Quality of life after upper third molar removal: A prospective longitudinal study.

BACKGROUND: Third molar extraction is a very common procedure in Dentistry. The aim of this study was to evaluate the quality of life (QoL) and satisfaction of patients undergoing extraction of an upper third molar under local anesthesia. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after surgery and its relationship with pre- and intraoperative factors. MATERIAL AND METHODS: A prospective longitudinal cohort study was made. Fifty-five patients received a questionnaire assessing social and working isolation, eating and speaking ability, diet modifications, sleep impairment, physical appearance, discomfort at suture removal and overall satisfaction. Pain was registered daily on a VAS scale. A descriptive and bivariate analysis of the data was performed. RESULTS: Forty-seven patients were included. Pain decreased lineally across the 7 days, and relief was significant between days 2 and 3. Intraoperative complications were significantly associated with pain. The complication that showed the highest pain score was the tuberosity fracture. CONCLUSIONS: Upper third molar removal significantly affects the patient's quality of life, particularly during the first 2 days after extraction.

Foliar potassium nitrate application improves the tolerance of Citrus macrophylla L. seedlings to drought conditions.

Scarcity of water is a severe limitation in citrus tree productivity. There are few studies that consider how to manage nitrogen (N) nutrition in crops suffering water deficit. A pot experiment under controlled-environment chambers was conducted to explore if additional N supply via foliar application could improve the drought tolerance of Citrus macrophylla L. seedlings under dry conditions. Two-month-old seedlings were subjected to a completely random design with two water treatments (drought stress and 100% water/field capacity). Plants under drought stress (DS) received three different N supplies via foliar application (DS: 0, DS + NH4NO3: 2% NH4NO3, DS + KNO3: 2% KNO3). KNO3-spraying increased leaf and stem DW as compared with DS + NH4NO3 and DS treatments. Leaf water potential (Ψw) was decreased by drought stress in all the treatments. However, in plants from DS + NH4NO and DS + KNO3, this was due to a decrease in the leaf osmotic potential, whereas the decrease in those from the DS treatment was due to a decrease in the leaf turgor potential. These responses were correlated with the leaf proline and K concentrations. DS + KNO3-treated plants had a higher leaf proline and K concentration than DS-treated plants. In terms of leaf gas exchange parameters, it was observed that net assimilation of CO2 [Formula: see text] was decreased by drought stress, but this reduction was much lower in DS + KNO3-treated plants. Thus, when all results are taken into account, it can be concluded that a 2% foliar-KNO3 application can enhance the tolerance of citrus plants to water stress by increasing the osmotic adjustment process.

A retrospective database study of insulin initiation in patients with Type 2 diabetes in UK primary care.

AIMS: This study characterized UK primary care patients with Type 2 diabetes who initiated insulin treatment, and described the initial insulin regimens used, overall metabolic changes and health-care resource usage. METHODS: A retrospective cohort study was performed using quality-checked patient data from The Health Improvement Network database. Eligible patients who initiated insulin for the first time between 2004 and 2006 were grouped into four cohorts according to the type of insulin regimen initiated. Data on patient characteristics, metabolic and clinical outcomes and health-care resource use were collected at baseline and during 6 months of follow-up. RESULTS: In total, 4045 eligible adults [2269 male, 1776 female; mean age 62.6 ± 13.3 years; mean baseline HbA(1c) 82 ± 22 mmol/mol (9.6% ± 2.0%)] initiated insulin. Approximately half (52.4%) initiated insulin as basal insulin only, 41.6% as premixed only, 4.0% as basal-bolus and 2.1% as prandial insulin only. Among patients with ≥ 180 days follow-up (n=3815), the initial insulin regimen was not changed during follow-up in 75.1% of patients, while 13.7% discontinued, 7.0% switched and 4.7% intensified insulin therapy. The mean change in HbA(1c) was -14 mmol/mol (-1.3%, n=2881), with 17.3% of patients achieving an HbA(1c) of <53 mmol/mol (7%, n=3024). The mean weight change was +0.9 kg (n=2345). CONCLUSIONS: Basal and premixed insulin were the most common types of insulin initiated and in most patients no changes were made to the initial regimen over 6 months. However, few patients achieved glycemic control targets.

