Abordaje clínico mínimamente invasivo de fluorosis dental en estadios de TF1 a TF5. Revisión sistemática / Minimally invasive clinical approach of dental fluorosis in stages of TF1 to TF5. Systematic review

Introducción: El manejo clínico de las lesiones dentales ocasionadas por fluorosis dental se realiza mediante diversas técnicas que resultan ser muy agresivas y con pobres resultados estéticos, por estas razones se plantea como objetivo determinar el tratamiento mínimamente invasivo y estético para fluorosis dental en los estadios de 1 a 5 según el índice de Thylstrup and Fejerskov, descritos en la literatura. Metodología: Revisión sistemática de 2.299 artículos, procedentes de cuatro bases de datos: PubMed, Embase, Science Direct y EBSCO; la búsqueda se realizó con ocho términos MeSH y tres conectores booleanos para una selección final de 22 artículos en inglés, español y portugués, publicados entre enero de 2009 y diciembre de 2018. Resultados: El tratamiento más efectivo para lesiones en estadios TF1 y TF2 fue aclaramiento dental con peróxido de carbamida a 15% o peróxido de hidrógeno a 35% durante tres sesiones de 15 minutos cada una, reforzado con peróxido de carbamida a 10%. Para estadios TF3 y TF4 fue microabrasión con ácido clorhídrico al 6% y carburo de silicio y/o con aclaramiento dental. Para lesioneTF5 fue la técnica combinada de macro y microabrasión con ácido fosfórico a 37% o ácido clorhídrico a 6%, 15% y 18%, aclaramiento y aplicación de resina infiltrante. Conclusión: Existen bases científicas que indican que el tratamiento de la Fluorosis es directamente proporcional al estadio de la lesión. (AU)

Introduction: The clinical management of dental lesions caused by dental fluorosis is carried out through various techniques that are very aggressive and with poor aesthetic results. For these reasons, the aim is to determine the minimally invasive and aesthetic treatment for dental fluorosis in stages of 1 to 5 according to the Thylstrup and Fejerskov index, described in the literature. Methodology: Systematic review of 2,299 articles, from four databases: PubMed, Embase, Science Direct and EBSCO; the search was carried out with eight MeSHterms and three Boolean connectors for a final selection of 22 articles in English, Spanish and Portuguese, published between January 2009 and December2018. Results: The most effective treatment for lesions in stages TF1 and TF2 was dental clearance with carbamide peroxide at 15% or hydrogen peroxide at 35% for three sessions of 15 minutes each, reinforced with 10% carbamide peroxide. For stages TF3 and TF4 it was microabrasion with 6% hydrochloric acid and silicon carbide and / or with dental clearance. For lesioneTF5 was the combined technique of macro and microabrasion with phosphoric acid at 37% or hydrochloric acid at 6%, 15% and 18%, clearance and application of infiltrating resin. Conclusion: There are scientific bases that indicate that the treatment of Fluorosis is directly proportional to the stage of the lesion. (AU)

Burnout prevalence and correlates amongst Colombian dental students: the STRESSCODE study.

INTRODUCTION: Accumulating evidence amongst dental students indicates an alarming prevalence of stress, which can precipitate the development of burnout--a state of mental or physical exhaustion and disengagement. Understanding individual and educational correlates of burnout is necessary for its prevention. The aims of this study were to determine the prevalence of burnout amongst a large sample of Colombian dental undergraduates and investigate its psychosocial and educational correlates. MATERIALS AND METHODS: Survey data collected from 5647 students participating in the Stress in Colombian Dental Education study were used for this analysis. Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS). Covariates included participants' socio-demographic characteristics and perceived stress, as well as educational environment factors. Descriptive, bivariate and multivariate methods based on multilevel mixed-effects logistic regression modelling were used for data analysis. RESULTS: Seven per cent of the students surveyed met the criteria for burnout. The prevalence of burnout was higher amongst upper classes, older and married students, those who reported not having passed all required courses and not having dentistry as their first career choice, as well as students in public institutions and those with large class sizes. Moreover, students' perceived stress in the domains of workload and self-efficacy was significantly and positively associated with burnout. CONCLUSIONS: Both personal and educational environment characteristics were found to be associated with burnout. Irrespective of these factors, students' perceived stress with regard to workload and self-efficacy was a strong influence on burnout and its alleviation may be a promising avenue to prevent psychological morbidity.

