Influencia de parámetros quirúrgicos en la mortalidad tras cirugía de fracturas extracapsulares de cadera en el paciente anciano / Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly

INTRODUCCIÓN: La fractura de cadera es una patología traumática muy frecuente en el anciano con alta mortalidad. Diferentes factores se han asociado con la mortalidad tras la cirugía (edad comorbilidades). Hay factores quirúrgicos que se asocian con la mortalidad, pero no se han relacionado con los diferentes índices de mortalidad y comorbilidades médicas. OBJETIVO: Analizar los parámetros quirúrgicos con influencia en la mortalidad en la cirugía de las fracturas extracapsulares de cadera en el paciente anciano, así como la influencia de las comorbilidades médicas de estos pacientes en la mortalidad, mediante el índice de comorbilidad de Charlson abreviado (CCI). MATERIAL Y MÉTODO: Revisión retrospectiva de 187 pacientes intervenidos en 2015. Se recogieron datos sobre la edad y sexo, lateralidad y tipo de fractura; demora quirúrgica, tiempo quirúrgico, tipo de material de osteosíntesis, estancia media. La presencia de comorbilidades se determinó empleando el CCI. RESULTADOS: La edad media fue de 85 años. Con respecto al índice de comorbilidad de Charlson abreviado, 67,4% de los pacientes tenían una puntuación entre 0 y 1, el 23,5% de 2, y un 9,1% > 2. La mortalidad al mes y al año tras la cirugía fue de 5,3% y 14,4%, respectivamente. Se registraron 43 complicaciones, de las cuales 31 fueron complicaciones médicas. De los 27 pacientes fallecidos en el primer año, 14 (51,8%) sufrieron complicaciones, 48,2% de las mismas fueron complicaciones médicas. DISCUSIÓN: El análisis multivariante mostró diferencias significativas con respecto a edad, complicaciones médicas e índice de Charlson abreviado de dos con respecto a la mortalidad. No existe asociación entre demora y tiempo quirúrgico con el aumento de la mortalidad. CONCLUSIONES: No se demostró asociación de los parámetros quirúrgicos estudiados (demora y tiempo quirúrgico, patrón y estabilidad de la fractura, criterios de reducción, complicaciones quirúrgicas) con aumento de mortalidad a corto y largo plazo. Los pacientes con mayor edad, comorbilidades medidas con CCI abreviado y los que sufren complicaciones médicas presentan mayor riesgo de mortalidad al mes y al año de la cirugía

INTRODUCTION: Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities. OBJECTIVE: To analyze the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI). METHOD: Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC. RESULTS: Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications. DISCUSSION: Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality. CONCLUSIONS: No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery

Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly. / Influencia de parámetros quirúrgicos en la mortalidad tras cirugía de fracturas extracapsulares de cadera en el paciente anciano.

INTRODUCTION: Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities. OBJECTIVE: To analyze the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI). METHOD: Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC. RESULTS: Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications. DISCUSSION: Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality. CONCLUSIONS: No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery.

Effectiveness of 1% versus 0.2% chlorhexidine gels in reducing alveolar osteitis from mandibular third molar surgery: A randomized, double-blind clinical trial

Purpose: Alveolar osteitis (AO) is the most common postoperative complication of dental extractions. The purpose of this study was to compare the effectiveness of 1% versus 0.2% chlorhexidine (CHX) gel in reducing postoperative AO after surgical extraction of mandibular third molars, and assess the impact of treatment on the Oral HealthRelated Quality of Life (OHRQoL). Material and Methods: This clinical study was a randomized, double-blind clinical trial. Eighty eight patients underwent surgical extraction of one retained mandibular third molar with the intra-alveolar application of 0.2% CHX gel. Afterwards, they were assigned to one of two groups: 1% CHX gel (n=42) or 0.2% CHX gel (n=46). The patients applied the gel twice a day to the wound for one week. All patients were evaluated for AO. Results: In the 0.2% CHX gel group, 13% of AO incidence was found, while in the 1% CHX gel group, AO incidence was 7%, a difference that was not statistically significant. Variables such as sensation of pain and inflammation at baseline and during one week, as well as OHRQoL of the patients at 24 hours and 7 days post-extraction, gave no statistically significant differences. Conclusions: There are no significant differences in AO after surgical extraction of mandibular third molars, when comparing applying 1% CHX gel twice a day for 7 days with 0.2% CHX gel (AU)

Effectiveness of 1% versus 0.2% chlorhexidine gels in reducing alveolar osteitis from mandibular third molar surgery: a randomized, double-blind clinical trial.

