Potential Association of Molar-Incisor Hypomineralization (MIH) with Dental Agenesis and Infraoccluded Deciduous Molars: Is MIH Related to Dental Anomaly Pattern (DAP)? An Observational Cross-Sectional Study.

Background: Dental Anomaly Pattern (DAP) is a collection of morphologic, numeric, and eruptive anomalies of teeth that are often observed together, suggesting a potential genetic relationship. Our objective was to assess the potential associations of Molar-Incisor Hypomineralization (MIH), a common developmental defect of enamel mineralization with a controversial etiology, with two specific components of DAP: (1) agenesis (AG) and (2) infraoccluded deciduous molars (IODM). Establishing such an association between MIH and one or both anomalies would provide evidence supporting a genetic link between MIH and DAP. Methods: We examined pretreatment intraoral standardized photographies and panoramic radiographs from 574 children aged 8-14 years, 287 having MIH and 287 without MIH, comparing the frequencies of AG and IODM in both groups. The subject samples were sourced from the databases of the orthodontic department at a university hospital. Results: The frequencies of AG in the MIH and non-MIH groups were 7% and 8%, respectively (p = 0.751). The corresponding frequencies of IODM were 27% and 19.2%, respectively (p = 0.082). That is, children with MIH did not exhibit an increased frequency of AG or IODM compared to those without MIH. Conclusions: These findings do not support the inclusion of MIH in DAP. Nevertheless, further analysis of possible associations is necessary to definitively validate or invalidate this hypothesis.

Predictive Value of Hypomineralization of Second Primary Molars for Molar Incisor Hypomineralization and Other Relationships between Both Developmental Defects of Dental Enamel.

Molar incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM) are dental enamel developmental defects with significant prevalence and psychophysical impact, posing a public health concern. We examined the relationship between HSPM and MIH in 426 children aged 7 to 10 years (213 with MIH, 213 without MIH). The frequency of HSPM was higher in children with MIH (37.1% vs. 11.3%, p < 0.001). However, there was no correlation between MIH severity and presence of HSPM (p = 0.296). In patients with both defects (n = 79), 90% of severe MIH cases were associated with severe HSPM, while 87.8% of mild MIH cases were associated with mild HSPM (p < 0.001). The involvement of permanent incisors by MIH was not influenced by the presence of HSPM or HSPM severity. HSPM exhibited a positive predictive value of 76.7, negative predictive value of 58.8, sensitivity of 37.1% (95% CI = 30.6-43.6%), and specificity of 88.7% (95% CI = 84.5-93%). The odds ratio for MIH based on HSPM was 4.64 (95% CI). HSPM may serve as a predictor of MIH, but its absence does not rule out the occurrence of MIH. The results highlight the need for surveillance programs in children presenting with HSPM to facilitate early diagnosis and preventive measures for MIH-related complications.

Parámetros bioquímicos y biometría hemática de pacientes con COVID-19 moderado y grave en terapia intensiva de un hospital básico de Ecuador / Biochemical parameters and blood count of patients with moderate and severe COVID-19 in intensive care at a basic hospital in Ecuador

La infección por COVID-19 se presenta principalmente de forma leve y grave, ésta última hace necesaria la hospitalización y soporte respiratorio por complicaciones como el síndrome respiratorio agudo severo (SARS), cuyo curso clínico ha sido ampliamente descrito; sin embargo, la alteración de los perfiles de laboratorio no ha sido establecida de manera precisa. Se realizó un estudio retrospectivo para determinar parámetros bioquímicos y biometría hemática en 32 pacientes con COVID-19 moderado y grave, recluidos en el Hospital Básico "Raúl Maldonado Mejía" de Cayambe, Ecuador y evaluar su utilidad como indicadores de gravedad. Se revisaron las historias clínicas, obteniendo datos clínicos, bioquímicos y hematimétricos. Se observó mayor proporción de casos COVID moderado y grave en hombres, y de la forma grave en ambos géneros, con un promedio de edad entre 45-73 años. Las comorbilidades más frecuentes fueron: hipertensión arterial (HTA), diabetes mellitus tipo 2 (DM2), insuficiencia cardíaca congestiva (ICC) y obesidad. Los parámetros bioquímicos y hematimétricos con peor pronóstico para gravedad fueron: elevación de la actividad de lactato deshidrogenasa (LDH), alanina aminotranferasa (ALT), aspartato aminotranferasa (AST), niveles de proteina C reactiva (PCR), prolongación del tiempo de protrombina (TP), contaje total de leucocitos, índice neutrófilo/linfocito (INL) y disminución de linfocitos. Los parámetros bioquímicos (LDH, PCR, ALT, AST), de coagulación (TP) y hematimétricos (recuento de leucocitos, linfocitos e INL), pueden ser útiles indicadores de gravedad en pacientes con COVID-19, permitiendo identificar precozmente pacientes con enfermedad moderada y evitar el desarrollo de la forma más severa de la enfermedad y sus complicaciones(AU)

