Mejora funcional en personas mayores frágiles mediante el programa de ejercicios Vivifrail, durante dos años de pandemia / Functional improvement in frail older adults through the Vivifrail exercise program, during two years of pandemic

Antecedentes y objetivo El ejercicio físico aumenta la capacidad funcional en personas mayores ayudando a evitar o retrasar situaciones de dependencia. En este estudio se evalúa el impacto de una intervención de ejercicio físico multicomponente basado en el programa Vivifrail realizado en un centro de atención primaria en dos años coincidente con la pandemia COVID. Sujetos y métodos Diseño descriptivo longitudinal con comparación antes-después sin grupo control. Personas mayores de 65 años con alteración de funcionalidad medida mediante test de ejecución, adscritos al centro de salud El Palo, Málaga. La intervención consiste en dos sesiones semanales grupales de ejercicio físico guiadas por monitor, según programa Vivifrail. Variables: índice de Barthel, velocidad de la marcha, categoría Vivifrail, calidad de vida (EuroQol 5-D [EQ-5D]) uso de ayudas para la marcha, número de caídas el año previo. Mediciones: basal, segunda (un año) y final (dos años). Análisis test de Kruskal-Wallis, nivel significación 0,05. Resultados Se incluyen evaluaciones de 20 pacientes. Entre primera y segunda valoración, objetivamos modificación significativa en uso de ayudas para la marcha (p 0,01) y categorías Vivifrail: de B inicial, 50% permanecen, 25% pasa a A, 16,7% C2 y 8,3% D (p 0,048). En análisis valoración basal-final, encontramos mejora estadísticamente significativa en calidad de vida medida por EQ-5D (aumento medio 24 puntos en medición de calidad de vida hoy, termómetro EQ-5D, con IC 95% (9,6-38,3), p 0,004) y de categoría Vivifrail (n=10) 60% permanecen categoría B y 40% pasan a D (autónomos) (p<0,0001). Se observa tendencia a mejoría en velocidad de la marcha, tiempo de paseo diario y número de caídas, sin alcanzar significación estadística. Conclusiones El ejercicio físico multicomponente mejora la calidad de vida percibida medida mediante EQ-5D y produce una tendencia a la mejora en capacidad funcional, estado de ánimo y número de caídas (AU)

Background and objective Physical exercise increases functional capacity in older adults, helping to prevent or delay dependence. This study evaluates the impact of a multicomponent physical exercise intervention based on the Vivifrail program, conducted in a primary care center over two years coinciding with the COVID pandemic. Subjects and methods Descriptive longitudinal design with before-after comparison without control group. Participants were older than 65 years old with functional impairment measured by execution test, enrolled in the El Palo Health Center, Málaga. The intervention consists of two weekly group sessions of physical exercise guided by a monitor, according to the Vivifrail program. Variables: Barthel Index, Gait Speed, Vivifrail Category, Quality of Life (EuroQol 5-D [EQ-5D]), use of walking aids, number of falls in the previous year. Measurements: baseline, second (one year) and final (two years). Analysis of the Kruskal-Wallis test, significance level 0.05. Results Twenty patients were evaluated. Between the first and second evaluation, we observed a significant modification in the use of walking aids (p 0.01) and Vivifrail categories: from an initial B category, 50% remained, 25% moved to A, 16.7% to C2 and 8.3% to D (p 0.048). In the analysis of the baseline-final evaluation, we found a statistically significant improvement in quality of life measured by EQ-5D (mean increase of 24 points in today's quality of life measurement, EQ-5D thermometer, with 95% CI (9.6-38.3), p 0.004) and Vivifrail category (n=10) with 60% remaining in category B and 40% moving to D (autonomous) (p<0.0001). There was a trend towards improvement in gait speed, daily walking time, and number of falls, but without reaching statistical significance. Conclusions Multicomponent physical exercise improves perceived quality of life measured by EQ-5D and leads to a trend towards improvement in functional capacity, mood, and number of falls (AU)

How common is extra-articular knee deformity? How to achieve a ''safe zone'' alignment total knee arthroplasty in patients with extra-articular deformity.

The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0°. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a "safe zone" alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3°. How can we achieve a "safe zone" alignment total knee arthroplasty in patients with extra-articular deformity?