PURPOSE: Alveolar osteitis (AO) is the most common postoperative complication of dental extractions. The purpose of this study was to compare the effectiveness of 1% versus 0.2% chlorhexidine (CHX) gel in reducing postoperative AO after surgical extraction of mandibular third molars, and assess the impact of treatment on the Oral HealthRelated Quality of Life (OHRQoL). MATERIAL AND METHODS: This clinical study was a randomized, double-blind clinical trial. Eighty eight patients underwent surgical extraction of one retained mandibular third molar with the intra-alveolar application of 0.2% CHX gel. Afterwards, they were assigned to one of two groups: 1% CHX gel (n=42) or 0.2% CHX gel (n=46). The patients applied the gel twice a day to the wound for one week. All patients were evaluated for AO. RESULTS: In the 0.2% CHX gel group, 13% of AO incidence was found, while in the 1% CHX gel group, AO incidence was 7%, a difference that was not statistically significant. Variables such as sensation of pain and inflammation at baseline and during one week, as well as OHRQoL of the patients at 24 hours and 7 days post-extraction, gave no statistically significant differences. CONCLUSIONS: There are no significant differences in AO after surgical extraction of mandibular third molars, when comparing applying 1% CHX gel twice a day for 7 days with 0.2% CHX gel.

Calidad de vida relacionada con la salud en pacientes tratados de cáncer oral / Health-related quality of patiens treated for oral cancer

El tratamiento del cáncer oral puede tener un importante impacto en la calidad de vida de los pacientes. Su evaluación a través de cuestionarios es cada vez más habitual en esta área. Junto con los análisis de recurrencia y supervivencia, la medida de la calidad de vida ayuda a anticipar los resultados del tratamiento en beneficio del paciente. El objetivo de este trabajo ha sido revisar los artículos publicados durante el periodo 2002-2012 que evalúan la calidad de vida relacionada con la salud en pacientes tratados de cáncer oral. Son necesarias nuevas investigaciones para poder incorporar los cuestionarios de calidad de vida relacionada con la salud en la práctica diaria (AU)

Oral cancer treatment may have a significant impact on patients’ quality of life. Its assessment through questionnaires is increasingly common in this area. In conjunction with analysis of recurrence and survival, the measure of the quality of life helps to anticipate the outcomes of treatment in the patient’s benefit. The purpose of this article has been to review the papers published for the period 2002-2012 that assess the quality of life related to health in patients treated for oral cancer. Further research is need to incorporate the questionnaires of quality of life related to health in daily practice (AU)

Prevalence of enamel defects in primary and permanent teeth ina group of schoolchildren from Granada (Spain)

Objective: The purpose of this study was to determine and compare the prevalence and presentations of developmental defects of the enamel (DDE) in the primary and permanent dentitions of a group of healthy schoolchildren residing in Granada (Spain).Study Design: A total of 1,414 healthy schoolchildren were examined using modified DDE criteria for recording enamel defects. Results: The prevalence of DDE of any type was 40.2% in primary dentition and 52% in permanent dentition (p<0.033). Of the 31,820 primary and permanent teeth examined in the study, 699 (4.1%) primary and 1,232 (8.3%) permanent teeth had some form of DDE. Diffuse opacity was the most common type of DDE observed in primary teeth, and demarcated opacity in the permanent teeth. Enamel hypoplasia was the least prevalent defect in both dentition types. Conclusions: The study population showed a high prevalence of DDE in primary as well as in permanent dentition, reflecting the current increasing trend of this condition, which should be considered as a significant public health problem (AU)

Prevalence of enamel defects in primary and permanent teeth in a group of schoolchildren from Granada (Spain).