COVID-19 infection occurs mainly in mild and severe forms, the latter requiring hospitalization and respiratory support due to complications such as severe acute respiratory syndrome (SARS), the clinical course of which has been widely described; however, the alteration of laboratory profiles has not been precisely established. A retrospective study was carried out to determine biochemical parameters and blood counts in 32 patients with moderate and severe COVID-19, confined at the "Raúl Maldonado Mejía" Basic Hospital in Cayambe, Ecuador, and to evaluate their usefulness as indicators of severity. Medical records were reviewed. , obtaining clinical, biochemical and hematometric data. A higher proportion of moderate and severe COVID cases was observed in men, and the severe form in both genders, with an average age between 45-73 years. The most frequent comorbidities were: arterial hypertension (HTA), type 2 diabetes mellitus (DM2), congestive heart failure (CHF) and obesity. The biochemical and blood count parameters with the worst prognosis for severity were: elevation of lactate dehydrogenase (LDH) activity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP) levels, prothrombin time (PT) prolonged, total leukocyte count, ne index utrophil/lymphocyte (INL) and decreased lymphocytes. Biochemical parameters (LDH, CRP, ALT, AST), coagulation (PT) and blood counts (leukocyte count, lymphocytes and INL) can be useful indicators of severity in patients with COVID-19, allowing early identification of patients with moderate disease and avoid the development of the most severe form of the disease and its complications(AU)

Cambios en el perfil de las urgencias atendidas por un dentista de guardia 24 horas durante las etapas iniciales de la primera ola de COVID-19 / Changes in urgent dental care provided by a 24-hour on-call dentist during the first wave of the covid-19 pandemic

OBJETIVO: Comparar la asistencia urgente prestada por un dentista de guardia 24 horas a dos grupos de pacientes en dos periodos de la primera ola de Covid-19 en Madrid: durante el confinamiento de la población y cierre de la mayoría de las clínicas dentales y una vez levantado el confinamiento y reabiertas las clínicas. MÉTODO: En ambos grupos se compararon edad y sexo, tiempo transcurrido desde el comienzo de los síntomas, frecuencia de citas nocturnas, frecuencia y duración de tratamientos médicos previos, patologías objeto de consulta y tratamientos realizados. RESULTADOS: En el primer periodo (45 días) se vieron 187 pacientes y en el segundo (19 días), 94 (4.15 y 4.8 pacientes/día, respectivamente). El tiempo transcurrido desde el comienzo de los síntomas en ambos periodos fue 10+/1 y 3+/-1 días. Habían recibido tratamiento antibiótico/antiinflamatorio previo el 80% y el 30% de los pacientes, respectivamente. El diagnóstico más frecuente en el primer periodo fue inflamación pulpar (p = 0.001) y en el segundo, pulpitis irreversible (p < 0.05). En el primer periodo se realizaron más extracciones (58.7% vs 41.5%, p < 0.05) y en el segundo más endodoncias (8.5% vs 2.1%, p < 0.05) y tratamientos farmacológicos (19.1% vs 9.6%, p < 0.05). CONCLUSIONES: Durante el segundo periodo de la primera ola de COVID-19, cuando el confinamiento se levantó y se reabrieron las clínicas, la atención dental urgente cambió con respecto a las primeras 6 semanas de confinamiento estricto, tanto en el perfil de la patología, como en los tratamientos realizados que fueron más conservadores

AIM: To compare urgent dental care provided by a general dentist 24-hours on-call at two early stages of the first wave of Covid-19 pandemic in Madrid (Spain): during the lockdown of the population and closure of most dental clinics, and once the lockdown was relaxed and dental offices partially reopened. METHOD: In both groups we compared demographic data, time elapsed from onset of symptoms, rate of late-night appointments, proportion of patients receiving pharmacologic treatment and frequencies of the pathologies causing the consultation and treatments performed. RESULTS: In the first and second stages -45 and 19 days respectively- 187 and 94 patients, (4.15 and 4.8 patients/day, respectively) were seen. The time elapsed from onset of symptoms was 10+/1 days in the first group and 3+/-1 days in the second, while 80% and 30% of patients were receiving some medical treatment respectively. Pulpal inflammation predominated in the first stage (p = 0.001) and irreversible pulpitis in the second (p < 0.05). Extractions were more frequent in the first stage (58.7% vs 41.5%, p < 0.05), and root canal therapy (8.5% vs 2.1%, p < 0.05) and pharmacological treatment (19.1% vs 9.6%, p < 0.05) in the second. CONCLUSION: During the second stage of the first wave of COVID-19 pandemic, once lockdown was partially relaxed, significant differences were observed in urgent dental care compared with the first six weeks of the pandemic, both in the profile of the pathology and the treatments provided, which were more conservative

Changes in orthodontics during the COVID-19 pandemic that have come to stay.