[Obstructive symptoms in young woman by left hydrosalpinx]. / Sintomatología obstructiva en mujer joven por hidrosalpinx izquierdo.

We describe the case of a 43 years old woman with obstructive and irritative symptoms after having an hysterectomy. Bladder outlet obstruction was observed in an urodinamyc study. She was later diagnosed with left hidrosalpinx. Salpingectomy was performed, as a result all symptoms have disap-

Comparación de la amplificación del DNA por PCR y los métodos clásicos para detectar el Mycobacteri um Leprae en diferentes tipos de muestras clinicas en paciente y contactos de lepra

Se han comparado en distintas muestras clínicas (suero, frotis cutáneos, biopsias y torundas) los métodos convencionales de tincion y examen microscópico de la muestra con las técnicas de Biología Molecular de amplificación DNA para la reacción en cadena de la polimerasa (PCR) de un fragmento de 531 bp de un gen M. leprae específico que codifica el antígeno 36 kDa y los antígenos M. leprae específicos (PG-1 y D-BSA) para determinaciones serológicas. Se dividieron los 60 pacientes del estado en varios grupos: (i) 20 pacientes multibacilares (MB) con índices bacteriológicos positivos (IB) por métodos convencionales y en tratamiento farmacológico (MDT), recomendado por la OMS, (ii) 30 pacientes MB con IB negativos y que han completado 2 años mínimo de multiterapia OMS; (iii) 10 pacientes paucibacilares que completaron 6 meses de MDT hace ya, al menos, 8 años. El grupo control incluye 4 no-pacientes de lepra con métodos PCR y 40 controles sanos y 10 pacientes de tuberculosis para evaluar las determinaciones serológicas.En el grupo multibacilar IB positivo, se detectó una buena correlación entre todos los métodos. Todas las técnicas resultaron negativas para el grupo paucibacilar. Aunque haya que tener en cuenta que es un grupo muy reducido y con muchos años de tratamiento, hay que ser muy cauto con la utilidad potencial de estas técnicas más modernas. También, se evaluaron distintas combinaciones de métodos diagnóstico para la lepra, para determinar el riesgo potencial en un grupo de contactos de pacientes de lepra. Se evaluaron la prevalencia de anticuerpos frente a antígenos M. leprae específico en suero junto a la detección de DNA M. leprae nasal, y respuesta a la lepromina en un grupo de 43 controles de pacientes de lepra (12 convivientes y 31 contacto ocupacional) para analizar su valor en el mantenimiento de los reservorios de infecciones y transmisión de la enfermedad. Se encontraron 2 individuos que formarían un grupo de alto riesgo potencial (AU)

Comparison of PCR mediated amplification of DNA and the classical methods for detection of Mycobacterium leprae in different types of clinical samples in leprosy patients and contacts.

Traditional staining and microscopic examination techniques for the detection of Mycobacterium leprae, DNA amplification by polymerase chain reaction (PCR) of a 531-bp fragment of the M. leprae specific gene encoding the 36-kDa antigen, and serodiagnosis with M. leprae specific antigens (PGL-1 and D-BSA) were compared on different clinical specimens (serum samples, slit-skin smears, biopsies and swabs) from 60 leprosy patients attending the Sanatorium of Fontilles. Patients were divided into groups; (i) 20 multibacillary patients (MB) with positive bacteriological index (BI) by conventional methods and on WHO multidrug therapy (MDT); (ii) 30 MB patients with negative BI and completed minimum 2 years treatment MDT; (iii) 10 paucibacillary (PB) patients who had completed 6 months MDT at least 8 years ago. Control groups included four non-leprosy patients for PCR methods and 40 health control patients and 10 tuberculosis patients for serological methods. In the multibacillary BI positive group, there was a good correlation between all methods. All tests were negative in the paucibacillary group, although only a few patients were tested and all had been treated many years ago. One must be cautious concerning the diagnostic potential of these techniques in this type of leprosy. We also studied different combinations of leprosy diagnosis methods to determine the potential risk in a leprosy contact individuals group. The prevalence of antibodies to M. leprae antigens in serum was measured, together with the presence of M. leprae DNA in the nose and lepromin status in a group of 43 contacts of leprosy patients (12 household and 31 occupational) to evaluate the maintenance of infection reservoirs and transmission of the disease. Only two individuals were found to form a potential high risk group.

