de 311 artículos, 12 artículos relacionaban enfermedades orales y calidad de vida relacionada a salud oral siendo "historia de caries" uno más de los parámetros medidos y 6 artículos tenían como objetivo relacionar directamente "historia de caries" y "calidad de vida", en estos últimos las dimensiones más afectadas fueron: dolor dental, comer-masticar alimentos, lavarse los dientes y sonreír.

Aim: To determine, through a review of published literature, the existence of studies focused on the relationship between history of decay and quality of life related to oral health (QOLROH), using validated instruments. Material and Method: Literature review of reports published in the last ten years using the MEDLINE database. Two reviewers independently assessed and analyzed articles in two stages: In the first stage the articles whose abstract related dental caries and quality of life using a validated measurement instrument were selected, excluding those in which individuals had a systemic pathology affecting itself their quality of life, and excluding articles of validation. In a second stage the full text of the previously selected articles was analyzed, experimental and observational studies were accepted and review articles were excluded. Disagreements were resolved by consensus. Results: Out of a total of 311 articles, 12 articles connected oral diseases and quality of life related to oral health, being "history of decay" one more of the measured parameters and only 6 articles related directly "history of decay" and "quality of life". In the latter the most affected dimensions were: Dental pain, eat-chew food, brushing your teeth and smile.

Severidad de caries y pérdida de dientes de una población pre-Hispánica del norte de Chile / Caries severity and tooth loss in an ancient pre-Columbian culture in the north of Chile

El conocer la historia natural de las patologías bucales sin intervenciones modernas, permite comparar el desarrollo de éstas con los datos actuales. Este estudio tiene como objetivo conocer la severidad de caries dental y de pérdida de dientes en una muestra de restos humanos de la cultura Atacameña (500 DC) en San Pedro de Atacama en el norte de Chile. Se estudiaron 139 restos humanos, en cada uno de ellos se realizó un examen clínico, consignado la información en una ficha individual donde se registró, el número de dientes presentes y perdidos pre y post mortem y el número de lesiones de caries. Estas variables permitieron calcular el índice CPD (Obturadas=0). El análisis estadístico incluyó una descripción de frecuencias y el cálculo de estadísticas de dispersión y tendencia central para las variables continuas. Los resultados muestran que el índice CPD mínimo, asume que las piezas perdidas post mortem estaban sanas fue 17.14 con un promedio de 3.93 lesiones de caries y 13.2 dientes perdidos en vida. Los restos humanos de la población estudiada presentan un gran daño de su salud bucal. Gran cantidad de piezas dentarias perdidas en vida y bajo número de dientes sanos.

The aim of this study was to determine the severity of dental caries and tooth loss in a sample of 139 human remains of the Atacama culture (500 AD) in San Pedro de Atacama, northern Chile. A clinical examination was performed on each remain by a calibrated examiner. The number of present and missing teeth in pre-and post-mortem stages and the number of carious lesions were recorded. The DMT index (filled = 0) was calculated. Statistical analysis included a description of frequency and calculation of statistical dispersion and central tendency for continuous variables. The results reveal a DMT of 17.14 with an average of 3.93 carious lesions and 13.2 teeth lost in life. The oral health situation of the studied population presented severe damage, high rate of tooth loss and DMT scores.

Prevalencia de caries en escolares de 6 a 15 años, Isla de Pascua / Caries prevalence in 6 to 15 year-old school children, from Easter Island

Objetivo: El objetivo de este estudio fue determinar la prevalencia y severidad de caries de piezas permanentes y algunos factores de riesgo relacionados en un grupo de escolares de Isla de Pascua. Materiales y Métodos: 116 niños de 6 a 15 años de edad fueron seleccionados al azar. Se efectuó examen clínico individualizado y se registraron los índices COP-D, significante de caries (SIC), de Higiene Oral de Greene y Vermillon (G-V) y se realizó una encuesta de dieta. Para conocer la frecuencia y recuento de Streptococcus mutans y Streptococcus sobrinus, se tomaron muestras de saliva estimulada a 23 niños Rapa Nui elegidos al azar. Finalmente, se analizaron muestras de agua potable en 3 sitios distintos de la isla para medir la cantidad de flúor disponible. Resultados: La prevalencia de caries en piezas permanentes fue 38 por ciento. El COP-D fue 1.19. El valor promedio del G-V fue 1.63. Se aisló e identificó S. mutans y S. sobrinus en el 56.2 por ciento y 13.2 por ciento respectivamente. El recuento promedio para S. mutans fue de 3.3x105 UFC/ml saliva y para S. sobrinus fue de 7.2x104 UFC/ml. Se observó un promedio de 0.223 ppm/Fluoruro en el agua. Desviación Estándar 0.025 ppm. Según la encuesta de dieta el 30 por ciento de los niños presenta bajo riesgo de caries, el 47 por ciento presenta mediano riesgo y el 23 por ciento presenta alto riesgo. Conclusión: El 38 por ciento presenta historia de caries en piezas permanentes. El COP-D promedio es 1.19. En niños Rapa Nui 0.9 y en No Rapa Nui 1.77.