La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0°. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de "zona segura", que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3°. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de "zona segura" en pacientes con deformidad extraarticular?

[Functional improvement in frail older adults through the Vivifrail exercise program, during two years of pandemic]. / Mejora funcional en personas mayores frágiles mediante el programa de ejercicios Vivifrail, durante dos años de pandemia.

BACKGROUND AND OBJECTIVE: Physical exercise increases functional capacity in older adults, helping to prevent or delay dependence. This study evaluates the impact of a multicomponent physical exercise intervention based on the Vivifrail program, conducted in a primary care center over two years coinciding with the COVID pandemic. SUBJECTS AND METHODS: Descriptive longitudinal design with before-after comparison without control group. Participants were older than 65 years old with functional impairment measured by execution test, enrolled in the El Palo Health Center, Málaga. The intervention consists of two weekly group sessions of physical exercise guided by a monitor, according to the Vivifrail program. VARIABLES: Barthel Index, Gait Speed, Vivifrail Category, Quality of Life (EuroQol 5-D [EQ-5D]), use of walking aids, number of falls in the previous year. MEASUREMENTS: baseline, second (one year) and final (two years). Analysis of the Kruskal-Wallis test, significance level 0.05. RESULTS: Twenty patients were evaluated. Between the first and second evaluation, we observed a significant modification in the use of walking aids (p 0.01) and Vivifrail categories: from an initial B category, 50% remained, 25% moved to A, 16.7% to C2 and 8.3% to D (p 0.048). In the analysis of the baseline-final evaluation, we found a statistically significant improvement in quality of life measured by EQ-5D (mean increase of 24 points in today's quality of life measurement, EQ-5D thermometer, with 95% CI (9.6-38.3), p 0.004) and Vivifrail category (n=10) with 60% remaining in category B and 40% moving to D (autonomous) (p<0.0001). There was a trend towards improvement in gait speed, daily walking time, and number of falls, but without reaching statistical significance. CONCLUSIONS: Multicomponent physical exercise improves perceived quality of life measured by EQ-5D and leads to a trend towards improvement in functional capacity, mood, and number of falls.

How common is extra-articular knee deformity? How to achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity / ¿Qué tan común es la deformidad extraarticular de rodilla? ¿Cómo lograr una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Abstract: The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0o. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a «safe zone¼ alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3o. How can we achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity?

Resumen: La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0o. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de «zona segura¼, que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3o. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Sin elevación, también puede haber oclusión / Without elevation, there may also be occlusion

Resumen Ante un dolor torácico agudo y evidencia de elevación del segmento ST, se debe instaurar un tratamiento de reperfusión urgente, con el objetivo de abrir la arteria ocluida y minimizar el daño miocárdico y, así, mejorar el pronóstico del paciente. Por ello, es necesario conocer aquellos patrones eléctricos de alto riesgo equivalentes a una elevación del segmento ST e indicativos de una oclusión coronaria aguda, para evitar que se produzca una demora inadmisible en los tiempos de actuación, tal y como ocurrió en el caso que se presenta.

Abstract In light of an acute chest pain and evidence of ST-segment elevation, an emergent reperfusion treatment should be started with the objective of opening the occluded artery and reducing myocardial damage, thus, improving the patients´s prognosis. Therefore, it is mandatory to keep in mind those high-risk electrical patterns equivalent to a ST-segment elevation and indicative of an acute coronary occlusion to avoid an unacceptable delay in the times of action, such was the case that is reported.

Effect of “triple whammy” combination in hospitalization due to acute kidney injury: a protocol of a nested case-control study / Efecto de la combinación «triple whammy» en la hospitalización por fallo renal agudo: protocolo del estudio de casos y controles anidado en una cohorte

