Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study / Factores determinantes de la mortalidad en pacientes con cáncer ingresados de forma no programada en la Unidad de Cuidados Intensivos: estudio multicéntrico prospectivo

Objectives To analyze clinical fatures associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. Design An observational study was carried out. Setting A total of 123 Intensive Care Units across Spain. Patient All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. Interventions None. Main variables Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. Results A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064–1.143), medical admission (OR 3.587; 95% CI 1.327–9.701), lung cancer (OR 2.98; 95% CI 1.48–5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09–4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09–0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups (AU)

Objetivos Determinar las características clínicas asociadas con la mortalidad en pacientes oncológicos ingresados de forma no programada en la UCI. También evaluamos si estos factores de riesgos difieren en los pacientes con neoplasias hematológicas o tumores sólidos. Diseño Estudio observacional. Ámbito Ciento veintitrés Unidades de Cuidados Intensivos en España. Pacientes Todos los pacientes con cáncer ingresados de forma no programada debido a una enfermedad aguda asociada con la enfermedad oncológica. Intervenciones Ninguna. Variables principales Las variables analizadas fueron los datos demográficos, escalas pronósticas de gravedad y el estado clínico del paciente. Se analizó la mortalidad y los factores relacionados con ésta. Se aplicó un análisis de regresión logística binaria multivariante. Resultados Se incluyó a un total de 482 pacientes: con tumores sólidos (n=331) y con neoplasias hematológicas (n=171). En el análisis de regresión multivariante, los factores asociados de manera independiente con la mortalidad en la UCI fueron la puntuación APACHE II (OR 1,102; IC del 95% 1,064-1,143), el ingreso médico (OR 3,587; IC del 95% 1,327-9,701), el cáncer de pulmón (OR 2,98, IC del 95% 1,48-5,99) y la ventilación mecánica tras las primeras 24h de ingreso en la UCI (OR 2,27; IC del 95% 1,09-4,73), mientras que la no necesidad de ventilación mecánica fue un factor protector (OR 0,15; IC del 95% 0,09-0,28). En el caso de los tumores sólidos, la puntuación APACHE II, el ingreso médico, la administración de antibióticos en las 48 h previas y el cáncer de pulmón fueron variables independientes relacionadas con la mortalidad, y la no necesidad de ventilación mecánica se identificó como un factor protector. En el análisis multivariante, la puntuación APACHE II y la ventilación mecánica al cabo de 24h desde el ingreso en la UCI se asociaron de manera independiente con mortalidad en pacientes con neoplasias hematológicas (AU)

Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study.

OBJECTIVES: To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN: An observational study was carried out. SETTING: A total of 123 Intensive Care Units across Spain. PATIENTS: All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS: None. MAIN VARIABLES: Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS: A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS: The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis.

BACKGROUND: Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). MATERIAL AND METHODS: A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student's t test, 2 test and multivariate logistic regression were used in the statistical analysis. RESULTS: Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome "periapical status" (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 - 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 - 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 - 472.15; p = 0.002), regardless of IBD type. CONCLUSIONS: The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment.

Evaluation of undergraduate Endodontic teaching in dental schools within Spain.

AIM: To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools. METHODOLOGY: An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools. RESULTS: The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full-time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P = 0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate-based endodontic cements, irrigating solutions, inter-visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P = 0.041), spend significantly more hours in clinical training (P = 0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P = 0.010). CONCLUSIONS: Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed.

Cardiovascular diseases and apical periodontitis: association not always implies causality.

BACKGROUND: Several studies published in the last two decades have found an association between the prevalence of apical periodontitis (AP) or root canal treatment (RCT) and cardiovascular diseases (CVDs). However, the demonstration of association does not prove by itself the existence of a cause-effect relationship. Two diseases can appear as statistically related without any of them directly affecting the values of the other, resulting in a non-causal relationship. The aim of this narrative review is to summarize the current state of knowledge regarding the association between AP and CVDs, analysing it according to the Hill's causality criteria. MATERIALS AND METHODS: Epidemiological studies carried out on the association between CVDs and AP or RCT published in English until 8 December 2019 were identified. Forty-four articles were selected and its results were analysed. RESULTS: Numerous cross-sectional epidemiological studies have found significant relationship between CVDs and AP. The odds ratio values range 1.6 - 5.4. However, other studies have not found significant association. Respect to RCT, some studies found correlation, but others found no association or even found that RCT is a protective factor against CVDs. CONCLUSIONS: The results are inconsistent and a causal relationship between CVDS and endodontic disease cannot be stablished. The risk factors common to both diseases can act as confounding factors, biasing the results. To reach definitive conclusions about the type of association (causal or non-causal) between both diseases, longitudinal epidemiological studies must be carried out to establish the temporal relationship and the dose-response gradient.