Aim: The aim of this study was to determine the prevalence and severity of caries and some related risk factors in a group of school children from Easter Island. Materials and Methods: 116 children aged 6 to 15 years were randomly selected. Individual clinical examination was performed and index COP-D, significant caries index (SIC), Greene and Vermillon Oral Hygiene index (GV) were recorded. A diet survey was performed. To determine the frequency and count of Streptococcus mutans and Streptococcus sobrinus, stimulated saliva samples were collected from 23 Rapa Nui children randomly selected. Finally, samples of drinking water in 3 different places of the island were analyzed to measure the amount of fluoride available. Results: Caries prevalence was 38 percent. COP-D index was 1.19. The mean value of G-V was 1.63. S. mutans and S. sobrinus were isolated and identified in 56.2 percent and 13.2 percent of the samples, respectively. The average count for S. mutans was 3.3 x105 CFU/ml saliva and for S. sobrinus was 7.2 x104 CFU/ml. A mean of 0.223 Standard Deviation 0.025 ppm/Fluoride was observed in drinking water. According to the diet survey, 30 percent of children have a low risk of caries, 47 percent have medium risk and 23 percent a high risk. Conclusion: According to this study 38 percent have caries history in permanent teeth. Mean COP-D index was 1.19. In Rapa Nui children 0.9 and Not Rapa Nui children 1.77.

Tratamiento de lesiones de caries interproximales mediante el uso de infiltrantes / Treatment of approximal caries lesions using infiltrants

Basados en el respeto por la estructura dentaria junto a un adecuado tratamiento y detención de las lesiones de caries, se ha desarrollado ICON®, un sistema que penetra los tejidos afectados con una resina de baja viscosidad fotopolimerizable (infiltrante) sin necesidad de la apertura mecánica de una cavidad. De este modo se introducen los “infiltrantes” como herramientas para el tratamiento de las lesiones proximales. El “infiltrante” actúa bloqueando la progresión de la lesión de caries y estabilizando la estructura dentaria. En este reporte se muestra la técnica de infiltración con el uso del kit ICON®, mediante la presentación de un caso clínico de lesión proximal extendida al tercio externo de la dentina.

Based on the respect for the tooth structure with adequate treatment and arrest of carious lesions, ICON ® has been developed. This system enters the affected tissue with a low-viscosity light-curing resin (infiltrant) with no need for mechanical opening of a cavity. This will introduce the infiltrants as tools for the treatment of proximal lesions. The “infiltrant” works by blocking the progression of caries lesion and stabilizing tooth structure. This report shows the technique with the use of the ICON ® kit, by presenting a case of proximal carious lesion extended to the outer third of dentin.

MacroH2A subtypes contribute antagonistically to the transcriptional regulation of the ribosomal cistron during seasonal acclimatization of the carp fish.

BACKGROUND: Incorporation of histone variants into chromatin is one of the epigenetic mechanisms used for regulation of gene expression. Macro (m)H2A is a histone variant that has two different subtypes in vertebrates: mH2A1 and mH2A2. It is known that mH2A is associated with gene silencing, but recent studies indicate that these mH2A subtypes could contribute more widely to transcriptional regulation. We have previously demonstrated that the gene-reprogramming response mediates adaptation of the carp fish to its environment, and that ribosomal gene transcription is seasonally regulated in carp. However, there have been few studies investigating how epigenetic mechanisms contribute to environmental adaptation and, in particular, to ribosomal cistron regulation. RESULTS: In this paper, we report the occurrence of differential incorporation of mH2A subtypes into chromatin during seasonal adaptation in the carp, an event that concurs with opposing transcriptional states. Moreover, we observed that enrichment of mH2A1 in the ribosomal cistron during winter, and conversely, enrichment of mH2A2 during summer. mH2A1 consistently colocalizes with a heterochromatin marker (H3K27me2; histone H3 trimethylated at lysine 27) and mH2A2 with a euchromatin marker (H3K4me3; histone H3 trimethylated at lysine 4). Similar results were found for the L41gene, with enrichment of mH2A in the promoter region. CONCLUSIONS: We have characterized both mH2A subtypes from carp fish, and evaluated their participation in the regulation of the ribosomal cistron. Our findings indicate that differential incorporation of mH2A subtypes into the ribosome could regulate gene expression during the acclimatization process in carp. Our results reveal differential chromatin incorporation of the mH2A subtypes during the environmental adaptation process, correlating wtih antagonistic transcriptional states in the carp ribosomal cistron.