Objective: Acute kidney injury (AKI) is a life-threatening condition characterized by an abrupt deterioration in kidney function. The simultaneous use of diuretics, renin-angiotensin-aldosterone system inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizol, known as «triple whammy» (TW), has been associated with an increased risk of AKI. The main objective of the study is to analyse the risk of hospitalization due to AKI with the TW combination versus non-exposure to TW. Additionally, hospitalization due to AKI according to the time and duration of the TW exposure, and depending on whether the TW includes NSAIDs or metamizol; mortality; and the requirement of renal replacement therapy will be determined.Methods: A case-control study nested in a cohort will be carried out. Data for the study will be extracted from the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP), managed by the Spanish Agency for Medicines and Medicine and Health Products (AEMPS). Adults admitted to hospital due to AKI between 2010 and 2018 (cases) will be matched with up to 10 controls per case. The exposure to TW during the 12 months prior to the index date will be determined. The association between the exposure to TW and the outcomes will be analysed using multivariate logistic regression models adjusting by potential confounding factors. A subgroup analysis will be performed to evaluate the risk of hospitalization due to AKI with the exposure to TW in patients older than 75 years. (AU)

Objetivo: El fallo renal agudo (FRA) se caracteriza por un deterioro abrupto de la función renal que puede aumentar el riesgo de mortalidad. El uso simultáneo de diuréticos, antihipertensivos inhibidores del sistema renina-angiotensina, y antiinflamatorios no esteroideos (AINE) o metamizol, conocido como “triple whammy” (TW), se ha visto asociado a un incremento del riesgo de FRA. El objetivo principal consiste en analizar el riesgo de hospitalización por FRA con la combinación TW frente a la no exposición a dicha combinación. Adicionalmente se analizará la hospitalización por FRA en función del momento de la exposición a TW y de su duración, y dependiendo de si la TW incluye AINE o metamizol; la mortalidad; y el requerimiento de terapia de reemplazo renal.Métodos: Se llevará a cabo un estudio de casos y controles anidado en una cohorte. Los datos para el estudio se extraerán de la Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), gestionada por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Los adultos con hospitalización por FRA entre 2010-2018 (casos) se emparejarán con hasta 10 controles por caso. La asociación entre la exposición a TW y las variables de resultado se analizará mediante modelos de regresión logística ajustados por potenciales factores de confusión. Se realizará un análisis de subgrupos para evaluar la variable principal en pacientes mayores de 75 años. (AU)

High prevalence of clarithromycin resistance and effect on Helicobacter pylori eradication in a population from Santiago, Chile: cohort study and meta-analysis.

Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4-6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04-0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9-38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy.

Mercury in Populations of River Dolphins of the Amazon and Orinoco Basins.

In the Amazon and Orinoco basins, mercury has been released from artisanal and industrial gold mining since the Colonial time, as well as a result of deforestation and burning of primary forest, that release natural deposits of methyl mercury, affecting the local aquatic vertebrate fauna. This study reports the presence of mercury in river dolphins' genera Inia and Sotalia. Mercury concentrations were analysed in muscle tissue samples collected from 46 individuals at the Arauca and Orinoco Rivers (Colombia), the Amazon River (Colombia), a tributary of the Itenez River (Bolivia) and from the Tapajos River (Brazil). Ranges of total mercury (Hg) concentration in muscle tissue of the four different taxa sampled were: I. geoffrensis humboldtiana 0.003-3.99 mg kg-1 ww (n = 21, Me = 0.4), I. g. geoffrensis 0.1-2.6 mg kg-1 ww (n = 15, Me = 0.55), I. boliviensis 0.03-0.4 mg kg-1 ww (n = 8, Me = 0.1) and S. fluviatilis 0.1-0.87 mg kg-1 ww (n = 2, Me = 0.5). The highest Hg concentration in our study was obtained at the Orinoco basin, recorded from a juvenile male of I. g. humboldtiana (3.99 mg kg-1 ww). At the Amazon basin, higher concentrations of mercury were recorded in the Tapajos River (Brazil) from an adult male of I. g. geoffrensis (2.6 mg kg-1 ww) and the Amazon River from an adult female of S. fluviatilis (0.87 mg kg-1 ww). Our data support the presence of total Hg in river dolphins distributed across the evaluated basins, evidencing the role of these cetaceans as sentinel species and bioindicators of the presence of this heavy metal in natural aquatic environments.

Management of inferior vena cava aneurysm.