Association between dental anxiety and intraoperative pain during root canal treatment: a cross-sectional study.

AIM: To investigate whether dental anxiety influences the intraoperative pain felt by patients during root canal treatment. METHODOLOGY: In a cross-sectional design, 180 patients (90 men and 90 women) were included. Pre-operative anxiety levels were assessed using the short-form Dental Anxiety Inventory (S-DAI). Pain during root canal treatment was evaluated using a 10-cm visual analogue scale (VAS) that ranked the level of pain between 'Absence of pain' and 'Unbearable pain'. The minimal sample size was determined using the software of the National Center for Advancing Translational Sciences (NIH, UK). Multivariate logistic regression analysis was used to identify relationships between variables. RESULTS: Mean pain level during root canal treatment was 2.2 ± 2.1. The mean anxiety S-DAI score was 27.2 ± 12.5. Fifty percent of men had mild anxiety levels, while in 70% of women anxiety was moderate or high (P = 0.017). Anxiety correlated positively with intraoperative pain (R = 0.406). Multivariate logistic regression analysis revealed that anxiety was significantly associated with intraoperative pain felt by patients (OR = 4.0; 95% C.I. = 1.7-9.3; P = 0.001). CONCLUSIONS: Anxious patients were more than twice as likely to feel moderate or intense intraoperative pain during root canal treatment. To know the patient´s degree of anxiety could help the dentist to decide whether to use anxiolytic premedication and/or supplemental local anaesthesia to assure better control of pain during root canal treatment.

Tratamiento de la periodontitis apical persistente: cirugía periapical versus retratamiento endodóncico no quirúrgico / Treatment of persistent apical periodontitis: periapical surgery versus nonsurgical retreatment

Se denomina Periodontitis Apical Crónica Persistente (PACP) al proceso inflamatorio periapical que se desarrolla o persiste tras el tratamiento de conductos. Las opciones terapéuticas en el tratamiento de la PACP, cuando el diente puede conservarse, son el retratamiento de conductos por vía ortógrada o la cirugía periapical, e incluso puede ser necesaria una combinación de ambos tratamientos. El objetivo de este trabajo ha sido buscar respuesta a la siguiente pregunta: ¿En un paciente con un diente al que se le ha realizado tratamiento endodóncico que ha fracasado y sufre periodontitis apical crónica persistente (PACP), se obtiene mayor tasa de curación del proceso inflamatorio periapical mediante el retratamiento por vía ortógrada o con la cirugía periapical? La búsqueda realizada proporcionó 7 artículos: 3 ensayos clínicos aleatorios, 3 revisiones sistemáticas y 1 revisión no sistemática. La evidencia científica disponible sugiere que no existen diferencias significativas en las tasas de éxito a largo plazo del retratamiento endodóncico por vía ortógrada y la cirugía periapical, en casos de periodontitis apical crónica persistente tras el tratamiento endodóncico. El retratamiento endodóncico por vía ortógrada obtiene mejores resultados a largo plazo, mientras que la cirugía periapical tiene una tasa de curación más rápida. El retratamiento ortógrado conlleva un mejor postoperatorio para el paciente, mientras que la cirugía periapical implica una mayor necesidad de trata-miento analgésico y antiinflamatorio en los primeros 7 días

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Endodontics and diabetes: association versus causation.

Endodontic Medicine has gained more attention and is becoming a more important issue in Endodontics. As an example, more than one hundred articles on this topic have been published in the last eight years. Several of these studies have found an association between endodontic variables, that is the prevalence of apical periodontitis, the prevalence of root canal treatment (RCT) and the outcome of RCT assessed as root filled teeth (RFT) with radiolucent periapical lesions (RPL) or non-retained RFT, and several systemic diseases, such as diabetes, cardiovascular disease, smoking habits, osteoporosis, inherited coagulopaties, biological medications, low birth weight or physical fitness. However, the demonstration of association does not prove by itself the existence of a cause-effect relationship. Two variables can be related statistically to each other without either variable directly affecting the values of the other thus resulting in a non-causal relationship. Causality is assumed when one variable is shown to contribute to the development of the other, and its removal is shown to reduce the frequency of disease. Therefore, once a significant statistical association has been found between two variables, it is necessary to exclude the presence of bias, which would imply that the association is artefactual, and to analyse if the causation criteria defined by Hill (Proceedings of the Royal Society of Medicine 1965; 58: 295-300) are fulfilled to establish a causal relationship. Only if they are satisfied, can it be concluded that the association is causal. The aim of this study was to analyse the difference between association and causation, applying the criteria of causality to the specific case of the association between endodontic disease and diabetes mellitus.