The coronavirus disease 2019 pandemic will have a long-lasting impact on orthodontic practice. Some of the adaptations needed will improve the orthodontist's line of work when the pandemic will be defeated, but others will not be sufficiently cost-effective. These changes concern 4 areas of orthodontic practice: (1) microbiologic control measures, with increased use of personal protective equipment, stricter protocols inside and outside of the clinical area, and minimization of procedures that generate aerosols; (2) social distancing measures by redistributing spaces and decreasing the number of patients and companions in the clinics; (3) increasing teleorthodontics and use of appliances and techniques that require fewer scheduled and urgent appointments; and (4) bioethical considerations that promote a broader view of the psychosocial aspects of patients, their families, and the community. Some of these important adaptations, implemented while we are still suffering the effects of the pandemic, may be reversible, but others have come to stay.

Enfermedad de Pompe: detección de portadores en un estado del sureste de México: reporte de un caso / Pompe disease: carrier detection in a southeastern state of Mexico: a case report

Resumen ANTECEDENTES: La enfermedad de Pompe es un padecimiento autosómico recesivo del metabolismo del glucógeno causado por la deficiencia parcial o total de la enzima lisosomal alfa-glucosidasa ácida (GAA). Su incidencia es variable y depende de la región geográfica y el origen étnico. OBJETIVO: Reportar un caso de mutación previamente descrita en población mexicana relacionada con enfermedad de Pompe. CASO CLÍNICO: Paciente de 21 años, llegó al servicio de Genética enviada de un centro de salud por el antecedente de dos muertes perinatales. En la evaluación de la pareja se encontraron antecedentes de importancia de consanguinidad (primos hermanos) y ginecoobstétricos: dos embarazos, dos partos y dos muertes perinatales por miocardiopatía de causa desconocida. Las ecografías de los embarazos previos no reportaron alteraciones, tampoco en la exploración física. Debido a los antecedentes se decidió la búsqueda de portadores de la enfermedad de Pompe en la rama materna. CONCLUSIÓN: Se tomaron en consideración la detección y diagnóstico de portadores de errores innatos del metabolismo debido a los antecedentes recopilados en la historia clínica (muertes perinatales, consanguinidad). Se reporta una mutación previamente descrita en población mexicana relacionada con la enfermedad de Pompe.

Abstract BACKGROUND: Pompe's disease is an autosomal recessive disease of glycogen metabolism; caused by partial or total deficiency of the lysosomal enzyme alpha-glucosidase acid (GAA). Its incidence is variable and depends on the geographical region and ethnicity. OBJECTIVE: Report a case of previously described mutation in Mexican population related to Pompe disease. CLINICAL CASE: A 21-year-old female who attends first-time genetics services, with reference to a health center due to a history of two perinatal deaths. An evaluation of the couple is performed, with a history of the importance of consanguinity (first cousins), a gynecoobstetric history: pregnancy 2, births 2. Two perinatal deaths due to cardiomyopathy of unknown cause. Ultrasound findings of previous pregnancies, without report of alterations. A physical examination of both patients, without phenotypic alteration. Due to the aforementioned background, it is decided to search for carriers of Pompe disease in the maternal branch. CONCLUSION: In this case the detection and diagnosis of carriers of inborn errors of metabolism, the antecedents collected in the clinical history (perinatal deaths, consanguinity) were taken into consideration. Publicizing a mutation previously described in the Mexican population, which is related to Pompe disease.

Displasia fibromuscular en la Argentina. Registro del grupo de trabajo de Hipertensión Secundaria de la Sociedad Argentina de Hipertensión Arterial (SAHARA-DF): proyecto de protocolo y resultados preliminares / Fibromuscular dysplasia in Argentina. A registry from the Secondary Hypertension working group of the Argentine Society of Hypertension (SAHARA-DF): project protocol and preliminary results