AIM: Inferior vena cava (IVC) aneurysm is an infrequent but potentially lethal abnormality. We have seen one such case in our group practice. We have added this case to a review of 53 previously reported cases in order to develop a management algorithm for this entity. METHODS: We conducted a MedLine search of all English-language articles from the first reported case in 1950 through August 2013. Patient demographics, clinical data, management and outcomes were extracted. IVC aneurysms were categorized in 4 types as per Gradman and Steinberg classification. RESULTS: The mean patient age was 27.1 years (range 5-89) and 57.4% were male. A total of 11 (20.3%) had associated vascular anomalies and iliocaval thrombosis was found in 10 (18.5%). There were 23 type I aneurysms, 8 type IIs, 21 type IIIs and 2 type IVs. All but 1 type I was successfully managed conservatively without complications. For type IIs, only 3 patients were managed conservatively with 1 death related to stroke from paradoxical embolus. For type IIIs, resection was the most common management option (14 patients). One patient was treated endovascularly with aneurysm embolization. A total of 6 asymptomatic patients were treated conservatively with 1 death due to thromboembolism. For type IVs, all cases underwent expectant management with 1 death due to aneurysm rupture. CONCLUSION: IVC aneurysms are rare with only 54 cases reported in the literature. Associated vascular anomalies and iliocaval thrombosis should be expected in approximately 20% of cases. Type I aneurysms can be managed expectantly with close surveillance unless symptomatic. For type II-IV, surgical consideration should be given based on high rates of thromboembolic complications and non-negligible risk of rupture.

Asociación de la partición hepática y ligadura de la vena portal para hepatectomía por etapas, un nuevo procedimiento en cirugía hepática / Associating liver partition and portal vein ligation for staged hepatectomy, a new hepatic procedure

Introduction: Hepatic resection is the standard treatment for the liver tumors and in most cases the only potentially curative option. The most feared complication, in the major hepatic resection, is the postoperative liver failure. A new technique has recently been published in the literature: Liver partition associated to a portal vein ligation for staged hepatectomy. This technique allows an accelerated hipertrophy of the remnant liver, facilitates greater resection surgery, reducing the risk of postoperative hepatic ischemia. The results reported in the literature are promising. We report the first case in Chile with its evolution to 2 years and a discussion about the topic.

La resección hepática es el tratamiento estándar para los tumores hepáticos malignos y en la mayoría de los casos la única opción potencialmente curativa. La complicación más temida, en las grandes resecciones, es la insuficiencia hepática postquirúrgica. Una nueva técnica ha sido recientemente publicada en la literatura: La partición hepática asociada a la ligadura de la vena portal para realizar una hepatectomía por etapas. Esta técnica permite una hipertrofia acelerada del hígado remanente que posibilita una cirugía resectiva mayor, disminuyendo el riesgo de isquemia hepática postquirúrgica. Los resultados expuestos en la literatura son promisorios. Presentamos el primer caso clínico en Chile con su evolución a 2 años y una discusión del tema.

Recycling of residual IGCC slags and their benefits as degreasers in ceramics.

This work studies the evolution of IGCC slag grains within a ceramic matrix fired at different temperatures to investigate the effect of using IGCC slag as a degreaser. Pressed ceramic specimens from two clay mixtures are used in this study. The M1 mixture is composed of standard clays, whereas the M2 mixture is composed of the same clay mixture as M1 mixture but contains 15% by weight IGCC slag. The amount of IGCC slag added coincides with the amount of slag typically used as a degreaser in the ceramic industry. Specimens are fired at 950 °C, 1000 °C, 1050 °C, 1100 °C and 1150 °C. The mineralogical composition and the IGCC slag grain shape within the ceramic matrix are determined by X-ray diffraction, polarized light microscopy and scanning electron microscopy. The results reveal that the surface of the slag grains is welded to the ceramic matrix while the quartz grains are separated, which causes increased water absorption and reduces the mechanical strength. IGCC slag, however, reduces water absorption. This behaviour is due to the softening temperature of the slag. This property is quite important from an industrial viewpoint because IGCC slag can serve as an alternative to traditional degreasing agents in the ceramic building industry. Additionally, using IGCC slag allows for the transformation of waste into a secondary raw material, thereby avoiding disposal at landfills; moreover, these industrial wastes are made inert and improve the properties of ceramics.