Association between diabetes and nonretention of root filled teeth: a systematic review and meta-analysis.

Previous studies have found an association between the outcome of root canal treatment (RCT) and diabetic status. This systematic review and meta-analysis aimed to analyse the potential relationship between diabetes and the occurrence of extracted root filled teeth (RFT). The clinical PICO question was as follows: in adult patients with RFT, does the absence or presence of diabetes influence the prevalence of RFT extraction? The key words used in the systematic search were as follows: (Diabetes OR Diabetes Mellitus OR Hyperglycaemia OR Diabetic) AND (Endodontic OR Endodontics OR Endodontic Treatment OR Root Canal Treatment OR Root Canal Preparation OR Root Canal Therapy OR Root Filled Teeth OR Endodontically Treated Teeth) AND (Extraction OR Retention OR Survival OR Success OR Failure OR Outcome). The primary outcome variable was odds ratio (OR) for the frequency of extracted RFT in diabetics and healthy subjects. The method of DerSimonian-Laird with random effects was used to calculate the overall OR. Three hundred titles were identified, and three studies achieved the inclusion criteria. Data from 54 936 root canal treatments, 50 301 in nondiabetic control subjects and 4635 in diabetic patients, were analysed. The calculated overall odds ratio (OR = 2.44; 95% CI = 1.54-3.88; P = 0.0001) implies that diabetics had a significantly higher prevalence of extracted RFT than healthy nondiabetic subjects. The results of available studies indicate a significant relationship between DM and increased frequency of nonretained root filled teeth. Diabetes mellitus should be considered an important preoperative prognostic factor in root canal treatment.

Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review.

Regenerative endodontic procedures (REPs) are biologically based procedures planned to replace damaged tissues, including dentinee and root structures, as well as cells of the pulp-dentine complex. Effective sterilization of the root canal is essential in REPs, and antibiotics have been widely used to disinfect root canals. The aim of this paper was to review the scientific literature on (i) Effectiveness of antibiotics used in REPs against bacteria implicated in endodontic disease; (ii) Scientific evidence supporting the use of topical antibiotics in REPs; (iii) Clinical implications of the use of antibiotics in REPs and the possible side effects; (iv) Effect of antibiotics on dental pulp stem cells; and (v) Ongoing research on the use of antibiotics in REPs. Antibiotics used in REPs are effective against bacteria implicated in endodontic infections. Triple antibiotic pastes with minocycline attain complete disinfection of immature teeth with necrotic pulps, without affecting SCAP. Experimental studies carried out in dogs support the use of antibiotics in REPs. Clinical studies report high success rates of RET using antibiotics as intracanal dressings. However, tooth discolouration is an important side effect of the use of TAP. An antibiotic paste containing only metronidazole and ciprofloxacin could be a good alternative to the use of TAP. The use of antibiotic-containing scaffolds or clindamycin-modified triple antibiotic (metronidazole, ciprofloxacin and clindamycin) polymer could be a biologically safe antimicrobial drug delivery system in REPs.

Dental students' knowledge regarding the indications for antibiotics in the management of endodontic infections.

AIM: To determine the knowledge of undergraduate Spanish dental students regarding the indications of systemic antibiotics in the management of endodontic infections. METHODOLOGY: The final year dental students from four Spanish dental schools were requested to answer a one-page questionnaire on the indications for systemic antibiotics in the treatment of endodontic infections. One hundred and seventy-five students were asked to participate in this research. Data were analysed using descriptive statistics and chi-square test. RESULTS: One hundred and four students (93.7%) completed satisfactorily the survey and were included in the study. The average duration of antibiotic therapy was 7.0 ± 2.0 days. All respondents chose amoxicillin as the first-choice antibiotic in patients with no medical allergies, alone (47%) or associated with clavulanic acid (53%). The first drug of choice for patients with an allergy to penicillin was clindamycin 300 mg (99%). For cases of irreversible pulpitis, up to 63% of students would prescribe antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 44% would prescribe antibiotics. Almost 40% of students would prescribe antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract. CONCLUSIONS: It is necessary for the Spanish schools of dentistry to improve students' knowledge about antibiotics and their indications in endodontics. Interactive education analysing real endodontic cases using problem-based learning would help students acquire better skills in prescribing antibiotics in pulp-periapical pathosis.