En la Argentina no existen datos epidemiológicos sobre displasia fibromuscular. La realización de un registro nacional puede aportar información que conduzca a una actualización de los consensos y recomendaciones para un correcto diagnóstico, evaluación y tratamiento. El Registro Argentino de Displasia Fibromuscular (SAHARA-DF) inició su actividad de recopilación de datos en octubre de 2015. Al año 2019 se confirmaron 49 pacientes (44 mujeres, 38 hipertensos, edad 45,3 ± 17,2 años, 12 con presentación neurológica). Veintidós pacientes tuvieron lesiones vasculares en más de un sitio, a pesar del sesgo diagnóstico por falta de estudios complementarios en casi la mitad de los casos. El sitio afectado más frecuente fue el renovascular, seguido por el carotídeo y el ilíaco, y las lesiones multifocales fueron más frecuentes que las unifocales (35 versus 14, respectivamente). Se constató la presencia de aneurismas asociados en 13 casos y disección arterial en 4 casos. De las 22 angioplastias renales realizadas, 14 fueron con colocación de stent (endoprótesis). En este estudio preliminar de una población argentina se evidencia el carácter sistémico de la enfermedad y se plantea un llamado a actuar en cuanto a la necesidad de debatir el algoritmo diagnóstico y el método de tratamiento. (AU)

In Argentina there are no epidemiological data regarding fibromuscular dysplasia. Building a National Registry may provide information leading to updated consensus and recommendations for a correct diagnosis, assessment and treatment. Data gathering for the Argentine Registry of Fibromuscular Dysplasia (SAHARA-DF) was initiated in October 2015. By 2019, 49 patients were confirmed (44 women, 38 hypertensives, age 45.3 ± 17.2 years, 12 with a neurological presentation). Twenty-two patients had multi-site vascular lesions, in spite of a diagnosis bias due to lack of supporting studies in almost half of the cases. The renovascular site was the most affected, followed by the carotid and iliac sites, and multifocal lesions were more frequent than unifocal (35 versus 14, respectively). Associated aneurysms were found in 13 cases, and arterial dissection in 4. Twenty-two renal angioplasties were performed, 14 with stent placement. In this preliminary study of an Argentinian population, the systemic nature of the disease is evidenced, and a call for action arises regarding the need for discussing the diagnostic algorithm and treatment method. (AU)

Comparing Office, Central, Home and Ambulatory Blood Pressure in Predicting Left Ventricular Mass / Comparación entre presión arterial de consultorio, central, domiciliaria y ambulatoria para predecir masa ventricular izquierda

The blood pressure measurement method that more accurately predicts a left ventricular mass is controversial, and the evidence suggesting superiority of central over brachial measurements is contradictory. The aim of this study was to compare the relationship between the different clinic and out-of-clinic blood pressure measurements methods with left ventricular mass in patients who attended a specialised hypertension centre for a central blood pressure measurement. An analysis was performed on the correlations between left ventricular mass and central and brachial blood pressure measurements made in the clinic, and home, as well as 24-h systolic blood pressure measurements. A linear regression analysis was then performed to assess the independent relationship of each blood pressure measurement with left ventricular mass. The results on 824 treated and 123 untreated patients showed no significant differences between correlations, although home readings tended to have the best correlations. In regression adjusted models, for each 10 mmHg increase in systolic home blood pressure the left ventricular mass increased 10 g/m2 (95% CI; 3.7-27, p=.01, adjR2 0.38), and for 24-h ambulatory systolic blood pressure it increased 2.3 g/m2 (95% CI 0.76-3.9, p<.01, adjR2 0.15) in treated and untreated patients, respectively. The association of systolic blood pressure with left ventricular mass was better explained by home and 24-h ambulatory monitoring than to clinic-based measurements in treated and untreated patients, respectively. In the clinic, however, the central measurement was not superior to brachial blood pressure

Existe controversia sobre qué método de medición de presión arterial predice más precisamente la masa ventricular izquierda. La evidencia que sugiere superioridad de las mediciones centrales sobre las braquiales resulta contradictoria. Nuestro objetivo fue comparar la asociación de diferentes formas de medir la presión dentro y fuera del consultorio con masa ventricular izquierda en pacientes que asistieron a un centro especializado en hipertensión a medirse la presión central. Analizamos las correlaciones entre masa ventricular izquierda y presión sistólica a nivel central y braquial en consultorio, en el domicilio y ambulatoria de 24h. Luego realizamos un análisis de regresión lineal para evaluar la asociación independiente de cada método con la masa ventricular izquierda. Como resultado, en 824 pacientes tratados y 123 no tratados las diferencias entre correlaciones no fueron significativas, aunque las lecturas tomadas fuera del consultorio tuvieron mejores asociaciones. En los modelos ajustados, por cada 10mmHg de aumento en la presión sistólica domiciliaria la masa ventricular aumentó 10g/m2 (IC 95%: 3,7-27; p=0,01; R2aj: 0,38), y para la presión sistólica ambulatoria de 24h aumentó 2,3g/m2 (IC 95%: 0,76-3,9; p<0,01; R2aj: 0,15) en pacientes tratados y no tratados, respectivamente. La asociación de la presión arterial sistólica con masa ventricular izquierda fue explicada mejor por el monitoreo domiciliario y ambulatorio de 24h, más que con las mediciones de consultorio en pacientes tratados y no tratados, respectivamente. En el consultorio, sin embargo, la presión central no fue superior a la braquial

Comparing Office, Central, Home and Ambulatory Blood Pressure in Predicting Left Ventricular Mass.