Intensity of the humoral response to cytomegalovirus is associated with the phenotypic and functional status of the immune system.

Cytomegalovirus (CMV) infection exerts an enormous effect on human immunity, as it is associated with an immune-impaired response, a variety of chronic diseases, and overall survival in elderly individuals. Levels of anti-CMV antibodies may be associated with the differentiation degree of T cell subsets. Titers are significantly higher in the elderly and positively correlated with specific CD4(+) T cell responses to CMV. In the elderly, antibody titers are associated with the degree of differentiation and the T cell receptor excision circle (TREC) content in CD4(+) T cells, with other features of the immune risk profile, and with a reduced ability to respond to immunization in vivo. Associations may be absent in young subjects because their anti-CMV antibody titers are lower than those of the elderly. However, comparing young and elderly individuals with similar antibody levels reveals differences in their highly differentiated and naïve T cells. These are more marked in individuals with high titers. In parallel with the increase in anti-CMV antibodies, the elderly experience a significant reduction in absolute counts of naïve CD4(+) T cells, which may be a strategy to compensate for the expansion of differentiated cells and to avoid an increase in total T cells. In summary, our results show that titers of anti-CMV antibodies, and not only CMV seropositivity, are related to differentiation status and immunocompetence in the elderly, making this as an important prognostic marker of the status of immune system function.

Hemorragia digestiva baja grave en joven de 25 años / Severe lower gastrointestinal bleeding in a 25-year-old patient

La hemorragia digestiva baja se define como la que tiene su origen por debajo del ligamento de Treitz. La etiología de la misma varía dependiendo de la edad de los pacientes. Excluida la patología anorrectal benigna, en niños y jóvenes las causas más habituales son el divertículo de Meckel, los pólipos juveniles y la enfermedad inflamatoria intestinal. El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal, estando presente en el 2% de la población general. La mayoría de los divertículos de Meckel son asintomáticos y se diagnostican de forma incidental. Aproximadamente, el riesgo de presentar complicaciones es del 4-6%, siendo la hemorragia una de ellas. Presentamos el caso de un paciente de 25 años, que acudió a nuestro servicio con un cuadro de molestias abdominales inespecíficas y rectorregia. Tras estudio endoscópico completo, el diagnóstico de divertículo de Meckel se realizó intraoperatoriamente. Se realizó resección ileal incluyendo el divertículo, con evolución posterior satisfactoria(AU)

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel’s diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel’s diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them(AU)

[Severe lower gastrointestinal bleeding in a 25-year-old patient]. / Hemorragia digestiva baja grave en joven de 25 años.

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.

Niveles de conocimiento y práctica sobre prevención en salud bucodental de padres cuyos hijos acuden a la Cátedra de Odontopediatría de la Facultad de Odontología de la Universidad Nacional de Asunción en el año 2009 / Levels of knowledge and practice of prevention in oral health of parents whose children attend the Department of Dentistry of the Fucultad of Dentistry, National University of Asunción in 2009

Los padres son los únicos responsables de la salud bucal de sus hijos durante le primeros años de vida, tienen la responsabilidad de inicia a sus hijos en las prácticas de higiene bucal, proporcionarle una dieta equilibrada para favorecer un desarrollo óptimo en todas las estructuras corporal y velar, con la ayuda de un profesional odontológico, por un desarrollo equilibrado de toda la estructura estogmatognática. Este estudio observacional descriptivo de corte transversal, tuvo como objetivo determinar el nivel de conocimiento y práctica sobre prevención en salud bucodental de padres cuyo hijos acudieron a la cátedra de odontopediatría de la Facultad de Odontología de la Universidad Nacional de Asunción durante el año 2009, para lo cual se realizó una encuesta sobre higiene bucal, dieta, Flúor, alimentos cariogénicos y erupción dentaria, que constituyeron las variables de interés. La muestra estuvo constituida por 152 sujetos de ambos sexos. Los resultados del estudio demostraron que un 78,9% de los padres encuestados posee conocimiento suficiente, frente a un 21,19% que posee conocimiento insuficiente

Quality of mesorectum after laparoscopic resection for rectal cancer - results of an audited teaching programme in Spain.