Geminación y fusión: un desafío en la práctica clínica / Gemination and fusion: a challenge for clinical practice

Los términos geminación y fusion dentaria son utilizados para describir dos anomalías dentarias por unión en las que se afectan el número, la estructura, la forma, y el tamaño dentario. Su diagnóstico diferencial es muy complicado, a pesar de los numerosos casos que se pueden encontrar en la literatura. Es por ello, que muchos autores denominan a este grupo de anomalías como «diente doble» o «diente gemelo», considerándolos así como términos sinónimos. El diagnóstico y tratamiento del «diente doble» es un desafío para el dentista, así como su nomenclatura. Debe llevarse a cabo un diagnóstico diferencial con la macrodoncia. Los dientes afectados representan frecuentemente un problema estético, siendo más susceptibles a la caries y a la enfermedad periodontal. Es necesario llevar a cabo un examen clínico y radiográfico exhaustivo, para obtener un diagnóstico correcto que permita alcanzar un tratamiento temprano, en caso de que sea necesario. La opción de tratamiento del «diente doble» depende del tipo de dentición afectada, la repercusión estética, la morfología del arco dental y el patrón de oclusión. Cuando se requiere tratamiento endodóncico, es obligatorio prestar más atención durante determinadas fases, especialmente en el diagnóstico radiológico, y en el acceso y localización de conductos. Este artículo discute la prevalencia, etiología, patogenia, diagnóstico diferencial y tratamiento del diente doble mediante cuatro casos clínicos

Gemination and fusion are terms used to describe two dental anomalies by union, where number, shape, structure and tooth size are affected. Differential diagnosis is complicated, in spite of numerous cases described in literature. Thereby, many authors describe this group of anomalies as «double teeth» or «twin-teeth», considering them as synonymous terms. «Double teeth» diagnosis and treatment are a challenge for dentist, as well as its nomenclature. Differential diagnosis with macrodontia must be carried out. Affected tooth frequently show poor aesthetic, being more susceptible to caries and periodontal disease. It is necessary to carry out an exhaustive clinical and radiographic examination to provide a correct diagnosis for achieving an early treatment, if necessary. Treatment choice in double-teeth depends upon the type of affected dentition, aesthetic involvement, dental arch morphology and occlusion pattern. When requiring endodontic treatment, more attention during certain stages, especially in diagnostic radiology, and in access, and location of roots canals are compulsory. This article discuss the prevalence, etiology, pathogenesis, differential diagnosis and treatment of double-teeth through four clinical cases

Niña con calcinosis y manifestaciones dermatológicas de conectivopatía / A child with calcinosis and dermatological signs of connective tissue disease

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Intervención educativa para prevenir incontinenciaen ancianos con fractura de cadera ECA: resultados preliminares / No disponible

Evaluar la efectividad de una intervención educativa para reducir la incidencia de incontinencia en pacientes >65 años confractura de cadera. Diseño: Ensayo clínico aleatorio. Muestreo consecutivo con asignación aleatoria a los grupos experimental y control(enmascaramiento de la secuencia de aleatorización). En el grupo experimental se realiza la intervención educativa «Entrenamiento delhábito urinario» (taxonomía NIC) en el posoperatorio, reforzando la enseñanza al paciente y cuidador con un folleto de diseño propio.Se evalúa el desarrollo de incontinencia urinaria a los tres y seis meses tras el alta. En los 45 sujetos incluidos hasta junio, la incidencia deincontinencia urinaria a los 6 meses en el grupo control ha sido del 46,7%, y en el grupo experimental del 28,6%; RR=0,61 [IC 95% 0,23-1,65]. Prevenir la incontinencia evita sufrimiento al paciente, disminuye la carga del cuidador y el gasto (AU)

To evaluate the effectiveness of an educational intervention to reduce the incidence of incontinence in pacientes >65 years withhip fracture. Design: Random clinical test. Consecutive sampling with experimental random assignment for the groups and control (maskingof the sequence of randomization). In the experimental group the educational intervention «Urinary habit Training» (taxonomy NIC) inthe postoperative is carried out, reinforcing the teaching to the patient and carer with a leaflet of own design. The development of urinaryincontinence in the three and six months after the discharge is evaluated. In the 45 individuals included until June, the incidence of urinaryincontinence at the 6 months in the control group has been of 46.7%, and in the experimental group of 28.6%; RR=0,61 [IC 95% 0.23-1.65]. To prevent the incontinence saves suffering to the patient, decreases the burden of the carer and the expense (AU)

La transfusión de hematíes incrementa la oxigenación tisular y mejora el resultado clínico (con) / Red blood cell transfusion increases tissue oxygenation and improves the clinical outcome (con)

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