Survival of Pantoea agglomerans strain CPA-2 in a spray-drying process.

Spray drying could be a suitable method for preserving microorganisms, as it allows large quantities of cultures to be dried at low cost. The aims of this paper were to evaluate the effects of spray-drying conditions on survival of the biocontrol agent Pantoea agglomerans CPA-2, which has shown antifungal activity against Penicillium expansum and Penicillium digitatum on citrus fruits. Various compounds cited in the bibliography as carriers were tested in our spray drying, and some salts (MgSO4, K2SO4. and Na2CO3) and dairy products (lactoserum or nonfat skimmed milk [NFSM]) showed the best results in terms of recovered powder. Outlet temperature had more influence on the death of bacteria than inlet temperature. P. agglomerans was heat sensitive, and the activation energy was around 6 kcal/mol K when MgSO4 (10%) or NFSM (10%) were used as carriers and only 3 kcal/mol K when the combination of MgSO4 (10%) and NFSM (10%) was used. The highest powder recovery was obtained when NFSM was used as the rehydration medium. Although the percentage of powder recovery was not high (around 50%) and viability was low, the results suggest that with bigger spray dryers, we could expect a lower outlet temperature and probably an increased viability. Further research into spray-dryer design is needed in order to demonstrate this.

Atención al paciente con cáncer en fase terminal en el domicilio / Home care for terminal cancer patients

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Utilización de medicamentos en pacientes atendidos a través del servicio de hospitalización domiciliaria / Medication utilization in patients admitted to a domiciliary hospitalization unit

La hospitalización domiciliaria (HD) constituye un sistema de atención sociosanitaria alternativa a la hospitalización tradicional que resulta coste-efectiva. El objetivo del presente trabajo es estudiar la utilización de medicamentos en la unidad de HD, tomando como unidad de medida el número de DDD/100 estancias, así como identificar los tipos de pacientes más frecuentemente atendidos y establecer una relación con el consumo de medicamentos y el coste de los mismos. Para ello se ha realizado un estudio prospectivo de los pacientes ingresados en esta unidad durante el período enero-marzo de 1999. Se utilizó con este fin una hoja de recogida de datos que fue completada a partir de las epicrisis de los pacientes a su ingreso en HD, y cuando fue necesario, a partir de la historia clínica. También se obtuvieron los consumos de medicamentos por paciente a partir del módulo de dosis unitarias Farmasyst-APD y los datos de consumo global y coste a partir del módulo de gestión. En total se analizaron 130 ingresos (correspondientes a 125 pacientes con una media de edad de setenta y tres años). La media de diagnósticos por ingreso fue de 2,4 y el número de estancias por ingreso de dieciocho días. El coste por ingreso fue de 11.542 pesetas y el coste por estancia de 641 pesetas. Las patologías de mayor frecuencia de presentación fueron neoplasias, enfermedades respiratorias (infecciones, síndromes obstructivos, insuficiencia respiratoria) y enfermedades cardiovascu¡ares (insuficiencia cardiaca y cardiorrespiratoria, accidentes cardiovasculares, etc.). El número de DDD/100 estancias por grupo terapéutico puede desglosarse de la siguiente forma, por orden de mayor a menor: grupo respiratorio: 33,4; grupo digestivo: 24,5; grupo terapia hormonal (corticoides): 21,1; grupo cardiovascular: 14,2; grupo sistema nervioso (incluyendo analgésicos): 10,0; grupo antiinfecciosos: 7,5; grupo sangre y órganos hematopoyéticos: 4,0, y grupo dietéticos: 0,55. (AU)

The statistical distribution of wrist movements during sleep.

The purpose of this work was to describe the basic statistical properties of the process of production of movements measured with a wrist actimeter, along a complete sleep period in normal human subjects. Two distinct types of random magnitudes were considered to analyze the data, the times between successive groups of movements and the number of movements at each fixed time (1 min) measurement epoch. Suitable probabilistic models for the two variates were chosen, fitting theoretical distribution functions to the observed data. It is concluded that interval data fit a one-parameter exponential distribution, while the number of movements fit a two-parameter negative binomial distribution. The estimated values of these parameters, besides being necessary to perform further statistical analysis, are a measure of the intensity and frequency of the movements. Finally the relationship between polysomnography measures and the elicited parameters was studied.