OBJECTIVE: The purpose of this study was to determine and compare the prevalence and presentations of developmental defects of the enamel (DDE) in the primary and permanent dentitions of a group of healthy schoolchildren residing in Granada (Spain). STUDY DESIGN: A total of 1,414 healthy schoolchildren were examined using modified DDE criteria for recording enamel defects. RESULTS: The prevalence of DDE of any type was 40.2% in primary dentition and 52% in permanent dentition (p<0.033). Of the 31,820 primary and permanent teeth examined in the study, 699 (4.1%) primary and 1,232 (8.3%) permanent teeth had some form of DDE. Diffuse opacity was the most common type of DDE observed in primary teeth, and demarcated opacity in the permanent teeth. Enamel hypoplasia was the least prevalent defect in both dentition types. CONCLUSIONS: The study population showed a high prevalence of DDE in primary as well as in permanent dentition, reflecting the current increasing trend of this condition, which should be considered as a significant public health problem.

Sarcomas sinoviales en el área sanitaria de Lugo en el período de 2002 a 2006 / Synovial sarcomas in Lugo between 2002–2006

Objetivo Estudiar las características epidemiológicas y clínicas de todos los pacientes adultos diagnosticados de sarcoma sinovial (SS) en el período de 2002 a 2006 en el Hospital Xeral-Calde de Lugo. Pacientes y método Estudio retrospectivo de todos los pacientes mayores de 18 años diagnosticados mediante estudio de anatomía patológica de SS desde enero de 2002 hasta diciembre de 2006. Este hospital da asistencia sanitaria a 250.000 habitantes. Resultados Un total de 4 casos (3 mujeres) cumplían los criterios establecidos para este estudio, con edades comprendidas entre los 22 y los 41 años (media de 35 años).El motivo de consulta fue tumoración (media de 6,7cm) y dolor predominantemente en las extremidades inferiores. El retraso diagnóstico promedio fue de 17 meses, aunque en algún caso se llegó a los 2,5 años. Excepto para el caso de SS de localización cervical, un mayor retraso al diagnóstico se correlacionó con un mayor tamaño del tumor y un estadio más avanzado. El seguimiento medio de los enfermos fue de 25,5 meses. Un paciente falleció al cabo de un año y medio del diagnóstico. Conclusiones El promedio de incidencia mínima estimada de los SS en mayores de 18 años en el área de Lugo fue de 0,32 por cada 105 habitantes al año. A pesar de su baja incidencia, ante una persona joven que presenta una masa, a veces dolorosa, en las extremidades inferiores, debe incluirse el SS en el diagnóstico diferencial. Un mayor índice de sospecha por parte de los médicos puede evitar un diagnóstico tardío (AU)

Objective To study the clinical and epidemiological characteristics of all adults patients as having synovial sarcoma in the Hospital Xeral-Calde (Lugo) between 2002 and 2006.Patients and method. We conducted a retrospective study of the case records of all adults patients diagnosed with synovial sarcoma from January 2002 through December 2006. Patients were considered to be adults if they were more than 18. In all cases a tissue-biopsy sample showing synovial sarcoma was required. The Hospital Xeral-Calde is the only referral center for a population of almost 250.000 people. Results Four cases (3 women) met the classification criteria for this study. The mean age was 35 years old (range, 22–41).The most common presentation was a palpable mass (mean 6.7cm.) associated with pain in lower extremities. The mean delay for the diagnosis was 17 months, but in one case has been noted as long as 2.5 years. Unlike the neck synovial sarcoma case, a long delay in the diagnosis implied a major tumor size and a higher histologic grade. The mean follow-up was 25.5 months; one patient died 1.5 years after the diagnosis. Conclusions The overall annual incidence rate of synovial sarcoma in the Lugo region between January 2002 and 2006 for the population older than 18 years was a minimum estimate 0.32/105. Better physician awareness may contribute to the progressive increase in the recognition of this condition, especially in young people presenting with palpable mass. A long delay at the diagnosis implied a poor prognosis (AU)