The blood pressure measurement method that more accurately predicts a left ventricular mass is controversial, and the evidence suggesting superiority of central over brachial measurements is contradictory. The aim of this study was to compare the relationship between the different clinic and out-of-clinic blood pressure measurements methods with left ventricular mass in patients who attended a specialised hypertension centre for a central blood pressure measurement. An analysis was performed on the correlations between left ventricular mass and central and brachial blood pressure measurements made in the clinic, and home, as well as 24-h systolic blood pressure measurements. A linear regression analysis was then performed to assess the independent relationship of each blood pressure measurement with left ventricular mass. The results on 824 treated and 123 untreated patients showed no significant differences between correlations, although home readings tended to have the best correlations. In regression adjusted models, for each 10 mmHg increase in systolic home blood pressure the left ventricular mass increased 10 g/m2 (95% CI; 3.7-27, p=.01, adjR2 0.38), and for 24-h ambulatory systolic blood pressure it increased 2.3 g/m2 (95% CI 0.76-3.9, p<.01, adjR2 0.15) in treated and untreated patients, respectively. The association of systolic blood pressure with left ventricular mass was better explained by home and 24-h ambulatory monitoring than to clinic-based measurements in treated and untreated patients, respectively. In the clinic, however, the central measurement was not superior to brachial blood pressure.

Prevalence and related factors of office and home hypotension in older treated hypertensive patients.

BACKGROUND: Older hypertensive adults under treatment are especially susceptible to hypotensive episodes, which entail an elevated risk. However, data on this subject are very scarce. AIM: The purpose of this study was to determine the prevalence and predictors of office and home hypotension in older (≥ 65 years) treated hypertensive adults. METHODS: Blood pressure (BP) was measured at the office and at home, using a validated oscillometric device. Office and home hypotension were defined as systolic BP (SBP) < 110 and/or diastolic BP (DBP) < 70 mmHg, and SBP < 105 and/or DBP < 65 mmHg, respectively. Masked hypotension was considered when office BP ≥ 110/70 and home BP < 105 and/or < 65 mmHg. We evaluated factors associated with hypotension both at the office and at home through multivariable models. RESULTS: The prevalence of hypotension among the 302 patients included in the study was 29.8% at the office and 23.9% at home, whereas the prevalence of masked hypotension was 10.4%. Older age, lower body mass index and use of calcium channel blockers were associated with office hypotension, while older age, diabetes and ischemic heart disease were predictors for home hypotension. CONCLUSION: Hypotension is frequent in older hypertensive adults under treatment. The presence of diabetes, ischemic heart disease and older age should alert for screening of hypotension at home to avoid overtreatment.

Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation.

Exaggerated orthostatic blood pressure variation (EOV) is a poorly understood phenomenon related to high cardiovascular risk. We aimed to determine whether hypertensive patients with EOV have a distinct hemodynamic pattern, assessed through impedance cardiography. METHODS: In treated hypertensive patients, we measured the cardiac index (CI), systemic vascular resistance index (SVRI), blood pressure (BP), and heart rate (HR) in the supine and standing (after 3 minutes) positions, defining three groups according to BP variation: 1) Normal orthostatic BP variation (NOV): standing systolic BP (stSBP)-supine systolic BP (suSBP) between -20 and 20 mmHg and standing diastolic BP (stDBP)-supine diastolic BP (suDBP) between -10 and 10 mmHg; 2) orthostatic hypotension (OHypo): stSBP-suSBP≤-20 or stDBP-suDBP≤-10 mmHg; 3) orthostatic hypertension (OHyper): stSBP-suSBP≥20 or stDBP-suDBP≥10 mmHg. We performed multivariable analyses to determine the association of hemodynamic variables with EOV. RESULTS: We included 186 patients. Those with OHyper had lower suDBP and higher orthostatic SVRI variation compared to NOV. In multivariable analyses, orthostatic HR variation (OR = 1.06 (95%CI 1.01-1.13), p = 0.03) and orthostatic SVRI variation (OR = 1.16 (95%CI 1.06-1.28), p = 0.002) were independently related to OHyper. No variables were independently associated with OHypo. CONCLUSION: Patients with OHyper have a distinct hemodynamic pattern, with an exaggerated increase in SVRI and HR when standing.