OBJECTIVE: The aim of this prospective observational study was to compare the quality of total mesorectal excision between laparoscopic and open surgery for rectal cancer. METHOD: In April 2006, the Spanish Association of Surgeons started an audited teaching programme. The project was similar to the Norwegian one and several training courses were arranged. Patients were classified into two groups: laparoscopic rectal resection (LR) and open rectal resection (OR). The quality of the mesorectum was scored: complete, nearly complete or incomplete. The circumferential margin (CRM) was considered positive, if tumour was located 1 mm or less from the surface of the specimen. RESULTS: Between 2006 and 2008, 604 patients underwent rectal resection with total mesorectal excision for rectal cancer: 209 patients were included in the LR group and 395 patients in the OR group. There were no differences in terms of number of lymph nodes affected, distance of the tumour from CRM. The mesorectum was complete in 464 (76.8%), nearly complete in 91 (15.1%) and incomplete in 49 patients (8.1%). CRM was negative in 534 patients (88.4%). No differences were observed between the two groups. The overall postoperative morbidity rate was 38.8% in LR group and 44.6% in OR group (P = 0.170). Overall postoperative mortality rate was 2.5%. One patient died (0.5%) in the LR group and 14 patients died (3.5%) in the OR group (P = 0.021). CONCLUSION: Laparoscopic resection for rectal cancer is feasible with the quality of mesorectal excision and postoperative outcomes similar to those of open surgery.

Papel etiológico de los virus en la enfermedad periodontal / Etiologic role of virus in periodontal disease

El objetivo de esta revisión es presentar la evidencia disponible que relaciona la infección por virus con el desarrollo de periodontitis. Esta relación se ha visto con los virus de la familia herpes, sobretodo el citomegalovirus humano (CMV) y el virus Epstein-Barr (VEB), así como con el virus de la inmunodeficiencia humana (HIV). Las infecciones por herpesvirus generalmente sucede en dos fases, durante la primoinfección la clínica suele ser leve o asintomática y a esta le sigue una fase asintomática en la que el virus se encuentra en estado de latencia. Dicho estado se verá interrumpido esporádicamente por periodos de activación en los que se produce una replicación viral y posiblemente se dé una manifestación de la enfermedad que explicaría, en parte, el progreso en episodios de la enfermedad periodontal . De hecho, algunas de las causas que llevan a la reactivación del virus también se consideran factores de riesgo de la enfermedad periodontal y podrían relacionar a ambas patologías (AU)

The purpose of this review is to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. This relationship has been found mainly with the herpesvirus family, especially with human cytomegalovirus (CMV) and with Epstein-Barr virus (EBV), but also with human immunodeficiency virus (HIV). The herpesvirus infection generally involves a mild or asymptomatic primary phase followed by an asymptomatic latent phase interrupted sporadically by periods of activation, where viral replication and possibly clinical disease become manifest and which will in part, explain the episodic progressive nature of human periodontitis. In fact, herpesvirus reactivation is triggered by a number of immunosuppressing factors, some of which have also been shown to be risk indicators of periodontal disease and which could relate both pathologies (AU)

Streptococo agalactiae y taponamiento pericárdico / Streptococcus agalactiae and pericardial tamponade

No disponible

[New therapeutic options in Alzheimer's disease]. / Nuevas opciones terapéuticas en la enfermedad de Alzheimer.

INTRODUCTION: At present, cholinesterase inhibitors constitute the basis for therapy of Alzheimer's disease (AD); these drugs were rationally introduced given the loss of central cholinergic neurotransmission, even though there are many other systems affected in AD, including glutamatergic pathway. DEVELOPMENT: In addition to the loss of central cholinergic neurotransmission, biochemical evidence suggests glutamatergic dysfunction in AD and thus, therapeutic strategies directed at the glutamatergic system may be useful. These drugs include milacemide, cicloserine and ampakines (positive modulation) and memantine (negative modulation). Lithium seems to be a promising agent in AD, although the mechanism of action is poorly understood. Finally anti-inflammatory agents may be another therapeutic approach to AD. CONCLUSION: In addition to drugs acting on the cholinergic system, a large number of drugs with different mechanism could be used for the treatment and prevention of AD.