Validation the Oral Health Impact Profile (OHIP-14sp) for adults in Spain

Objectives:The oral health-related quality of life indicators are increasingly used to measure the impact of oral conditions on qualityof life to complement clinical data in cross-sectional and longitudinal studies. One of the most internationally spread indicatorsis the Oral Health Impact Profile (OHIP-14), but it has still never been applied in Spain. The aim of this study wasto validate the OHIP-14 for use among adults in Spain.Study design:A cross-sectional study was performed in Granada (Spain). A consecutive sample (n=270) of the Regional Government staffvisiting the Employment Risk Prevention Centre for a routine medical check-up participated in this study. All participantsself-completed the piloted OHIP-14sp and were examined according to World Health Organization methodology for caries,periodontal disease and prosthesis. Reliability analyses and validity tests were carried out to evaluate the psychometricproperties of the OHIP-14sp by using two different methods of total scoring (i.e. the Additive and the Simple Count).Results:The reliability coefficient (Cronbach´s alpha) of the OHIP-14sp was above the recommended 0.7 threshold and consideredexcellent (alpha: 0.89). Some subjective factors (perceived dental treatment need, complaints about mouth and self-ratedoral satisfaction) were strongly associated with both total scoring methods of the OHIP-14sp, supporting the criterion,construct and convergent validity. Moreover the impact levels were mainly influenced by caries data, e.g., number of teethrequiring extraction (r = 0.21; p<0.01) and number of decayed visible teeth (between premolars) (r = 0.17; p<0.01). (..) (AU)

Validation the Oral Health Impact Profile (OHIP-14sp) for adults in Spain.

OBJECTIVES: The oral health-related quality of life indicators are increasingly used to measure the impact of oral conditions on quality of life to complement clinical data in cross-sectional and longitudinal studies. One of the most internationally spread indicators is the Oral Health Impact Profile (OHIP-14), but it has still never been applied in Spain. The aim of this study was to validate the OHIP-14 for use among adults in Spain. STUDY DESIGN: A cross-sectional study was performed in Granada (Spain). A consecutive sample (n=270) of the Regional Government staff visiting the Employment Risk Prevention Centre for a routine medical check-up participated in this study. All participants self-completed the piloted OHIP-14sp and were examined according to World Health Organization methodology for caries, periodontal disease and prosthesis. Reliability analyses and validity tests were carried out to evaluate the psychometric properties of the OHIP-14sp by using two different methods of total scoring (i.e. the Additive and the Simple Count). RESULTS: The reliability coefficient (Cronbach's alpha) of the OHIP-14sp was above the recommended 0.7 threshold and considered excellent (alpha: 0.89). Some subjective factors (perceived dental treatment need, complaints about mouth and self-rated oral satisfaction) were strongly associated with both total scoring methods of the OHIP-14sp, supporting the criterion, construct and convergent validity. Moreover the impact levels were mainly influenced by caries data, e.g., number of teeth requiring extraction (r = 0.21; p<0.01) and number of decayed visible teeth (between premolars) (r = 0.17; p<0.01). The prevalence of impacts was 80.7% using the occasional or more frequently threshold. The most prevalently affected OHIP domains were "psychological discomfort" (53.7%), "functional limitation" (51.1%) and "physical pain" (42.2%). CONCLUSIONS: The OHIP-14sp is a precise, valid and reliable instrument for assessing oral health-related quality of life among adult population in Spain.

[Synovial sarcomas in Lugo between 2002-2006]. / Sarcomas sinoviales en el área sanitaria de Lugo en el período de 2002 a 2006.

OBJECTIVE: To study the clinical and epidemiological characteristics of all adults patients as having synovial sarcoma in the Hospital Xeral-Calde (Lugo) between 2002 and 2006. PATIENTS AND METHOD: We conducted a retrospective study of the case records of all adults patients diagnosed with synovial sarcoma from January 2002 through December 2006. Patients were considered to be adults if they were more than 18. In all cases a tissue-biopsy sample showing synovial sarcoma was required. The Hospital Xeral-Calde is the only referral center for a population of almost 250.000 people. RESULTS: Four cases (3 women) met the classification criteria for this study. The mean age was 35 years old (range, 22-41). The most common presentation was a palpable mass (mean 6.7cm.) associated with pain in lower extremities. The mean delay for the diagnosis was 17 months, but in one case has been noted as long as 2.5 years. Unlike the neck synovial sarcoma case, a long delay in the diagnosis implied a major tumor size and a higher histologic grade. The mean follow-up was 25.5 months; one patient died 1.5 years after the diagnosis. CONCLUSIONS: The overall annual incidence rate of synovial sarcoma in the Lugo region between January 2002 and 2006 for the population older than 18 years was a minimum estimate 0.32/10(5). Better physician awareness may contribute to the progressive increase in the recognition of this condition, especially in young people presenting with palpable mass. A long delay at the diagnosis implied a poor prognosis.