Validation of a new piezoelectric device for noninvasive measurement of central aortic systolic blood pressure.

OBJECTIVE: The objective of this study was to compare the aortic piezoelectric device for noninvasive measurement of central aortic systolic blood pressure (cSBP) with the SphygmoCor. PARTICIPANTS AND METHODS: A total of 85 participants from both sexes, aged 18-80 years, were stratified into three age groups (<30, 30-60, >60 years), with an equal number of healthy volunteers and hypertensive patients. We performed three cSBP measurements with each device, in an alternate manner, using the Bland-Altman method to determine the level of agreement. The standard of the Association for the Advancement of Medical Instrumentation for brachial blood pressure evaluation was used for the comparison. RESULTS: The mean cSBPs were 109.3±12.05 and 109.0±12.2 mmHg with the SphygmoCor and the Aortic device, respectively, showing a strong correlation (r=0.98, P<0.001). A mean difference of 0.35±2.43 mmHg (95% confidence interval: 0.17-0.87, P=NS) was obtained with the Bland-Altman method. The 95% limits of agreement was -4.4 to +5.1 mmHg. CONCLUSION: Complying with the Association for the Advancement of Medical Instrumentation criteria, cSBP measurements obtained with the Aortic and the SphygmoCor devices are equivalent.

Alerting Reaction in Office Blood Pressure and Target Organ Damage: An Innocent Phenomenon?

BACKGROUND: An alerting reaction is a physician-induced phenomenon which produces a transient blood pressure rise in the office. OBJECTIVE: To determine its relationship with target organ damage in treated hypertensives. METHOD: We used three different indexes for calculating alerting reaction depending on the first, second or third office blood pressure measurement. We correlated these indexes with glomerular filtration rate, left ventricular mass index and pulse wave velocity. Thereafter, for multivariate analysis, we selected the index which better correlated with each target organ damage subtype. RESULTS: We included 174 adults, mean age 67(±13.7) years. 75% of the patients had some degree of blood pressure fall between measurements 1-3. In multivariate linear regression models, after adjusting for classic risk factors, two out of the three systolic alerting reaction indexes showed an independent association with target organ damage. After further adjusting for office blood pressure and white coat effect (calculated with standardized home blood pressure monitoring), left ventricular mass index maintained a statistically significant association. CONCLUSION: A higher alerting reaction in the office seems to be related to increased target organ damage in treated hypertensives and should not be considered an innocent phenomenon.

Arterial Stiffness in Treated Hypertensive Patients With White-Coat Hypertension.

Arterial stiffness, assessed through pulse wave velocity (PWV), independently predicts cardiovascular outcomes. In untreated persons, white-coat hypertension (WCH) has been related to arterial stiffness, but data in treated patients with WCH are scarce. The authors aimed to determine a possible association between WCH and arterial stiffness in this population. Adult treated hypertensive patients underwent home blood pressure monitoring and PWV assessment. Variables associated with PWV in univariable analyses were entered into a multivariable linear regression model. The study included 121 patients, 33.9% men, median age 67.9 (interquartile range 18.4) years, 5.8% with diabetes, and 3.3% with a history of cardiovascular or cerebrovascular disease. In multivariable analysis, WCH in treated hypertensive patients remained a determinant of PWV: ß=1.1 (95% confidence interval, 0.1-2.1 [P=.037]; adjusted R2 0.49). In conclusion, WCH is independently associated with arterial stiffness in treated hypertensive patients. Whether this high-risk association is offset by antihypertensive treatment should be further investigated.

A de novo compound targeting α-synuclein improves deficits in models of Parkinson's disease.

Abnormal accumulation and propagation of the neuronal protein α-synuclein has been hypothesized to underlie the pathogenesis of Parkinson's disease, dementia with Lewy bodies and multiple system atrophy. Here we report a de novo-developed compound (NPT100-18A) that reduces α-synuclein toxicity through a novel mechanism that involves displacing α-synuclein from the membrane. This compound interacts with a domain in the C-terminus of α-synuclein. The E83R mutation reduces the compound interaction with the 80-90 amino acid region of α-synuclein and prevents the effects of NPT100-18A. In vitro studies showed that NPT100-18A reduced the formation of wild-type α-synuclein oligomers in membranes, reduced the neuronal accumulation of α-synuclein, and decreased markers of cell toxicity. In vivo studies were conducted in three different α-synuclein transgenic rodent models. Treatment with NPT100-18A ameliorated motor deficits in mThy1 wild-type α-synuclein transgenic mice in a dose-dependent manner at two independent institutions. Neuropathological examination showed that NPT100-18A decreased the accumulation of proteinase K-resistant α-synuclein aggregates in the CNS and was accompanied by the normalization of neuronal and inflammatory markers. These results were confirmed in a mutant line of α-synuclein transgenic mice that is prone to generate oligomers. In vivo imaging studies of α-synuclein-GFP transgenic mice using two-photon microscopy showed that NPT100-18A reduced the cortical synaptic accumulation of α-synuclein within 1 h post-administration. Taken together, these studies support the notion that altering the interaction of α-synuclein with the membrane might be a feasible therapeutic approach for developing new disease-modifying treatments of Parkinson's disease and other synucleinopathies.