[The assessment of cardiac involvement in a case of a thoracic injury from a firearm]. / Valoración de la afectación cardíaca en un caso de herida torácica por arma de fuego.

We report the case of a patient with a gunshot wound in the chest with a multiple small-caliber intrathoracic projectiles. The different noninvasive techniques employed to evaluate the anatomical location of these projectiles are discussed, together with their cardiac structural repercussions. The data provided by a simple chest X-ray, Computed Tomography (CT) and transthoracic echocardiography are commented on. A simple chest X-ray was unable to discern the location of the projectiles, in contrast to CT, which was able to identify both the number of projectiles and their location. The information provided was enhanced by transthoracic echocardiography, particularly in relation to those projectiles situated in anterior cardiac regions.

Perfusión Doppler con laser ionfrarrojo y cercano al rojo en manos de pacientes de lepra en España

Se ha empleado una nueva técnica de perfusión Doppler con láser a las longitudes de onda, rojo (663 nm) y cercano al rojo (780 nm) para obtener imágenes del flçujo sanguíneo de los dedos de pacientes de lepra y vonluntarios sanos en el Sanatorio de Fontilles. La técnica permite medir el flujo en las estructuras dérmicas y subdérmicas y podría ser útil para localizar deterioro microcirculatorio. Se pueden medir niveles muy elevados de riego en la pulpa de los dedos a la temperatura ambiente de Fontilles (23-6.ºC), ya debido a una abundante anastomosis arteriovenosa, desempeñan un papel termorregulador. Sin embargo en muchos pacientes, incluyendo los que no presentan un compromiso clínico en las manos, el riego sanguíneo y temperaturas cutáneas estaban significativamente reducidas, confirmando hallazgos previos en pacientes de lepra en India e Iran. Los hallazgos preliminares indican que estas disminuciones de riego no están localizadas a una región anatómica pero pueden afectar todos los dedos evaluados de un individuo sugiriendo un deterioro más generalizado de la función termoregulatoria. Mientras que esto puede implicar un mecanismo central, también se podría explicar por una vasculitis sub-cutánea continua de los dedos. Nuestros trabajos anteriores indicando una asociación entre pérdida de sensación y reducción del flujo sanguíneo, también sugieren factopres neurales como una depleción de neuropéptidos sensorilaes.

Phase advancement of slow-wave sleep in a patient with periodic hypersomnia.

Twenty-four-hour polysomnographic recordings were obtained during asymptomatic (ASP) and symptomatic (SP) periods in a patient with periodic hypersomnia. During both periods, an abnormal sleep architecture was detected, with a greater sleep fragmentation during the SP. An unexpected finding was a shortening of the latency of slow-wave sleep, with a difference of more than 5 hours between the ASP and the SP. The greater fragmentation of rapid eye movement sleep during the SP may suggest a disorganization of the ultradian rhythm of rapid eye movement sleep.

Effects of rHuEPO on Q-EEG and event-related potentials in chronic renal failure.

Quantitative electroencephalography is a powerful tool to evaluate brain function, and preliminary data have shown its usefulness in the evaluation of patients with chronic renal failure (CRF). In this study, baseline values of different quantitative EEG variables, as well as data from the P300 component of the visual event-related potential, in 43 patients with chronic renal failure, were compared with those of a group of healthy subjects and with the results obtained after 3, 6, 9 and 12 months of treatment of these patients with rHuEPO. Baseline total power was much lower in patients with CRF than in healthy subjects, and the distribution of power among the frequency bands was also abnormal. rHuEPO promptly normalized total power and progressively improved power distribution, although full normality was not achieved. Mean dominant frequencies in brain areas were abnormal in patients with CRF, and progressive improvement was seen along the study. The latency of P300, which was increased before treatment, decreased in all subjects, but normal values were not reached. The same applies to the hypomanic and psychopathic scores of psychological tests. Altogether, brain dysfunction of CRF seems to substantially improve by treatment of the anemia with rHuEPO.