Encuesta de Salud Oral de Preescolares en España 2007 / Survey of Oral Health of Prep school in Spain 2007

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Adhesion molecule CD44 expression in non-tumor epithelium adjacent to laryngeal cancer.

BACKGROUND: Studies of adjacent non-tumor epithelia (ANTE) of laryngeal cancer have presented contradictory results regarding the expression of the adhesion molecule CD44 and its role as an early event and risk marker for progression to cancer. METHODS: An immunohistochemical study was performed on changes in CD44 expression in the ANTE and tumor tissue of 112 cases of laryngeal cancer, using the anti-CD44 monoclonal antibody DF1485. The aim was to evaluate the importance of these changes as an early event in laryngeal carcinogenesis. RESULTS: The ANTE were histologically hyperplastic in 107 cases (95.5%) and presented epithelial dysplasia in 105 cases (93.7%). A significant association between tumor and epithelial CD44 expression was observed in both hyperplastic (p < 0.001) and dysplastic (p < 0.001) ANTE. There was no significant association between ANTE CD44 expression and clinical or histopathological relevant data. CONCLUSIONS: Loss of CD44 expression in ANTE can be considered an early event in laryngeal carcinogenesis and a marker of major alterations in CD44 expression in the derived tumor tissue.

Desigualdades geográficas en las cargas de trabajo por dentista en España entre 1987 y 1997. Cargas de trabajo por dentista / Inequalities in the workload per dentist in spain from 1987 to 1997. Workload per dentist

Introducción (fundamento y objetivo): durante las dos últimas décadas, la Odontología española asistió a un fuerte incremento del número de profesionales, habiéndose demostrado una reducción del 42,0 por ciento en las cargas privadas por dentista entre 1987 y 1997. El objetivo ha sido comparar esta pérdida de cargas de trabajo entre Comunidades Autónomas (CCAA). Método: se utilizaron los censos poblacionales y de dentistas, así como las Encuestas Nacionales de Salud. Se calculó el porcentaje de población que visitó al dentista en los tres meses previos a cada encuesta, y de ellos, el porcentaje cuya última visita fue privada. El total de visitas realizadas por esa población sirvió para estimar el total de visitas privadas en cada CCAA durante tres meses, que se dividió por el número de dentistas. Resultados y conclusiones: tanto en 1987 como en 1997 hay diferencias significativas en las cargas de trabajo por dentista según CCAA, si bien no en la reducción de las mismas (AU)

Influencia de programas públicos de salud oral en los esolares sobre la demanda privada de Odontología Restauradora / Influence of public oral health schoolchildren programmes on private restorative dentistry demand

lntroducción:(fundamento y objetivo): El objetivo es analizar la influencia de algunos programas públicos odontológicos sobre la demanda de odontología restauradora privada. Métodos: En el curso 96/97 se inició un ensayo de campo en Granada, con cuatro grupos ce escolares de 6-7 anos de edad Sellador (aplicados en el Centro de Salud, n=121), Sellador+Flúor (+ barniz de flúor en los colegios, n=119), Flúor (n=137) y Con-trol (n-95). Todos fueron explorados al inicio, y a los 6 meses. Se analiza el incremento de odontología restauradora privada, a través del índice cie restauración (dientes obturados del total de dientes cariados + obturados). Resultados y conclusiones El índice de restauración aumentó significativamente en los cuatro grupos. El incremento medio (- desviación estándar) de obturaciones 2s mayor en los grupos Sellador (0.54-1 1 57) y Sellador+Flúor (0.55+-1.27), que en los grupos Flúor (0.23 0.99) y Control (0.19ñ0 80), no habiendo diferencias significativas de incremento entre los grupos Sellador +Flúor y Sellador, ni entre Flúor y Control. Se concluye que un programa de selladores desde un centro de salud produce un incremento de la demanda de odontología restauradora, pero no un programa de flúor tópico profesional (barniz) realizado en el colegio (AU)