Efectos de la expansión maxilar sobre la mordida abierta dentoesquelética / Maxilar expansion effects on dentoesqueletal open-bite

Objetivo: valorar si la respuesta favorable en el grado de sobremordida observada tras la expansión maxilar en una muestra de pacientes con compresión palatina y mordida abierta anterior es independiente del patrón de crecimiento. Material y métodos: se comparó restrospectivamente la distribución de los patrones de crecimiento de dos muestras de 20 pacientes, una experimental, con compresión palatina y mordida abierta anterior y otra control con compresión pero sobremordida normal. Ambos grupos habían sido tratados con un Quad hélix y tras la expansión la mordida abierta del grupo experimental se había cerrado. Resultados y conclusión: La distribución de patrones de crecimiento en ambos grupos fue la misma, lo que apoya la hipótesis de que la mejoría posicional de la lengua trasladada a la bóveda palatina una vez ensanchada ésta, podrías ser un contribuyente clave de la respuesta vertical favorable que se observa en todos los patrones esqueléticos faciales (AU)

Aim: To evaluate if favourable change of the overbite observed after maxillary expansion in a simple of patients who presented anterior openbite and narrow maxilla associated with anterior openbite was related to the growth pattern. Method: Growth-pattern distribution was retrospectively compared in two groups of 20 patients with narrow maxilla, one an experimental group that had been treated by means of a Quad helix appliance and the other composed of controls. Before treatment, the experimental sample presented open bite that had closed after expansion. The control sample exhibited normal overbite. Results and conclusions: These findings provide evidence that maxillary expansion favours a more appropriate physiological position of the tongue in the palate. This new functional environment could be responsible for the improvement of the open bite that is observed in each growth pattern (AU)

Prevalencia de los patrones de anomalías dentarias (PAD) / Prevalence of dental anomaly patterns (DAP)

Introducción: Los patrones de anomalías dentarias (PAD) son alteraciones de los dientes que se manifiestan asociadas con mayor frecuencia de lo que cabría esperar por azar. Incluyen diversas alteraciones morfológicas, numéricas y trastornos eruptivos que probablemente comparten una etiopatogenia genética común. Conocemos la prevalencia de la mayoría de las anomalías integrantes de los PAD consideradas aisladamente, pero no la correspondiente a la entidad compleja. Objetivo: Analizar la prevalencia de los PAD en los últimos 100 pacientes estudiados consecutivamente en la unidad de Ortodoncia del hospital universitario Fundación Jiménez Díaz (uO-FJD). Método: Se examinaron retrospectivamente las radiografías panorámicas y fotografías intraorales de los últimos 100 pacientes de ambos sexos, etnia caucásica y edades comprendidas entre 8 y 15 años diagnosticados consecutivamente en la uO-FJD. Se registraron las siguientes anomalías: hipodoncia, microformas aisladas, tamaño dentario reducido, retraso eruptivo, infraoclusión de molares temporales, desplazamiento palatino de los caninos, transposición (CPmSup o C-IlatInf), distoangulación del segundo premolar inferior no erupcionado y taurodontismo. La asociación de dos o más anomalías se denominó PAD 'sensu stricto' y la presencia confirmada de una sóla anomalía, 'posible PAD'. Resultados: La prevalencia de los PAD 'sensu stricto' fué 18% y 'posible PAD' 16%. La de ambos tipos conjuntamente, 34%. Conclusiones: La prevalencia de los PADs es muy alta. Todo clínico debe estar familiarizado con este concepto, ya que el diagnóstico de una anomalía debe hacer sospechar la posible existencia -o posterior desarrollo- de otras, en el paciente o sus familiares (AU)