Anabolic androgenic steroids and intracellular calcium signaling: a mini review on mechanisms and physiological implications.

Increasing evidence suggests that nongenomic effects of testosterone and anabolic androgenic steroids (AAS) operate concertedly with genomic effects. Classically, these responses have been viewed as separate and independent processes, primarily because nongenomic responses are faster and appear to be mediated by membrane androgen receptors, whereas long-term genomic effects are mediated through cytosolic androgen receptors regulating transcriptional activity. Numerous studies have demonstrated increases in intracellular Ca2+ in response to AAS. These Ca2+ mediated responses have been seen in a diversity of cell types, including osteoblasts, platelets, skeletal muscle cells, cardiac myocytes and neurons. The versatility of Ca2+ as a second messenger provides these responses with a vast number of pathophysiological implications. In cardiac cells, testosterone elicits voltage-dependent Ca2+ oscillations and IP3R-mediated Ca2+ release from internal stores, leading to activation of MAPK and mTOR signaling that promotes cardiac hypertrophy. In neurons, depending upon concentration, testosterone can provoke either physiological Ca2+ oscillations, essential for synaptic plasticity, or sustained, pathological Ca2+ transients that lead to neuronal apoptosis. We propose therefore, that Ca2+ acts as an important point of crosstalk between nongenomic and genomic AAS signaling, representing a central regulator that bridges these previously thought to be divergent responses.

Cannibalism in paranoid schizophrenia: a case report.

In ancient times, cannibalism was deemed acceptable for reasons of survival when faced with extreme need or for religious or magic reasons. In today's society, these cases are extremely rare and are generally associated with severe mental illness. We present a case of cannibalism in an individual with schizophrenia. The patient who lacked insight into his illness admitted to committing acts of cannibalism and offered in-depth explanations of the procedures used to prepare the bodies. He made statements on television and to the press and was given the nickname of "the people-eater", an identity he readily accepted and integrated into his system of delusions. Cases of this nature are exceedingly unusual, but the fact that people with schizophrenia commit uncommon, unpredictable crimes attracts the media. This circumstance not only interferes with the natural course of the disease, but also affects the therapeutic behavior and how the patient is perceived by society.

Canibalismo en esquizofrenia paranoide: a propósito de un caso / Cannibalism in paranoid schizophrenia: a case report

En la antigüedad el canibalismo ha sido propiciado por factores de supervivencia ante una necesidad extrema o por razones mágicas o religiosas. En nuestra sociedad actual estos casos son de extrema rareza y se suelen asociar a personas con enfermedades mentales graves. Exponemos el caso de una persona con esquizofrenia y canibalismo. El paciente, sin conciencia de enfermedad mental, admitió los actos de canibalismo y explicó detalladamente los procedimientos para la preparación de los cuerpos. Realizó declaraciones en televisión y prensa y se le puso el sobrenombre de «el come gente», identificación que asumió rápidamente e integró a su sistema de delirios. Este tipo de casos son extremadamente raros, pero el hecho de que los pacientes con esquizofrenia cometan crímenes fuera de lo común y no previsibles atrae a los medios de comunicación. Esta circunstancia no sólo provocó interferencia en la evolución natural de la enfermedad, sino también en la conducta terapéutica y la visión social del paciente

In ancient times, cannibalism was deemed acceptable for reasons of survival when faced with extreme need or for religious or magic reasons. In today's society, these cases are extremely rare and are generally associated with severe mental illness. We present a case of cannibalism in an individual with schizophrenia. The patient who lacked insight into his illness admitted to committing acts of cannibalism and offered in-depth explanations of the procedures used to prepare the bodies. He made statements on television and to the press and was given the nickname of «the people-eater», an identity he readily accepted and integrated into his system of delusions. Cases of this nature are exceedingly unusual, but the fact that people with schizophrenia commit uncommon, unpredictable crimes attracts the media. This circumstance not only interferes with the natural course of the disease, but also affects the therapeutic behavior and how the patient is perceived by society

Self-perceived oral health among three subgroups of Asian-Americans in New York City: a preliminary study.