Tratamiento quirúrgico de hipertrofia maseterina: reporte de un caso con seguimiento de seis años / Surgical treatment for masseteric hypertrophy: case report with six-year follow-up

La hipertrofia maseterina es una condición benigna que puede manifestarse en forma bilateral o unilateral. Presenta como principal problema el componente estético. Se han planteado diversos tratamientos, siendo la alternativa quirúrgica la más radical y predecible. Se presenta el caso de una adolescente de 15 años que presentó hipertrofia maseterina unilateral, la cual fue tratada en forma quirúrgica y fue controlada durante 6 años sin recidivas(AU)

Masseteric hypertrophy is a benign condition that can be appear in an asymmetric or symmetric form. Aesthetics is the main problem. Many treatments have been proposed, the surgical alternative is the most predictable and radical. We present the case of a 15 year-old girl with asymmetric masseteric hypertrophy who is surgically treated and then monitored for 6 years without recurrences(AU)

Análisis regional de la hidatidosis humana y animal en Chile: 1989 a 1993 / Regional analysis of the human and animal hydatidosis in Chile: 1989 to 1993

A descriptive study of hydatidosis, a still very prevalennt zoonosis in Chile, was carried out with information up to 1993. Both human and animal data were included, the last one based on more reliable information. Regional human distribution up to 1991 shows persistent high notification rates in the extreme south of the country, Aysen and Magallanes hospital discharges, more reliable than notified cases, adds the IX Region of Araucania to the high risk areas, join with more than 30 hospitalizations per 100,000 people in 1989. Mortality case rate suggests strongly a very high subnotification in all the regions, mainly in O'Higgins. This zoonosis affects predominatly, young and middle aged adults, with a similae sex distribution. Cattle infection has decreased in the last 20 years, particulary in sheep. Proportion of infected dogs also tends to show a lowering trend in specific studies. It appears a strong need of a national program for controlling this zoonosis, to be initiated with an epidemiological evaluation by regions and centered in health education, dogs' infection control with treatment and better handling of slaughterhouses

Terapia inhalatoria ambulatoria en niños / Inhalatory ambulatory therapy in children

La terapia inhalatoria es un tratamiento efectivo en las afecciones bronquiales obstructivas de los niños, en quienes su empleo exige un conocimiento apropiado del procedimiento correspondiente. Se evaluó la forma en que los operadores, por lo general la madre de los pacientes, dispensaban los medicamentos para uso inhalatorio, mediante administración observada de una dosis por inhalación ante dos investigadores en la consulta ambulatoria y se correlacionó la frecuencia y magnitud de los errores cometidos, así como la calidad del procedimiento, con la edad e instrucción del operador, experiencia previa en suministro de terapia por inhaladores y número de hijos. En 60 por ciento de los casos se registraron errores en el método de administración y 36,9 por ciento de los procedimientos fueron calificados como tratamiento de mala calidad, lo que implica que una importante proporción de niños tratados por obstrucción bronquial reciben un manejo farmacológico deficiente por este solo mecanismo. No fue posible relacionar la incidencia de errores con ninguno de los factores específicos estudiados

Situación actual de la hidatidosis humana en Chile: dos propuestas de corrección de su subnotificación / Present situation of human hidatidosis in Chile: 2 correction proposals to the subnotification

Hydatidosis continues to be a prevalent disease in Chile. Since 1985 and until 1990, the number of notified cases decreased abruptly, probably due to sub-notification. Lethality, not calculated officially, increased since 1985 in a roughly similar proportion to the decrease in communicated incidence. This fact, along with an increase in hospital discharges due to the disease in the country, confirms the hypothesis that sub-notification is true. Two estimation systems for the magnitude of sub-notification are proposed, one based in the expected lethality and the other in the corrected hospital discharges, taking into account the phenomenon of re-admission. Both systems, although differing, disclose much higher incidence of hydatidosis than the communicated figure. A critical analysis of both systems is done