Introduction: Dental Anomaly Patterns (PAD) are dental abnormalities that are observed together more frequently than can be explained by chance alone. They include morphologic and numeric abnormalities together with eruption disorders that likely have shared genetic origins. The prevalence of some of these isolated anomalies, as hypodontia, is well known but the literature does not record the frequencies of PAD considered as groups of interrelated concomitant abnormalities. Aim: To analyze the frequency of DAP in a sample of 100 orthodontic patients consecutively diagnosed at the unit of Orthodontics of hospital universitario Fundación Jiménez Díaz (uO-FJD). Method: Panoramic radiographs and intraoral photographs of 100 orthodontic consecutively evaluated patients were retrospectively examined in order to analyze the following abnormalities: hypodontia, microforms and tooth-size reduction, delayed tooth formation, infraocclusion of deciduous molars, palatal displacement of canine, dental transposition (Mx.C-P1 or Mn.I2-C), distal angulation of unerupted mandibular second premolar and taurodontism. Ages ranged from 8 to 15 years. The association of two or more abnormalities was named PAD 'sensu stricto'; the presence of one confirmed abnormality was named 'possible PAD'. The frequency of both PADs was determined. Results: The prevalence of PAD 'sensu stricto' was 18% and 'possible PAD' 16%. Considered together both groups, the frequency of PAD reached 34%. Conclusions: The prevalence of PADs is very high. All clinicians possibly involved must recognize that diagnosis because one anomaly may be a marker of other undiagnosed or later appearing abnormalities in the same patient or their siblings (AU)

A brain-targeted, modified neurosin (kallikrein-6) reduces α-synuclein accumulation in a mouse model of multiple system atrophy.

BACKGROUND: Multiple system atrophy (MSA) is a progressive, neurodegenerative disease characterized by parkinsonism, resistance to dopamine therapy, ataxia, autonomic dysfunction, and pathological accumulation of α-synuclein (α-syn) in oligodendrocytes. Neurosin (kallikrein-6) is a serine protease capable of cleaving α-syn in the CNS, and we have previously shown that lentiviral (LV) vector delivery of neurosin into the brain of a mouse model of dementia with Lewy body/ Parkinson's disease reduces the accumulation of α-syn and improves neuronal synaptic integrity. RESULTS: In this study, we investigated the ability of a modified, systemically delivered neurosin to reduce the levels of α-syn in oligodendrocytes and reduce the cell-to-cell spread of α-syn to glial cells in a mouse model of MSA (MBP-α-syn). We engineered a viral vector that expresses a neurosin genetically modified for increased half-life (R80Q mutation) that also contains a brain-targeting sequence (apoB) for delivery into the CNS. Peripheral administration of the LV-neurosin-apoB to the MBP-α-syn tg model resulted in accumulation of neurosin-apoB in the CNS, reduced accumulation of α-syn in oligodendrocytes and astrocytes, improved myelin sheath formation in the corpus callosum and behavioral improvements. CONCLUSION: Thus, the modified, brain-targeted neurosin may warrant further investigation as potential therapy for MSA.

Extracciones en ortodoncia: puesta al día / Extractions in orthodontics: update

El objetivo de este artículo es revisar los principales criterios actuales sobre las extracciones dentarias en la profilaxis y el tratamiento de las maloclusiones y las deformidades dentofaciales. Las extracciones dentarias constituyen un arma terapéutica imprescindible para el manejo de ciertas maloclusiones. Sus indicaciones responden entre otras razones a la obtención de espacio en la arcada, la mejoría de la estética facial y la consecución de una oclusión equilibrada. Los patrones 'convencionales' de extracciones terapéuticas se corresponden con distintas combinaciones de extracción simétrica de premolares, pero cada vez son más frecuentes las extracciones atípicas, que no siguen un patrón definido. Éstas son más comunes en los pacientes adultos y se realizan por causas vinculadas a patología del propio diente que se extrae, o por exigencias del tratamiento no convencional de la maloclusión. Entre las extracciones atípicas hay que destacar la extracción de un incisivo inferior con indicaciones, contraindicaciones y efectos indeseables bien definidos. Las extracciones de dientes temporales pueden realizarse en el marco de un programa de guía de la erupción, que debe adaptarse a la situación de cada paciente y nunca considerarse como un esquema rígido de aplicación general (AU)

The aim of this paper is to update the most widely accepted criteria on dental extractions in the prevention and treatment of malocclusions and dentofacial deformities. Dental extractions constitute an undeniable tool for the management of some malocclusions. Their purpose is to obtain space in the dental arches, to improve face esthetics and to achieve an adequate occlusion. The traditional patterns of therapeutic extractions consist of different combinations of symmetric extraction of premolars, although atypical extractions without an established pattern are becoming increasingly more common. These are more frequent among adult patients, and are performed because of intrinsic pathology of the tooth to be extracted or due to the unconventional nature of the malocclusion treatment. The atypical extractions include the extraction of a lower incisor, whose indications, contraindications and side effects are well known. The extraction of temporary teeth can be performed as a part of a guide of eruption program. These programs must not be designed to be prescriptive, but rather adapted to the specific patient (AU)