OBJECTIVES: The aim of this preliminary study was to compare the perception of oral health among subgroups of Asian-American residents of New York City, USA. METHODS: A close-ended questionnaire was administered to 255 Chinese, 134 Indian and 84 Pakistani adults, aged 18-65 years, during 1994-95. A comprehensive dental and oral examination was also performed. The associations of demographic and oral health variables with perceived oral health were evaluated using multivariate ordinal regression models. RESULTS: When data were analyzed in a multivariate context, only ethnicity and income were significant predictors of perceived oral health, after adjusting for DMFT. The within-group multivariate analysis of the three ethnic subgroups' results were as follows: Among the Chinese there were no significant predictors, only income was strongly suggestive; among the Indians, number of missing teeth and number of years in the USA were significant predictors; and within the Pakistani group, DMFT was the only significant predictor. CONCLUSIONS: Results suggest that there are ethnic differences in the perception of oral health status even after adjusting for clinical variables as well as for demographic variables in this particular group of Asian-American residents of New York City. Predictors associated with the perception of oral health are different for each ethnic group. When designing oral health promotion activities to diverse ethnic groups, the cultural characteristics of each subgroup should be considered.

Dental caries experience, tooth loss, and factors associated with unmet needs of Haitian immigrants in New York City.

OBJECTIVE: The aim of this study was to characterize the dental caries experience, tooth loss, and unmet need of a group of Haitian immigrant residents of New York City. METHODS: A purposive sample of 523 adults was obtained through community outreach activities during 1997-98. Clinical examinations were performed by calibrated examiners, according to NIDCR criteria. A comprehensive survey also was administered to all the participants. RESULTS: For the whole group, the mean number of missing teeth was 2.64 (SD = 4.12), the mean DMFT = 6.05 (SD = 5.26), the mean DMFS = 18.80 (SD = 21.04), and the mean DFS = 5.58 (SD = 6.17). Seventeen percent of the subjects had all their teeth sound, 59 percent had at least one tooth missing, 60 percent had at least one decayed tooth, and only 38 percent had restorations. Multivariate analyses showed that age, sex, education, dental insurance, frequency of dental visits, and dental floss use were predictors of unmet need. CONCLUSIONS: Although results showed a relatively low caries experience among this group of Haitian immigrants, the unmet need was very high. Furthermore, the tooth loss experience was relatively high for all age groups, further denoting a lack of access to preventive and restorative services.

Comparison of neuropeptide Y, protein gene product 9.5, and acetylcholinesterase in the diagnosis of Hirschsprung's disease.

We compared the results of acetylcholinesterase (AChE) staining of mucosal rectal biopsy specimens with those using neuropeptide Y (NPY) and protein gene product 9.5 (PGP9.5) in biopsies from 68 patients. Thirty-three did not have Hirschsprung's disease (HD), 28 had proven HD, and biopsies from 7 patients had shown a slight increase in AChE stain but the patients did not have HD. In our hands, AChE stain was superior to the other two; it was easier to read and gave the most accurate results with no false-positive cases and only two instances in which the findings were suggestive but not diagnostic. Neuropeptide Y and PGP9.5 have the advantage that they can be used in paraffin-embedded material. With NPY, the results are closer than with PGP9.5 to those obtained with the AChE. Protein gene product 9.5 had the highest incidence of false-positive and false-negative results, but it stains nerve fibers and all neurons intensely and may be useful in the assessment of increased or decreased amounts of neural elements in the bowel.

Microdissection study of the myenteric plexus in acardia, ataxia-telangiectasia, cystic fibrosis, extrahepatic biliary atresia, pediatric AIDS and Werdnig-Hoffmann disease.

Microdissection-point count morphometric study of the myenteric (Auerbach) plexus or esophagus, small intestine, and colon was done for infants and children with acardia (2), ataxia-telangiectasia (5), cystic fibrosis of the pancreas (CFP) (25), extrahepatic biliary atresia (EBA) (17), pediatric AIDS (10), and Werdnig-Hoffmann disease (WHD) (8). Values for fractional area of neural tissue in the plane of the plexus were compared to those of control patients in same age range as those in each disease category by t-test. Statistically abnormal values included low values for small intestine and colon in Werdnig-Hoffmann disease, high values for small intestine and colon in biliary atresia, and high value for colon but a low value for small intestine in cystic fibrosis. Values for all three loci were within the normal range for ataxia telangiectasia and pediatric AIDS. The mechanisms of the low value for small and large intestines in WHD, which causes chronic constipation as a result of skeletal muscle weakness, and of the high values for colon in CFP and EBA, both causing malabsorption with bulky stools, are unclear. The value for small intestine in acardia was normal for term but lower than expected for fetal bowel of the same size, possibly because of reduced neural crest inflow to the fetal bowel.

Diagnostic aspects and syndromal associations of short trachea with bronchial intubation.

Conditions with disproportionately short trachea, with a reduced number of tracheal cartilage rings and a high level of tracheal bifurcation, have been reported. We have seen accidental bronchial intubation in nine patients with short trachea. This risk can be reduced by recognition of conditions associated with short trachea, by awareness that methods for calculating endotracheal tube length from body length can overpredict tube length for patients with short trachea, and when feasible, by use of preintubation chest roentgenograms showing air bronchograms to establish the thoracic level of tracheal bifurcation. Twelve patients with short trachea, four with bronchial intubation, and six conditions not previously associated with short trachea, are reported. Three of the patients also had laryngeal hypoplasia.

Short trachea, a hazard in tracheal intubation of neonates and infants: syndromal associations.

Short trachea results from reduction in number of tracheal cartilage rings to 15 or fewer from normal mean of 17 rings in infants. In a review of radiologic and pathologic data, the thoracic vertebral level of tracheal bifurcation as seen in anteroposterior chest radiographs of infants with congenital malformations, cardiovascular anomalies, and skeletal dysplasias, was compared with numbers of tracheal cartilage rings demonstrated in postmortem specimens. Increased frequency of short trachea was seen in patients with DiGeorge anomaly (77%), skeletal dysplasias (55%), brevicollis (57%), diaplacental rubella (40%), and patients with congenital heart disease who did not have DiGeorge anomaly (36%, with range 25-83% for different types, the highest, 83%, being interrupted aortic arch). Preintubation high kilovoltage chest radiographs to establish the level of tracheal bifurcation in patients with increased risk of short trachea can be helpful in avoiding bronchial intubation and its complications. Postintubation chest films to assure the level of the endotracheal tube tip should be considered for such patients. Growth in length of the trachea with age is accomplished both by increase in size of tracheal cartilage rings and interring membranes, and by increase in ring number.

Demonstration of myenteric plexus abnormalities in genetic diseases by a microdissection technique: preliminary studies.

Eighty-eight specimens of esophagus, small intestine, or colon from 45 patients, predominantly infants and children, with 30 different genetic diseases were analyzed by a microdissection technique for the following abnormalities of the Auerbach (myenteric) plexus: (1) abnormality of the pattern of the nervous network of the plexus, (2) abnormal fraction of neural tissue in the plane of the plexus, (3) abnormal size or appearance of the cytoplasm of the neurons of the plexus, and (4) abnormal number of neurons in the ganglia of the plexus. Seven of 8 specimens of esophagus from patients with neuronal storage diseases (infantile Niemann-Pick disease, Jansky-Bielschowsky disease, etc.) showed an increased fraction of neural tissue in the plane of the plexus, whereas 2 of 3 patients with Cockayne syndrome showed a reduced fraction, with abnormally slender interganglionic fibers. The fraction of neural tissue in the plane of the plexus was also abnormal at one or more levels in patients with adrenoleukodystrophy, ataxia telangiectasia, Krabbe disease, and juvenile metachromatic leukodystrophy. Abnormality of neuron size and cytology was seen in several neuronal lipidoses, including Jansky-Bielschowsky and Sandhoff diseases and juvenile GM2 gangliosidosis, with the most striking neuronal enlargement noted in infantile Niemann-Pick disease. Abnormalities of plexus mass or pattern, as well as those of neuronal cytoplasm and neuron number, offer improved insight into possible mechanisms producing gastrointestinal tract dysfunction (swallowing difficulty, gastroesophageal reflux, constipation, etc) in patients with genetic disorders.